curtcurt46 wrote:
I believe you are the one throwing the dart.
Did you read the articles? They lead me to believe that GERD can have an impact on breathing and in turn influence the events that occur. I concluded by saying the GERD might be at play but simply don't know for sure.
I really focused on the distress that might be caused by an upper respiratory condition. Did you look at her VB? Her numbers are high on her worse nights. I would have to read the apap patent to better understand what the machine does during VB, but its my guess the machine is limited during this type event because of the lack of being able to predict a solution.
Also, you did not address the underlying issue as to whether in Carla's case the machine is causing pressure induce events or it is responding to flow and the events are resolved at a particular pressure.
If Carla addresses the upper respiratory situation, with or without GERD, satisfactorly then she will see improvements in her stats. This is provided she addresses the leaks and a correct pressure is established.
I close by saying that Carla along with good medical care can find the causes that effect her therapy and in turn make the necessary adjustments to give her the best therapy possible.
Don't think so bud, where are you getting this variable breathing data?
This is a Remstar Auto it doesn't record variable breathing (VB), maybe if it was a AutoBipap it would, but not the Auto. Don't confuse variable breathing with erratic breathing after an event.
I'm looking at her last 4-day EncorePro report, go to the very last page under Remstar Auto Statistics, it says Auto-CPAP Mean Pressure = 10.6cm then it says Auto-CPAP "Peak" Average Pressure=17cm. Mean is the average pressure over the 4 day period (forget the highs and lows), then Peak is the average Peak seen over same 4-day period. If you look at the individual days compare the events with pressure used, her data looks good on all days when she stays under 10cm, the higher pressure goes the more events are seen.
Not too hard to see,
12/5 - 90% pressure was 15cm, AHI=15.1
12/6 - 90% pressure was 17cm, AHI=4.0
12/7 - 90% pressure was 14cm, AHI=8.7
12/8 - 90% pressure was 9cm, AHI=2.4 best of the 4-day period, also lowest 90% pressure.
Look at the last 12/8 daily report, leaks are well under control, pressure didn't go to high OA is not bad at 1.7, HI=0.8. She still had an average leak rate of 53.71L/m which is a bit high but that is due to use of the Hybrid mask, its exhaust leaks like a sieve.
The problem you need to understand with the reports is the machine reports
central apnea as obstructive,
this skews the data you are looking at. Large leak also skews the data, but that goes hand in hand with higher pressure. The ONLY time the machine "discards" the OA data is when it effectively logs an NR event (it tosses out the previous triple event). Now if there were only 2 apnea events not correctly scored, those 2 apneas go into the machines sample data stored in memory as obstructive so when it sees them again it may increase pressure making them actually worse. That is why the number of events increase with pressure.
If those events were obstructive apnea (even if caused by GERD in your therory) then pressure should stent them where the frequency reduces, but that is NOT the case here they increase in frequency as the pressure increases.
If the machine is not scoring apnea correctly you then have to question those hypopnea and even Flow limitations as well as they are even harder to distinguish.
How many of those Hypopnea reported are possibly central hypopnea vs obstructive hypopnea?
Nearly impossible to detect accurately without EEG and respiratory straps as used in a PSG.
If the Remstar is logging ANY NR events you can pretty much be assured it is not scoring other events accurately either. But that is not all bad you can still use the data to your advantage, if you know you are at risk of that disorder and that is what the NR flags are for to tell you there is a problem. Then you can do simple things to limit the exposure to them. You don't get any awards for using higher pressure.
If she keeps her maximum pressure under 10.cm leaks will become better controlled, she will have fewer events,
data seen will be more accurate, her aerophagia will get better. It is shown in every report she has put up.
If you guys are suggesting she has worse nights compared to others because of GERD
that doesn't really matter.
It is
what the machine is doing when she does have those worse nights whatever the reason may be.
Set the machine to the parameters I suggested and her worst night will be no worse than the 12/8's data shown even if she eats spaghetti for dinner.
On those worst nights her machine may peg or flat-line at 10cm, that is no big deal, the events causing the machine to want to go higher are being misread anyway. The increase from 5cm to 6cm on the Min pressure would probably reduce the FL's if that is what they truly are.
