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CA (cluster?) events not reducing
#11
RE: CA (cluster?) events not reducing
Sleeprider's most recent advice is to eliminate EPR entirely and to try using a low and fixed pressure. I'd suggest min = max = 6, as in your most recent charts. But turn the EPR off.

You'll want to give these settings some time, perhaps as long as a month. When CAs result from arousals from sleep, the body sometimes will adjust, either by reducing the number of arousals or reducing the length of the pauses you take after arousal breathing.

If the CAs settle down, you can try gradually re-introducing EPR.

Also, be aware that the prevalence of CAs can vary a lot from one night to the next.
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#12
RE: CA (cluster?) events not reducing
T818 - listen to Sleeprider and things will most likely improve.  Give it plenty of time.
If -- after giving suggested settings enough time for your body to adjust -- the experts are still leaning toward an ASV, they can help with those settings as well.

Definitely complicated but you're in a good place for support.
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#13
RE: CA (cluster?) events not reducing
On the positive side, the CPAP has eliminated the obstructive component of your apnea. It's going to be a process of trial and error to find settings that not only give you the best numbers, but that allow you to sleep comfortably. Keep notes on what has been tried and how you feel so we can help you to get the best results. Set minimum and maximum pressure at 6.0 and EPR off and let's see how it works out.
Sleeprider
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#14
RE: CA (cluster?) events not reducing
I tried with fixed pressure 6, EPR=off last night.

1st session seems really good  1.71 AHI with 4 HA, 5 CA. I have attached this session separately. this session was from 1 am to 6 am. Does sleeping hour has anything to do with better result?

2nd session was AHI 5.9, with 9 HA, 22 CA ( 6:30 am 11:59)
slept 12 hrs in total. 1 hr data is reported on next day. (till 1 pm)


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#15
RE: CA (cluster?) events not reducing
These results are an improvement in numbers. How was comfort and sleep quality? This shows us the obstructive part of your AHI is resolved with as little as 6.0 cm pressure. You can try alternative pressures, preferably fixed and without EPR.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#16
RE: CA (cluster?) events not reducing
(12-23-2022, 09:18 AM)Sleeprider Wrote: These results are an improvement in numbers. How was comfort and sleep quality?  This shows us the obstructive part of your AHI is resolved with as little as 6.0 cm pressure.  You can try alternative pressures, preferably fixed and without EPR.

Thanks a lot for taking your time again and again.

In terms of sleepiness, I didn't feel much difference compared to earlier settings. May be It will take a while to improve. There was mild headache throughout the day. Felt less foggy though.

I will continue with this setup for 2 weeks and post again unless you have any other suggestions to adjust.
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#17
RE: CA (cluster?) events not reducing
(12-22-2022, 02:54 PM)Brazen Wrote: T818 - listen to Sleeprider and things will most likely improve.  Give it plenty of time.
If -- after giving suggested settings enough time for your body to adjust -- the experts are still leaning toward an ASV, they can help with those settings as well.

Definitely complicated but you're in a good place for support.

Blessed and grateful to be in this place for sure.
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#18
RE: CA (cluster?) events not reducing
(12-22-2022, 01:49 PM)Dormeo Wrote: Sleeprider's most recent advice is to eliminate EPR entirely and to try using a low and fixed pressure.  I'd suggest min = max = 6, as in your most recent charts.  But turn the EPR off.

You'll want to give these settings some time, perhaps as long as a month.  When CAs result from arousals from sleep, the body sometimes will adjust, either by reducing the number of arousals or reducing the length of the pauses you take after arousal breathing.

If the CAs settle down, you can try gradually re-introducing EPR.

Also, be aware that the prevalence of CAs can vary a lot from one night to the next.
Yes, I have noticed that with same settings every night is different. Wondering how to deal with those bad days.
Thanks for your suggestions.
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#19
RE: CA (cluster?) events not reducing
This is my update after 2 weeks. I didnt feel any noticeable change. Foggy, cant focus, sleepy(varies day to day).

Should I give it more time?Any adjustment suggestions? or Ssould I consider ASV trial? Is Resmed Lumis 150 VPAP ST suitable for me? I have to get it from Resmed India which has below machines. Need to know what are my options.
https://shop.resmed.co.in/collections/devices?page=3

I have attached 3 reports. I tried with Fixed pressure 6, Fix 6 with EPR, Fix 6.6 with SCC and mouth tape. N30i nasal mask.


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#20
RE: CA (cluster?) events not reducing
I'm struck by the fact that the close-ups of CAs you've provided all show arousal breathing right before the CA. I'm inclined to think of the arousals as the problem, rather than the CAs.

What happens is that the arousal breathing is deeper and washes out some CO2 from your blood. This in turn delays the "breathe now" signal to your brain and you pause in your breathing. Once enough CO2 has accumulated, you resume breathing.

Meanwhile, you have fairly heavy flow limitations. FLs are what they sound like: limitations within your airway that don't qualify as hypopneas or obstructive apneas. FLs may be having no effect on your sleep, or they may be contributing to your arousals, which in turn leave you unrefreshed during the day.

FLs can be caused by nasal congestion. If that's the case for you, your machine can't help. But the can also be caused by the relaxation of the tissues that line your pharynx. If that's why you have FLs, EPR can help.

As you know, though, EPR can result in more CAs. That's because it can slightly increase the extent to which CO2 is washed out.

I would be curious to see what happens if you increase you max = min to 7 and set EPR to 3. (The machine can't go lower than 4, so 7 is the lowest pressure at which you can get EPR of 3.) If this reduced your FLs, that would be helpful information to have as you think about what your next steps should be. Of course what would be wonderful is if reduced FLs also led to fewer arousals and better sleep. But even just getting more information would be good.
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