ScantyZ

I am not sure if you have any time where EPR was set at 0 cm or off? The EPR was off for 1.12% of the total time of treatment and is was set to Ramp Only for 7.49%. I don't think it is significative to see a difference since my stuff goes up and down all the time.

I have a private insurance that covers CPAP but they have a time period of 5 years wait before you can submit a new reclamation.

One last thought is that if you are prepared to pay for a machine, there are no regulations that I am aware of preventing you from buying a used machine.

I did search for used machine and found only dealers that still require a prescription to buy one.

The only one I found without the requirement is shown on Facebook. I sent the guy 3 requests for him to contact me. He never answered.

I did a few graphs based on pressure but I don't think they are very useful.

So I will now request an interview with my lung doctor and do the best I can to convince her to write a new prescription.

Maybe it is because it is late and I can't get my fingers to hit the right keys, but this is my third attempt with this message.

To prepare my arguments for my doctor, I took a different look at the presentation of the data. Almost all graphs I have seen are time based and I thought of producing some based on the Flow Limitation.

The 2 first ones demonstrate that if I can get my Flow Limitation down to 0.1 as I was advised, I should get much better results.

The 2 last ones show that the pressure is maxed out above 0.1 for Flow Limitation. Since it seems only a BiPAP (I think) can lower Flow Limitation, there is my argument.

I would again greatly appreciate any comments you would submit.

BTW, should you like to have similar graphs, I can make them for you if you are not too familiar with Excel. I would only need your CSV files for the period you would like covered. To keep private, you can send anything to my email address:

I hope this is also useful for you and many thanks again for you superd support :-)

Thank you very much Sierra. I now have a better feeling about the tactic I should use. I am searching the data available to illustrate with graphics what you explained. Take a look at my screenshot. Following your comments, I believe that would be a good exemple???

Here I am once more with questions about flow limitation.

From advice on the subject, my case seemed to require a change of my AirSense 11 for a BiPAP (Resmed AirCurve vAuto).

I found that it is almost impossible to get such machine without a prescription which means I have to convince my lung doctor to change her initial prescription. So far I have not been successful.

I am thus trying to find more arguments to convince my doctor.

So, I took a different look at my results. Almost all graphs out there are time based. Showing different events per hour. I wanted to see if there is a relation between my AHI, my pressure and my flow limitation. Like you said, engineers like graphs :-)

The graph I produced confirmed pretty much one information I got that flow limitation under 0.1 is a good objective. You can see on the graph that below the 0.1 value for flow limitation, I have no events occurring. That is a clear indication for me.

Also shown on the graph is that higher the flow limitation is, higher the AHI also is.

From WiKi: .... Flow limitation may be inspiratory (during inhale) or expiratory (during exhale). It refers to any condition which impairs the flow rate of air through the respiratory tract.... Flow limitations can result from anatomical narrowing of the airway, airway obstruction, and positional obstruction where the airway is restricted due to an individual's sleep position resulting in occlusion of the airway (I am wearing a cervical collar). EFL may also result from intolerance to CPAP pressure during exhale. Both IFL and EFL seem to respond well to bilevel therapy where the exhale positive air pressure (EPAP) is a lower pressure than the inhale positive air pressure (IPAP).

So I do need to fight flow limitation which in my case sometimes goes up to 0.8.

I am thinking of presenting this argument to my lung doctor.

If you can improve/correct the above, please do so.

Thank you.

Then you might know my former employer, Alsthom (before it was Marine Industries Ltd). My last project was getting the order for 3 turbine/pumps for the Corps of Engineer. Then I moved to Hydro-Quebec. Some of the projects I oversaw were refurbishing of Shawinigan 2 & 3 power house & dam, La Gabelle powerhouse & dam and finally the construction of dam and powerhouse Peribonka.

It is a small world :-)

Thank you again Sierra.

Now I need to build a good argument to convince my doctor to prescribe a BiPAP. You have provided much valuable information that will help. Thank you.

B.T.W.

My career background is with large hydro turbines and generators design, fabrication, field installation for 10 years and then client representation for large refurbishing and construction hydro generation projects for another 15 years.

First, thank you Sierra for your patience with me. With age, my brain is getting slower than it used to be, I guess. :-(

Maybe I have it right now with your last explanation.

Please correct me if I am wrong.

With my APAP, when it requires higher inhale pressure, it will reduce that pressure on exhale by only 3 cm as fixed by the EPR setting being max 3 cm.

My exhale pressure being high would favor higher AHI and Flow Limitation.

The key to getting better results is then to get a lower exhale pressure than the limit of 3 cm below the inhale pressure.

With a BiPAP that would be possible, not with an APAP.

Just for example you may get away with a maximum pressure of 15 cm, but with a 10 cm pressure support. Then the machine pressure will alternate between 15 cm on inhale and 5 cm on exhale. This could be much more effective and more comfortable than what you are getting now, which is 20 cm on inhale and 17 cm on exhale.

I am confused. I can set my machine (AirSense 11) with a range of 4 to 20 cm. So I could set it to 5 - 15 cm. Is that what your saying? I had it set to 6 - 15 which is close.

I understand from your last post that a BiPAP is the solution for the pressure and the flow limitation. More pressure would reduce my AHI and the flow limitation. If that is the case, then I should fight to get my lung doctor to change her prescription for a BiPAP. I am not certain I could convince a doctor to change its mind.

If I can't get a BiPAP, what would be the long term effects of flow limitation on my health?

I switched on the EPR. My last night results:

Following his part of my history with flow limitation:

Am I still a candidate for a BiPAP machine ?

Any other information or graph you would like to see ?