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+--- Thread: [Treatment] Which came first - the pressure or the apnéa? (/Thread-Treatment-Which-came-first-the-pressure-or-the-apn%C3%A9a)
Which came first - the pressure or the apnéa? - whispergold - 01-19-2022
Attached below is two screenshots of data. I feel pretty good today, but i think that the algorithm might classify intense dreaming/breathing as flow limitation and increases pressure abnormally when it should not and hence waking me up. I had the pressure at 10-15 before and it kept going up to 15, however if i have the pressure tighter like 10-12 my data is much more calm and i feel better.
Can you tell by the graphs?
RE: Which came first - the pressure or the apnéa? - Papit - 01-19-2022
Welcome aboard, whispergold. There are some very well-informed members here who can better handle your question than I. That said, here's my admittedly shallow overview fwiw. First of all, most of us would be more than satisfied to see their OSCAR data resemble yours with an AHI close to zero. Attempting to tweak your clinician settings to achieve tiny improvement after arriving at such a happy place seems, well, unnecessary. As for your question, which came first the pressure or the apnea, the charts and data you posted tell me that you have no apnea. If you did have apnea events, I think the apneas would precede machine pressure changes as you are using an ASV ventilator. I would also note that if I were reviewing the settings on my machine, I would look at charts and data spanning a minimum of a week's or more sleep experience rather than two one-day charts to compare the results of any changed settings. Stay safe and sleep well, whispergold.
If I am all wet here, I hope other better informed folks will jump in and comment.
--papit
RE: Which came first - the pressure or the apnéa? - OpalRose - 01-19-2022
Flow Limitations will drive the pressure. I seriously can't answer what causes FL, as your theory is as good as any.
In your situation, with numbers as good as they are, comfort should be your priority.
To squash Flow Limitations, try setting EPR to 2. You mentioned you have used a setting of 10-12, and felt better. Did you still see FL with those settings?
I also notice that on one chart you're using the "soft" setting and the other "standard." Did you notice a difference? Did you sleep better?
The pressure stayed steady on the "soft" setting, plus FL was decreased.
I would stick with the "soft" setting, with minimum 12, maximum 15. (EPR 2).
When you make a pressure change, try to stick with it for a few days.
RE: Which came first - the pressure or the apnéa? - desaturator - 01-19-2022
I notice that there are periods of alarmingly high -- and almost certainly artefactual -- respiratory in these graphs. I wonder if the same thing is going on here as is also being discussed here:
http://www.apneaboard.com/forums/Thread-Symptoms-What-happened-between-04-40-05-00
I have the same thing myself, and don't regard it as a cause for concern. However, it is a bit odd.
BW, DS
RE: Which came first - the pressure or the apnéa? - selfcoacher - 01-19-2022
These increased periods of pressure are very likely your REM sleep stages. During REM you have most muscles shut off besides diaphragm and some other essential ones, so you do not act out your dreams. Your respiratory rate increases and becomes more erratic and so does your heart rate. In your case this muscle relaxation leads to REM related flow limits to which your machine predictably reacts.
RE: Which came first - the pressure or the apnéa? - whispergold - 01-19-2022
Can i first just say i love this community. Have been doing this on my own since 2012 with 0 help from healthcare (long story) and just found out about this forum from Nicko Dundai, just replaced my F&P Icon that i had for 6 years for an AS10. I have had some issues adjusting to the "nervous" behavior from this machine compared to the F&P. Great suggestions in this thread and i will:
1: Enable EPR at lvl 1, see how it goes
2: Enable CPAP at ~12ish
3: log for about a week and reevaluate
Thanks again all you great people, i appreciate it more than you can imagine
RE: Which came first - the pressure or the apnéa? - whispergold - 01-20-2022
Just wanted to update you all from last night, i feel like a million bucks. I did the changes and I'm gonna run with it for a few weeks see how it works out. Capping the pressure with CPAP mode and enabling EPR lvl 1 was the key. I still have somewhat issues falling asleep because the pressure in the mask makes it bounce a little which is a bit startling, but i can manage.
Thanks again!!
RE: Which came first - the pressure or the apnéa? - OpalRose - 01-20-2022
Glad you feel better today, but I don't see where you used EPR at all.
Look at your FL graph, line it up with your pressure graph. Do you see how the FL pushed your pressure to the max? It's also not good to see your respiratory rate bounce around like that either.
As I stated in my earlier post, you need to use EPR to get rid of FL. Although, I have seen some folk using EPR with no benefit, but we don't know if you don't try it.
I don't know what's causing the FL and erratic respiration (could be REM sleep), but using EPR will help you breathe against the pressure and hopefully squash this Flow Limitations. Set it up at EPR 2.
RE: Which came first - the pressure or the apnéa? - selfcoacher - 01-20-2022
Also, the erratic elevated respiratory rate is detected wrongly by the machine, so you might want to zoom in on the flow shapes and see what is going on.
RE: Which came first - the pressure or the apnéa? - Geer1 - 01-21-2022
Yeah your flow limits are occurring in a typical rem cycle pattern.
This could be due to odd shaped rem breaths (which would explain the incorrect reported respiration rate) or it could be because breathing quality is degrading in rem which is common.
Some zoomed in views, 3-4 minute durations would help understand if the flow limitations are real and worth trying to treat or if best to handcuff machine to minimize their effects on machine pressure and your therapy.