(09-02-2013 10:32 AM)bluederby Wrote:
CPAP Statistics as of Sunday, September 01, 2013
16 days of CPAP Data, between 8/15/2013 and 9/1/2013
Hours per Night 06:14
Average Leaks 14.99
95% Leaks 49.20
... my AHI is reasonable, why do I feel so horrible.
Some people have lots of sleep-disrupting events called Respiratory Effort Related Arousal (RERA) events which do not show up in their AHI numbers. The usual treatment to eliminate RERAs is bi-level PAP. Increasing the difference between the inhale pressure and the exhale pressure makes breathing easier and eliminates RERAs.
Are you using EPR? EPR is a form of bi-level therapy. A higher setting for EPR may reduce RERA events, but (for a few people) a higher setting for EPR may increase central apnea events. Also, if using a constant-pressure CPAP machine, a higher setting for EPR may increase obstructive apneas, unless the pressure is increased to compensate for the amount of EPR used. This is because too low of a pressure right before inhalation is associated with an increased number of obstructive events. Increasing the CPAP pressure setting to compensate for the amount of EPR used would knock the obstructive events back down, if EPR had caused them to become elevated. But increasing the CPAP pressure is unlikely to reduce central events. In many cases, increasing the pressure tends to increase the number of central apneas.
If your main problem is RERA events (which the S9 machines do not report or detect) and if you have already been using EPR=3, you may benefit from a bi-level Auto machine which can deliver a larger difference between inhale pressure versus exhale pressure and, because it is an Auto machine, can minimize your average therapy pressure. Examples of this type of machine would be the PRS1 BiPAP Auto or the ResMed S9 VPAP Auto.
If bi-level treatment causes your Central Apnea Index (CAI) to get larger than 5.0, then an ASV machine may be prescribed which would be able to treat/prevent both your obstructive and central events. However, some insurance companies will not cover an ASV machine unless the CAI is at least 15 ("moderate"), which would mean you could be faced with the prospect of paying for the ASV machine on your own, if you wanted to pursue ASV treatment. New ASV machines are nearly US$2,000 from Supplier #2
, and used machines are somewhat less. Examples of this type of machine would be the PRS1 BiPAP autoSV Advanced or the ResMed S9 VPAP Adapt.
On the other hand, if your main problem is central apnea events and if you have already been using EPR=3, you may benefit from turning EPR down or off, because (for a few people) turning EPR off can reduce or largely eliminate central apnea events and make sleep more restful.
So, what to do? Turn EPR very slowly up? Or turn EPR very slowly down and then off? Either one might help.