Your opinion please

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 9:50 am

FWIW...I have plain OSA...no real problem with centrals and I have used that ResMed AirCurve 10 ST model machine to deal with my OSA. It can be done...and S mode is sufficient as long as centrals aren't a problem.
So I am very familiar with that model machine...
When I made that suggestion...it's something that I have personal experience with and successful experience with.
Of course no guarantee that will equal success for you but it's worth trying to see how close we can get.
Gotta start somewhere.
Your PS isn't doing you any favors and could be making things worse.
I may have to RISE but I refuse to SHINE.

scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 10:16 am

What is the 'PS' ?

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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 10:19 am

PS is just pressure support.
The difference between EPAP (exhale) and IPAP (inhale).

With your AVAPS settings
6 EPAP and 12 IPAP...that means PS is 6
I may have to RISE but I refuse to SHINE.

scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 10:22 am

Ok,

So maybe 6 and 11 or 7 and 12......?

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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 10:33 am

No...4 PS...no more.
It's the most commonly used PS and for a reason. Start with most commonly used first...that's how it is done in a sleep lab.

6 EPAP isn't enough...no matter which machine you use or which mode...and with AVAPS you will need a LOT more EPAP.
That's why I suggested the ResMed ...better chance of success with just a little more EPAP.
I may have to RISE but I refuse to SHINE.

scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 10:37 am

I found some where I had the settings 5 and 9....
PS of four ......
No OA's listed and when I scrolled through the flow rate graph I really didn't find anything that I would class as obstructive....
Here is a snip of some which, I think, are clearly central:
screenshot-20180415-113250.png
screenshot-20180415-113250.png (143.42 KiB) Viewed 98 times

scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 10:43 am

Here is another section on the same day... just hypopneas but I don't see any sharp spike after them to indicate obstructive events...
screenshot-20180415-114037.png
screenshot-20180415-114037.png (143.71 KiB) Viewed 96 times

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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 10:49 am

And I don't think those UAs are centrals. I think they are obstructives...there's a tiny blip in the flow rate before the flag...means a tiny attempted breath.
Real centrals....zero blips or attempted breaths in that flow rate. A central apnea means no attempt at all in breathing.

And the reason for all the hyponeas...the EPAP and IPAP both were too low...you would have done better at say 7 EPAP and 11 IPAP

though I still stand by my original idea...ST machine in S mode with 8 and 12.

Your choice of course...you come here for ideas and I give you one. I can't force you to use it.
But if a person asks me what to do and won't try what I suggest......well you gotta trust me or not.
And I won't/can't force anyone to do anything and I will bow out.

Edit...those hyponeas...all obstructive in nature. I don't know where you are getting your flow reading stuff from but it's what happens before the flag and not after the flag that is the most important.
I may have to RISE but I refuse to SHINE.

scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 11:08 am

Well.... upon looking through the old reports 8 and 12 have never been tried so it is a place to start again.
I am not one to ignore advice without at least trying it out.
8 and 12 it is.... for a few nights anyway.

Back to the events though......
What I saw with the hypopneas was a steady waning to a shallow breath then a deeper breath.... not an initial deep gasp... just a breath. then it rose a couple of breaths then gradually waned... pause then a breath.

after the fourth mark, as an example, there was an initial deeper inhale then a large exhale.....
I am just a beginner with this stuff, but wouldn't an obstructive event end with a gasp.... since the obstruction would be keeping me from inhaling not exhaling?

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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 11:24 am

scottyl wrote:
Sun Apr 15, 2018 11:08 am
but wouldn't an obstructive event end with a gasp.... since the obstruction would be keeping me from inhaling not exhaling?
Maybe but not always and certainly not a given that is always going to happen.
Actually a lot of big gasps before or after a flag can mean sleep/wake/junk and not even real. Have to look at the big picture.

Hyponeas are nothing more than OAs that haven't grown up to meet the criteria for a full grown OA flag.
They have to last for at least 10 seconds and depending on the brand criteria for a flag...30 to 79% air flow reduction.
Once it hits 80% it gets the full grown OA flag.
Yours obviously show a reduced flow but not a flat line and obviously way less than 80% reduction in flow...
Hyponeas that are obstructive in nature...IMHO and fairly classic ones at that.
The waxing and waning...not part of the classification process and probably doesn't mean much...and nothing you can do about it anyway.

Trust your machine to know what to name stuff...it gets it right more often than it gets it wrong and as long as a person isn't confusing it with a lot of awake breathing...it's usually right. Awake breathing can cause false flags but I see nothing here that looks like awake breathing.

On a rare occasion hyponeas can be central in nature but that is not very common at all and if someone has those...they usually have a truckload of centrals on their diagnostic sleep studies.
I may have to RISE but I refuse to SHINE.

scottyl
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Joined: Sun Apr 15, 2018 7:15 am

Re: Your opinion please

Post by scottyl » Mon Apr 16, 2018 9:48 am

Hi,

I upped the epap to 7..... I figure a little bit at a time rather than all at once.... didn't expect much change right away so....
I left the IPAP at 13 for now (I figure I'll go up again tonight on the EPAP to try to reduce the PS).... I remember that the reason I had upped the IPAP to 13 is that the tidal volumes were low at 12...

Anyway, I guess my question right now is the flow rate pattern....
I read somewhere that it is supposed to be kind of smooth and rounded.

This section view is pretty much the norm all night... except for the events and stirring, etc.
So is this kind of abnormal or not really?
screenshot-20180416-103805.png
screenshot-20180416-103805.png (141.73 KiB) Viewed 65 times

TedVPAP
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Re: Your opinion please

Post by TedVPAP » Mon Apr 16, 2018 6:27 pm

Until you get the pressure set high enough to properly deal with your continued OSA, don't worry about anything else.

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