bjhunt01 therapy help thread

[zonker]

Please follow the link in this post for more meatbag details.
viewtopic.php?f=1&t=173195&p=1273291#p1273253

*I'M* not clicking on that thing.

you can't trick me.

It's YOUR therapy thread pal...

That's probably what he's afraid of.

that's EXACTLY what i'm afraid of!!

[bjhunt01]

Well I've been called a lot of things but I must say Volatile Meatbag is a new one!!!

I usually use the term "squidgy meatbag", is that better?

This could require some consideration of gender differences. Volatile would apply to us emotional women. Men are squidgy to hug if you are a woman and/or a man who likes men. There is a lot to ponder here....

[bjhunt01]

Please follow the link in this post for more meatbag details.
viewtopic.php?f=1&t=173195&p=1273291#p1273253

My gosh - that's awesome! Of course it came from MIT!!! It would appear that I need to add some Ketchup and Worcestershire Sauce to my humidifier tonight.

OK but on a MORE serious note, can someone explain in 3rd grade English what a flow limitation is, why I need to be concerned, and what could be causing them? I know. I know. But I HAVE looked it up and googled it and I'm just getting more confused. Could my very narrow Female Volatile Meatbag nostrils be causing this and deviated septum? Small educating if you don't mind. No rush.

[djams]

Well I've been called a lot of things but I must say Volatile Meatbag is a new one!!!

I usually use the term "squidgy meatbag", is that better?

This could require some consideration of gender differences. Volatile would apply to us emotional women. Men are squidgy to hug if you are a woman and/or a man who likes men. There is a lot to ponder here....

Food for thought...

squidgy. adjective. UK informal uk ​ /ˈskwɪdʒ.i/ us ​ /ˈskwɪdʒ.i/ soft and wet and changing shape easily when pressed:

[palerider]

Please follow the link in this post for more meatbag details.
viewtopic.php?f=1&t=173195&p=1273291#p1273253

My gosh - that's awesome! Of course it came from MIT!!! It would appear that I need to add some Ketchup and Worcestershire Sauce to my humidifier tonight.

OK but on a MORE serious note, can someone explain in 3rd grade English what a flow limitation is, why I need to be concerned, and what could be causing them? I know. I know. But I HAVE looked it up and googled it and I'm just getting more confused. Could my very narrow Female Volatile Meatbag nostrils be causing this and deviated septum? Small educating if you don't mind. No rush.

How 'bout I start with a video?

https://www.youtube.com/watch?v=-gie2dhqP2c

FLs are a reduction in airflow *RATE* (think, like trying to breathe through a straw.. you can still take a full breath, but it's a lot more work and you'll (well, at least *I*) start to get tired after a few minutes. As opposed to hypopneas, which are a reduction in flow *volume*.

Here's a nice pic of a flow limited breath compared to a normal breath:



How was that? Not sure if it was 3rd grade, it's been a long time, mighta been 5th grade.

[Dog Slobber]

Definitely watch the video palerider linked to, it's got a great explanation of Flow Limitation with diagrams just past the minute mark.

This is how I think of events, especially as they apply to me.

• Obstructive Apnea (OAs) - 80-100% closure of passage, lasting 10 seconds or longer.
• Hypopnea (Hs) - 50-80% closure of passage, lasting 10 seconds or longer.
• Flow Limitation - Partially closed passage or more fully closed but not lasting 10 seconds. These are one of the key indicators ResMed machines act on to prevent Hs and OAs.

My percentages might be off.


Here's a typical graph when my apnea was not being treated very well. Note the Flow Limit, while not as ugly as yours was present for a good part of the night.

Now look at the Pressure graph, my minimum was too low, the pressure was up and down and often bumped up against the cap to accommodate my aerophagia . Often the pressure increase simply didn't happen fast enough to address the apnea, thus my high AHI.

Oscar_AHI_260.png

Now let's take a look at a fairly recent chart.

My minimum pressure has been increased from 7 to 11.
Look at Flow Limitation very little, and then a cluster those clusters are likely REM sleep as my Apnea is worse during REM. But more importantly, during one of the clusters of Flow Limitations, look at the pressure graph, there is a correlating increase in pressure. Because my minimum pressure of 11 if keeping the passage open the pressure increase doesn't have to increase by much to keep the airway open.

Only 1 Hypopnea and 1 OA.

OSCAR_AHI_033.png

What's also worth noting, for me is, even though I increased my minimum pressure form from 7 to 11, the net result was less pressure as my median barely raises over 11 and I can't remember the last time my pressure raised above 12.

By increasing the minimum, it's easier to keep the airways open than to open them after they have closed.

Once again, YMMV. This is what worked well for me, and I included the diagrams to help illustrate. Your numbers and treatment are very likely to vary. We also now your initial charts are very different than mine because your pressure jumps to the maximum and spends the night there. This suggests too little pressure and explains your high Flow Limits. And that brings us back to your aerophagia.

Thus the common thread, try to find a gentle compromise between pressure and your high Flow Limit and Aerophagia.

[bjhunt01]

Please follow the link in this post for more meatbag details.
viewtopic.php?f=1&t=173195&p=1273291#p1273253

My gosh - that's awesome! Of course it came from MIT!!! It would appear that I need to add some Ketchup and Worcestershire Sauce to my humidifier tonight.

OK but on a MORE serious note, can someone explain in 3rd grade English what a flow limitation is, why I need to be concerned, and what could be causing them? I know. I know. But I HAVE looked it up and googled it and I'm just getting more confused. Could my very narrow Female Volatile Meatbag nostrils be causing this and deviated septum? Small educating if you don't mind. No rush.

How 'bout I start with a video?

https://www.youtube.com/watch?v=-gie2dhqP2c

FLs are a reduction in airflow *RATE* (think, like trying to breathe through a straw.. you can still take a full breath, but it's a lot more work and you'll (well, at least *I*) start to get tired after a few minutes. As opposed to hypopneas, which are a reduction in flow *volume*.

Here's a nice pic of a flow limited breath compared to a normal breath:



How was that? Not sure if it was 3rd grade, it's been a long time, mighta been 5th grade.

The video was EXTREMELY helpful. So what we are saying in 3rd grade words is that inspite of using a CPAP, my tongue still falls back in my throat closing off air? Is that correct?

[zonker]

and what palerider and dogslobber just referred to is the WHY of why we are all different in how we sleep. it's why sleepyhead or oscar graphs need to be posted. once those graphs are posted and a trend starts to develop, these bright johnnies can figure stuff out. they can easily spot what changes should be made.

mind you, this is all above my pay grade. "too much science, i don't understand". and that's fine by me.

i'm just happy cpaptalk exists and helped me get my act together.

[bjhunt01]

Definitely watch the video palerider linked to, it's got a great explanation of Flow Limitation with diagrams just past the minute mark.

This is how I think of events, especially as they apply to me.

• Obstructive Apnea (OAs) - 80-100% closure of passage, lasting 10 seconds or longer.
• Hypopnea (Hs) - 50-80% closure of passage, lasting 10 seconds or longer.
• Flow Limitation - Partially closed passage or more fully closed but not lasting 10 seconds. These are one of the key indicators ResMed machines act on to prevent Hs and OAs.

My percentages might be off.


Here's a typical graph when my apnea was not being treated very well. Note the Flow Limit, while not as ugly as yours was present for a good part of the night.

Now look at the Pressure graph, my minimum was too low, the pressure was up and down and often bumped up against the cap to accommodate my aerophagia . Often the pressure increase simply didn't happen fast enough to address the apnea, thus my high AHI.


Oscar_AHI_260.png


Now let's take a look at a fairly recent chart.

My minimum pressure has been increased from 7 to 11.
Look at Flow Limitation very little, and then a cluster those clusters are likely REM sleep as my Apnea is worse during REM. But more importantly, during one of the clusters of Flow Limitations, look at the pressure graph, there is a correlating increase in pressure. Because my minimum pressure of 11 if keeping the passage open the pressure increase doesn't have to increase by much to keep the airway open.

Only 1 Hypopnea and 1 OA.


OSCAR_AHI_033.png

What's also worth noting, for me is, even though I increased my minimum pressure form from 7 to 11, the net result was less pressure as my median barely raises over 11 and I can't remember the last time my pressure raised above 12.

By increasing the minimum, it's easier to keep the airways open than to open them after they have closed.

Once again, YMMV. This is what worked well for me, and I included the diagrams to help illustrate. Your numbers and treatment are very likely to vary. We also now your initial charts are very different than mine because your pressure jumps to the maximum and spends the night there. This suggests too little pressure and explains your high Flow Limits. And that brings us back to your aerophagia.

Thus the common thread, try to find a gentle compromise between pressure and your high Flow Limit and Aerophagia.

Hi DogSlobber: The video was EXTREMELY helpful. So what we are saying in 3rd grade words is that inspite of using a CPAP, my tongue still falls back in my throat closing off air? Is that correct? And to make matters crazier, aerophagia means I am taking air into my body, even though flow restriction says I'm having trouble breathing - yes?

Gosh you read my mind. I was going to ask someone to post a decent looking flow limitation chart. Thank you! Your explanations and charts are also VERY helpful. This is starting to come together for me. I notice that you also changed from nasal to nasal pillows on your charts. And you went from ramp off to ramp on for 45 minutes. Besides raising your minimum from 7 to 11, you lowered your maximum from 14 to 13.80. Was there a reason to lower your maximum? And your EPR is at 3.

So more of the MINIMUM pressure is what will keep the airway open if I am getting this? And will reduce the flow limitations right?(Sorry to anyone who may have already said this in a different way. I have an oxygen deprived brain and I'm a little slow - repetition is good).

Then next: what is the role of the MAXIMUM pressure?

What will prevent me from swallowing air? Is that related to pressure also? Is it related to minimum or maximum? Does a high EPR keep you from swallowing air since that's an exhale right?

I would run up and down the street screaming if I could get a chart like your second one! That is a thing of beauty!

[palerider]

. So what we are saying in 3rd grade words is that inspite of using a CPAP, my tongue still falls back in my throat closing off air? Is that correct?

*something* is closing of your airway, might be your tongue, might be something else.. but, yeah, cpap has to be tuned, it rarely is from the doctor...

[bjhunt01]

. So what we are saying in 3rd grade words is that inspite of using a CPAP, my tongue still falls back in my throat closing off air? Is that correct?

*something* is closing of your airway, might be your tongue, might be something else.. but, yeah, cpap has to be tuned, it rarely is from the doctor...

I see you note "Dallasish" in your location. I live in Dallas. Have you found a good sleep doctor and DME?
Also curious - and I know it doesn't necessarily apply to me - what are your current pressures and are they working for you? Do you have a lovely looking flow limitation and low AI's?

[palerider]

I see you note "Dallasish" in your location. I live in Dallas. Have you found a good sleep doctor and DME?

I'm rogue, I've never seen a sleep doctor, or gotten anything from a DME. I get my supplies from amazon and ebay for the most part.

Also curious - and I know it doesn't necessarily apply to me - what are your current pressures and are they working for you? Do you have a lovely looking flow limitation and low AI's?

My pressures are currently 18/12+ (bilevel) and my yearly AHI average was something like 0.24 last time I looked. sometimes it gets up to 1.0ish,

Here's a recent 'bad' night:

screenshot.png

[Jas_williams]

One thing to note the flow limitation graph always shows as more active when a Resmed machine is running in the ‘For Her’ mode, it seems the algorithm is mor sensitive, why we don’t know it’s just an observation, visible in both the Resmed software and Oscar so don’t always get hung up on flow limitations alone, they need to be taken into account with the pressure variations, the AHI and how you feel.

[Pugsy]

I am with Jas... on the "don't get hung up on the FL graph".....not now and not when battling the aerophagia stuff and the leaks and other sleep quality stuff.

More pressure is needed to tame that FL graph and more pressure will most likely invite the aerophagia monster to come set up house.
There are worse things in life than having an ugly FL graph.

[Dog Slobber]

Hi DogSlobber: The video was EXTREMELY helpful. So what we are saying in 3rd grade words is that inspite of using a CPAP, my tongue still falls back in my throat closing off air? Is that correct?

Something, may or may not be the tongue.

And to make matters crazier, aerophagia means I am taking air into my body, even though flow restriction says I'm having trouble breathing - yes?

Air's going down the wrong pipe.

Gosh you read my mind. I was going to ask someone to post a decent looking flow limitation chart. Thank you! Your explanations and charts are also VERY helpful. This is starting to come together for me. I notice that you also changed from nasal to nasal pillows on your charts. And you went from ramp off to ramp on for 45 minutes.

Yes, changed from Nasal Mask to Nasal Pillows. But didn't change the Ramp. My Ramp has always been set to Auto. SleepyHead/OSCAR has never reported Ramp correctly.

Besides raising your minimum from 7 to 11, you lowered your maximum from 14 to 13.80. Was there a reason to lower your maximum? And your EPR is at 3.

Actually at that point I was increasing my Maximum again. During the interim of those two graphs, I had lowered my maximum as low as 12, specifically to reduce my aerophagia. Then my aerophagia started lessening and is no longer a concern.

My max is now 15 and next time I make adjustments I'm just going to set it back to 20.

So more of the MINIMUM pressure is what will keep the airway open if I am getting this? And will reduce the flow limitations right?(Sorry to anyone who may have already said this in a different way. I have an oxygen deprived brain and I'm a little slow - repetition is good).

Then next: what is the role of the MAXIMUM pressure?

To cap how much pressure can be delivered, help with aerophagia, and intolerance to high CPAP pressure.

A lot of people believe that the Maximum should typically not be set (unless there is a very compelling reason to cap it. The thought process being, maximum doesn't matter unless the machine needs to go there, then why limit it.

I'm now in that camp.

What will prevent me from swallowing air? Is that related to pressure also? Is it related to minimum or maximum?
Does a high EPR keep you from swallowing air since that's an exhale right?

If only it were that simple.

Sleeping position might help? Inclined pillows? Less pressure? EPR? Mask type?