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PLP's Therapy Thread - PeaceLoveAndPizza - 08-31-2023
I need an insanity check on my OSCAR charts as to whether the events are positional or otherwise. Quick background, I've been using the same settings for years on my Resmed Aircurve 10 vAuto of 5-25 PS 4 with good success of most nights of an AHI < 1. Within the past month or so the AHI has jumped to > 2 with most appearing in clusters, which leads me to think it is positional. I wanted to run it by the hive mind to help figure out if that is the case or if I need to look elsewhere.
I've changed out my cervical collar, head gear, and P10 pillow, but no improvement so far. Wondering if there are other suggestions on things to consider, or if I am looking at this incorrectly.
Thanks!
-PLP
RE: Positional issues? - Sleeprider - 08-31-2023
These events are all central, and we normally look to obstructive events or flow limits as an indicator of positional obstruction. We would need a zoomed view of the events to see if they are obstructive rather than central.
RE: Positional issues? - Old Mike - 09-01-2023
If they were truly central, then they're not positional. But the technology (FOT) used by Resmed to differentiate between central and obstructive is not 100% accurate AFIK.
RE: Positional issues? - PeaceLoveAndPizza - 09-01-2023
@SleepRider and @OldMike, thanks…
Here are two zoomed-in views of a few events. I do toss-n-turn a bit during the night, so some are related to position changes. Others seem to have some flow limitations going on triggering things.
Appreciate the insights!
RE: Positional issues? - Sleeprider - 09-01-2023
This is just a case of being near the apneic threshold and appears to be mostly a suppression of respiration due to relatively low CO2 from the enhanced ventilation of your Vauto. We can usually resolve these "central" events by just changing the Trigger Sensitivity to High. This makes the machine trigger IPAP with less spontaneous effort on your part, and this is often sufficient to trigger a breath when an apnea might otherwise occur. Give that setting tweak a try and report back.
RE: Positional issues? - PeaceLoveAndPizza - 09-01-2023
Thank you for the suggestion. I will give the trigger setting change to “high” a go for a few days or so, then report back.
And thanks for the explanation about apneic threshold. Lots of things to ponder in the wiki on Optimizing Therapy.
PLP's Therapy Thread - PeaceLoveAndPizza - 09-16-2023
Following up on the changes recommended by SleepRider...
In general changing the trigger from "medium" to "high" made quite a difference in reducing CA. Changing it to "very high" made an even bigger reduction in CA.
Once things settled in I used it for a few nights and noticed that my median pressure was ~2 cmH2O higher than it was prior to the trigger change. I increased my pressures from EPAP 5 PS 4 to EPAP 7 PS 4. The combined changes have made for a much more restful night as can be seen in the attached graph.
One thing I would like to work on now is to reduce the arousals I'm seeing from the small flow limitations that remain. I am pondering changing the settings to EPAP 7 PS 5 to see how it affects the remaining FL's. Any thoughts from folks?
PS for the moderators - Would someone please change the title of this thread to "PLP's Therapy Thread"? Not sure how to do it myself.
RE: Positional issues? - Sleeprider - 09-16-2023
PLP, great to hear of the improvement and your own changes to improve therapy. I agree with what you have done and am actually encouraged when members start to take matters into their own hands with awareness of what is going on, and how to improve that. The arousal peaks are pretty obvious in the flow rate. Let's take a closer look at those so we can see what is leading up to them. 3-4 minute zoom screenshot.
RE: PLP's Therapy Thread - PeaceLoveAndPizza - 09-16-2023
Here are three slightly different takes on the arousals. Note that I changed the scale for the "flow limitations" graph from the default of 1.0 to 0.25 to bring the FL's out of the noise. For most cases there is an FL right around the time of the arousal.
Thanks very much for taking time to review. It has been going on a while and directional guidance is appreciated as I've far exceeded my current knowledge.
RE: PLP's Therapy Thread - Sleeprider - 09-16-2023
Except for 02:58 flow limitation is present. Could be transient positional issues or a need for higher PS only available from bilevel. I don't think setting changes are going to solve this. Overall therapy is excellent, but you know a number of us are using a Vauto. That is not because sleep specialists have a clue why PS works.