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AHI 7.9 need help adjusting
#1
Hi, 
So i have my screen shots.Can someone give me some good feed back, this was from last night. My Dr gave me the cpap with settings 4 -13 with epr off. I Lowered it because was very difficult at first to tolerate such a high pressure and turned epr to 3,it is becoming easier.  If there are screen shots I am missing please let me know. Thanks Thanks Guys

https://imgur.com/a/zJeZg
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#2
This is pretty straight-forward; your pressure is too low, and is undermined by excessive use of EPR.  It's fine to take some time to adapt to the therapy, but you need to move this up as you become more comfortable with the feeling of pressure.  Obstructive apnea is treated in bilevel by the exhale pressure, or in your case, by the pressure minus EPR.  With your current settings, your maximum EPAP pressure is 7.6 and it's not enough.  You can either reduce EPR to increase the EPAP, or increase the maximum pressure.  Either or both will work, but until you do your obstructive apnea rate will be unacceptably high.  To keep your EPR at 3 and still meet your doctor's prescription, your maximum pressure would need to be about 16 cm.  That said, this is likely a significant improvement over your untreated results and will benefit your health; however you will not realize the full benefits of the therapy until your pressure is higher. I encourage you to increase your minimum pressure to 7 and maximum to 15 if you plan to continue using EPR at 3. Keep in mind your EPAP pressure at 7.0 is still only 4-cm.

Take a closer look at those respiratory flow spikes around 04:50 to 05:30. That is respiratory distress (recovery breathing) you are causing yourself due to unreasonably low pressure.

[Image: gBrmlpw.png]
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#3
Wow ...ok I will drop EPR down to 2 And bump up the min and maximum pressures and see what happens. So if I drop EPR to 2 do you still think 7 and 15 are the magic numbers.
I get excited to see my results in the morning. How long does it take for blood pressure and other health problems to resolve,or do they resolve?
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#4
Would I benifit better from a bipap?
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#5
I wouldn't think so, your tidal volume and RR are fine, you aren't using that high of a pressure. I would just keep increasing the pressure till the events cleared, 7-15 is a good place to start.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#6
Awesome ..I will do it tonight and post results, thank you
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#7
Pressure set from 7 to 15 will produce EPAP from 5 to 13. I think that will work very well. It will be interesting to see where pressure settles out. Sorry about all the bilevel information in the first post, just TMI. All you need to do is have enough pressure in the settings to prevent obstruction. Everything else in your results is actually very good.
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#8
How do you feel now Justbreath?
I would think you should get there with just a bit of tweaking.

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#9
OK pretty rough night, the adjustments seemed to be too much air . it seemed once the pressure got high it stayed high , mask seemed to be having air escaping and i also swallowed some air because my stomach feels like it. i did try to titrate myself downward 3 times ,but failed miserably. Dont-know
here are my screen shots, any ideas? looks like the centrals kicked in which doesnt surprise me because i knew i had about a 50/50 ratio, was surprised though that all of my previous nights showed little to none.

dec 26th  

 https://imgur.com/a/BC7Rn


last night

https://imgur.com/a/XvoRT
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#10
Justbreath, did you have a titration study? If so it would help to see the results. Your most recent results showed the emergence of complex apnea when your pressure went above 10 cm, so that was an unexpected result and something we want to avoid. At this point, you're showing a relatively high rate of obstructive apnea with maximum pressure at 8.4, and a lot of mixed apnea above that threshold. In fact, your best results are when you are at or near your starting pressure of 5.

I'm starting to see your results as a possible complex apnea, and your maximum pressure needs to be kept to 6.0.
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