Treat FlowLimitations with increased pressure?

jagzoo · Post by **jagzoo** » Sun Sep 21, 2014 11:29 am

Hi, I haven't posted in while but read the forum daily!

OK, been in xpap for almost 2 years, my AHI runs less than 1, leaks are well below the limit, pressure is set as APAP 11/11. The problem is that my sleep is crappy - frequent awakenings although I go back to sleep fairly fast. ZEO reports my sleep score as 40 with no deep sleep.

SleepHead shows frequent flow limitations so I was wondering if I am sensitive to them and waking up. Yesterday I changed my pressure from a range of 9/11 to 11/11 incase that small a pressure change was waking me up. I felt that I had less awakenings last night but certainly to early to tell. ZEO wasn't on. FL were slightly less but again, to early to call.

My question is would increasing the pressure more possibly keep my airway collapsing the little bit that is causing the flow limitations? Any one had experience with this?

Would appreciate any feedback - I guess I am one that xpap looks to be effective, no mask problems etc. But sleep 9 hrs and not refreshed.

Jay Aitchsee · Post by **Jay Aitchsee** » Sun Sep 21, 2014 11:34 am

viewtopic/t100788/viewtopic.php?f=1&t=1 ... 26#p936554

Jay Aitchsee wrote:Lately, I've been getting some mask leaks after I fall asleep, I assume due to my jaw dropping as I relax. I decided to try something new, a soft neck brace I made from some 1'' foam I had. I made a piece that was about 3 1/2 inches tall that wrapped a little more than half-way around my neck and held it in place with one of those stick to itself ace bandages wrapped around the outside of the foam.

The surprising result is depicted below. My Flow Limitations, which I most recently became aware of with the purchase of a new S9, have almost disappeared! This has been a consistent result since I using started using the brace, about 6 days ago. I notice my pressure average, in auto, has dropped and all obstructive apneas and hypopneas have virtually disappeared as well.

I think what is happening here is that the brace is not only keeping my jaw from dropping, but it is also helping to keep my airway open by keeping my head from tipping forward.

I'm not sure the long term implications of this, but it seems, at the very least, I will be able to lower my pressure settings. I wish I could say I felt significantly better, I don't, but then I was feeling pretty good already, with a sub 1.0 AHI. Needless to say, I ordered a real soft cervical collar and should get it tomorrow.

I post this in the hopes it may help someone with their therapy.

I have ordered and received two commercial collars, but my home made one remains my favorite. To date, the result remains consistent with reduced flow limitations and few obstructive apneas.[/quote]

Julie · Post by **Julie** » Sun Sep 21, 2014 11:36 am

Why not just try straight Cpap at 11 and not fuss with auto settings? I'm sorry I can't comment on the FLs.

Pugsy · Post by **Pugsy** » Sun Sep 21, 2014 11:44 am

When using a Respironics machine if someone changes to cpap mode the flow limitation flagging system is turned off so there's no way to tell if a person didn't have any FLs. It's better to use apap mode with minimum set to maximum if someone wants to mimic cpap mode but not lose the Flow limitation flags.
So if FLs are a concern and need to be watched then cpap mode won't work so great.

jagzoo · Post by **jagzoo** » Sun Sep 21, 2014 12:19 pm

Jay, I'll try using a soft collar and see if that helps and see if I can sleep with it!

Pugsy, any comment on treating FL with increased pressure?

Thanks

Pugsy · Post by **Pugsy** » Sun Sep 21, 2014 12:27 pm

jagzoo wrote:Pugsy, any comment on treating FL with increased pressure?

That's what I would do and did a while back when my FLs were looking a big uglier than I preferred them to look.
As long as they are obstructive in nature....a little more pressure usually will reduce them.
Now will it help the quality of sleep? That's one of those many YMMV things. If they are a factor in poor sleep then reducing them should help but as we all know there are many other factors in poor sleep.
But it's sure worth a shot to try.

Meant to add this to my above post but I had to get off the computer and didn't have time.

kaiasgram · Post by **kaiasgram** » Sun Sep 21, 2014 12:57 pm

jagzoo, this illustrates nicely how increased pressure treats flow limitations: FL goes up, pressure increases. FL goes back down, pressure comes back down too. This is just to show that increasing the pressure (whether APAP or CPAP mode) does effectively treat flow limitations.

Sludge · Post by **Sludge** » Sun Sep 21, 2014 1:19 pm

What you might want to consider is try using BiPAP. The IPAP attack might round that FL off and be just what the doctor ordered (so to speak).

This assumes that the FLs are treatable (not fixed, like narrow nasal passages) and they are truly the cause of the (a) problem. This may be seen if you do a breath-by-breath analysis.

kaiasgram · Post by **kaiasgram** » Sun Sep 21, 2014 1:47 pm

Sludge wrote:This assumes that the FLs are treatable (not fixed, like narrow nasal passages) ...

Hey Sludge -- in untreatable FL cases like narrow nasal passages would we see a relatively unchanging FL graph with pressure (in auto modes) going or staying high (meaning "trying" to treat them)?

Sludge · Post by **Sludge** » Sun Sep 21, 2014 2:08 pm

kaiasgram wrote:
Sludge wrote:This assumes that the FLs are treatable (not fixed, like narrow nasal passages) ...
Hey Sludge -- in untreatable FL cases like narrow nasal passages would we see a relatively unchanging FL graph with pressure (in auto modes) going or staying high (meaning "trying" to treat them)?

I would think so, especially if the algorithm to attack FLs is aggressive. See McCoy bench testing:

And who remembers the PB420E with that IFL1 thing that would just go off the charts (see RG and -SWS discussions)!

Fortunately, it was a parameter that you could turn off.

Jay Aitchsee · Post by **Jay Aitchsee** » Sun Sep 21, 2014 4:07 pm

OK, FWIW, here's two recent nights. The one on top is without a soft cervical collar, the one on the bottom is with one. The one on the bottom looks better, but I can't honestly say it is. Subjectively, I felt about the same both nights and the AHI was about the same both nights The top one without the collar had 4 hypopneas and two OA. The one on the bottom with the collar had 3 CA, 1 hypopnea and 1OA. Obviously, the night without the collar required a higher average pressure.

kaiasgram · Post by **kaiasgram** » Sun Sep 21, 2014 7:56 pm

Sludge wrote:
kaiasgram wrote:
Sludge wrote:This assumes that the FLs are treatable (not fixed, like narrow nasal passages) ...
Hey Sludge -- in untreatable FL cases like narrow nasal passages would we see a relatively unchanging FL graph with pressure (in auto modes) going or staying high (meaning "trying" to treat them)?
I would think so, especially if the algorithm to attack FLs is aggressive. See McCoy bench testing:

Thanks S

jagzoo · Post by **jagzoo** » Sun Sep 21, 2014 8:04 pm

Thanks for all the info. I am encouraged to pursue trying to decrease FL, without messing anything else up! If I can decrease them, then I'll see if that decreases my awakenings also. If not, then I'll have to search for other reasons for the awakenings.

I had been diagnosed with RLS and take an alprazolam .5 at bed time but that seems completely controlled. At least while wake! I'll investigate that if decreasing FLs has no effect.

So, my plan is to keep the settings of APAP 13/13 for tonight, since I just changed them yesterday, as long as everything looks OK, then increase by .5 and then leave them steady for 5-7 days etc.

I'll post my progress when either when 1. FLs are decreased and so are my awakenings 2. FLs decreased but no effect on the awakenings 3. Everything went to H... And I returned to my original settings! All a learning experience.

Thanks to all for your help and encouragement!

Wulfman... · Post by **Wulfman...** » Sun Sep 21, 2014 8:14 pm

Sludge wrote:And who remembers the PB420E with that IFL1 thing that would just go off the charts (see RG and -SWS discussions)!

Fortunately, it was a parameter that you could turn off.

Raises hand.

Since you asked (with an exclamation mark).

Den

.

Treat FlowLimitations with increased pressure?

Treat FlowLimitations with increased pressure?

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