Respiratory Wave Form correction, Bilevel vs EPR advantages - OSCAR data UK user

[lazarus]

I am in 100% heart agreement with Ozij's earlier statement:

it seems to me that this is an issue for a thorough pulmonological workup. Not for dial winging.

That said, if I were between a rock and a hard place in which that ideal was unavailable to me in the medical red tape of the country I lived in for some reason, and it was my father, I could see myself obtaining a gray-market-ish ResMed autobilevel (VPAP Auto), reproducing what has worked in a ResMed APAP with EPR, and then watching OSCAR charts to see what a 4cm PS (then 5, then 6, etc.) did for him, just as you originally suggested, while making sure I did not increase AHI.

Although it is not ideal, I have known of some with overlap of OSA and COPD (just as an example) who did some minor dial-winging with a ResMed autobilevel with some success with some increasing of their own comfort and decreasing of AHI.

I am neither encouraging you nor discouraging you--just passing along what I think I know and what I believe I have seen, as some guy on the Internet. It wouldn't be my preference as an approach, but I also understand the concept of not allowing the perfect to be the enemy of the good, simultaneously keeping in mind the balancing principle of "striving to better, oft we mar what's well.”

[Applecheeks]

First rule of competent medicine: FIRST DO NO HARM.

I am very sympathetic to Egg's predicament (National Health Service).

[Applecheeks]

In the U.S., I would recommend that the expert eyes of an experienced Registered Respiratory Therapist be involved in (1) estimating possible benefits and (2) customizing the settings for the distance between IPAP and EPAP and the other settings. That level of help isn't always easy to get in any country, though. I am aware of only one set of eyes on this board that may have special insights on that deeper level.

Considering Egg Yokel's predicament - NHS and all - has this "one set of eyes on this board" weighed in on this thread?
If not, can you contact the "one eyes" as ask him for help for Egg and his Dad?

[ChicagoGranny]

is that due to his scoliosis combined with a kyphosis and associated poor neck posture and hunched over shoulders, his lung capacity/function is posturally limited in some way.

You could chase some expensive, complicated, time-consuming geese. When faced with these types of situations, it's best to first try some cheap, simple, quick, solutions.

I offer this possible solution with the consideration that the condition of his spine will allow him to try it.

When the head drops from normal posture so that it is tilted downward toward the chest, the airway tends to be crimped and is more subject to collapse and flow limitations. Many of us, without spinal or posture issues, wear foam cervical collars for use with CPAP. Foam cervical collars keep the head/chin up in a healthy position. Personally, I have been wearing one every night since starting CPAP. The results for me are amazingly good. A trial is inexpensive and quick.

[lazarus]

can you contact the "one eyes"

I assume he'll see the thread when he ain't fishing and then decide for himself whether to wade/weigh in.

And I assume anyone could PM Rubicon. I don't know. Not sure what his preferences are on that. But I pride myself in not taking it upon myself to irritate or pressure retired people whom I deeply respect.

I believe he may have his own ethical considerations for thread participation.

[Applecheeks]

@ Lazarus,
Completely understand, it was only a suggestion (as it apparently someone whose expert opinion you would value).
- and it would be completely inappropriate for me to call this situation to "his" attention, as he doesn't know me from Adam.

[Max46]

If Egg's Dad's kyphosis is anything like my father in law's, cervical collars will not prevent his chest cavity from being compressed, even if his chin is tilted upwards as much as possible.

kyphosis.jpg (8.93 KiB) Viewed 3735 times

[zonker]

can you contact the "one eyes"

I assume he'll see the thread when he ain't fishing and then decide for himself whether to wade/weigh in.

And I assume anyone could PM Rubicon. I don't know. Not sure what his preferences are on that. But I pride myself in not taking it upon myself to irritate or pressure retired people whom I deeply respect.

I believe he may have his own ethical considerations for thread participation.

i last saw rick blaine come in about two weeks ago. he posted to another uk listener something along the lines of "i'm composing a response for you".

hope rick is okay.

[ChicagoGranny]

If Egg's Dad's kyphosis is anything like my father in law's, cervical collars will not prevent his chest cavity from being compressed, even if his chin is tilted upwards as much as possible.

As far as I know, cervical collars do not prevent compression of the chest cavity. As previously stated, they can keep the head/chin from dropping toward the chest. This dropping tends to crimp and compromise the part of the airway that is in the throat. This part of the airway is where the most common problems are in OSA.

In the illustration you provided,
it appears to me that the chin could drop toward the chest, and that a cervical collar could prevent this.

But, this would be something Egg Yolkeo could easily check with a trial.

[lazarus]

understand, it was only a suggestion

I got where you were coming from.

I just appreciate it when he chooses to do his thing. He always makes me think. Which I try not to take personally.

hope rick is okay.

I just scheduled my flu shot and new Covid shot for next week. Trying to be a responsible adult. (Only one of my many impressions.) And I still do indoor crowds a favor by hiding my face behind a KN95. Some who know me are grateful. Others not so much.

Too many of my friends are in sick.

May we all be careful out there.

[Max46]

I’d agree. If throat compression by dropping the chin, is the principle problem. But as I said, my FIL’s issue was that the kyphosis compressed his chest cavity and made inspiration very halting (as Egg had previously described for his Dad). My FIL described inhalation as taking a lot of effort and occasionally painful. The OP’s flow charts looked much like my FIL. Spikey and halting, incomplete inspiration.
Interestingly, the FIL said that lying down, and being on his back made breathing less of an effort.

[ChicagoGranny]

I'm not campaigning for cervical collars. It's just an easy trial of something that has worked for many others. I would campaign for doing the simple, easy things first, or even concurrently while working on the more difficult problems.

The OP’s flow charts looked much like my FIL. Spikey and halting, incomplete inspiration.
Interestingly, the FIL said that lying down, and being on his back made breathing less of an effort.

Maybe you should do a quick, easy trial to see if a cervical collar helps your FIL.

[Max46]

Maybe you should do a quick, easy trial to see if a cervical collar helps your FIL.

A laugh emogie?
My FIL died three years ago.

[lazarus]

I'm sure Gran didn't mean anything by it.

Gran seems to recommend the collar to everyone--dead, alive, unborn, nonhuman, other dimensions, etc. I think she must have stock in the company, or something.

(Nothing untoward meant by the winking emoji.)

This post is mostly meant to serve as a bump of the thread to the top.

[Egg Yolkeo]

That said, if I were between a rock and a hard place in which that ideal was unavailable to me in the medical red tape of the country I lived in for some reason, and it was my father, I could see myself obtaining a gray-market-ish ResMed autobilevel (VPAP Auto), reproducing what has worked in a ResMed APAP with EPR, and then watching OSCAR charts to see what a 4cm PS (then 5, then 6, etc.) did for him, just as you originally suggested, while making sure I did not increase AHI.

Although it is not ideal, I have known of some with overlap of OSA and COPD (just as an example) who did some minor dial-winging with a ResMed autobilevel with some success with some increasing of their own comfort and decreasing of AHI.

I am neither encouraging you nor discouraging you--just passing along what I think I know and what I believe I have seen, as some guy on the Internet. It wouldn't be my preference as an approach, but I also understand the concept of not allowing the perfect to be the enemy of the good, simultaneously keeping in mind the balancing principle of "striving to better, oft we mar what's well.”

Thanks for the feedback, originally I had tried to go through the NHS to get his sleep apnea investigated, but this was during the height of Covid and his doctor wasnt that interested. Thankfully, unlike Bilevel or anything with IVAPS or ASV, its not so difficult to get access to CPAP machines in the UK. You can get an HNS approved home sleep test done for a relatively small amount of money and this allow's you to purchase a CPAP machine.

I started going back through his medical records to see if there was any avenues to pursue.
ENT examined him with an endoscope and said they didnt see any issues, although it was about 4 years ago and his posture has declined further since then.
I mentioned I did get him to see his doctor who assesed his breathing as being ok, despite it looking bit odd.
He did see another doctor who said they thought something wasnt right, and put a referral in the system about a year ago but no response since then. I will chase this up.

Whilst researching on this forum I did see a number of posts by Rick Blaine and saw one post with a reference to a specialist who could assist with providing Bipap machines, although I forgot to save it and need to look for it again. I think Bilevel or possibly Ivaps would be the only two options anyway. He doesnt have central sleep apnea and can breathe under his own steam so I dont think ASV would be relevant anyway. Its probably easier to get a prescription for Bilevel than iVAPS. It may be possible to get a second hand bilevel and if nothing else I can see how he gets on with that vs his existing CPAP treatment.