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Can a higher pressure actually increase CAs?
11-18-2014, 11:21 PM
For some people, changing your socks can cause a temporary increase in CA's. But then, some people don't change their socks and therefor avoid problems.
11-19-2014, 04:00 PM
(11-18-2014, 09:03 PM)retired_guy Wrote: ...I assume you're making the change because you're trying to knock out some existing ahi? What are your results currently? ..and what are the makeup of them: OA, Hypop, CA.........That is correct; I think we all want our AHI as low as possible.
My home test AHI was 56, and less than 5% of that was centrals. As soon as I went on APAP, the centrals were outnumbering obstructives 2 to 1, and that has not really changed.
I did 50 days at 5-20, and AHI was about 5 (higher in the first two weeks probably due to newbie adjustments).
I am now 25 days at 8-14, and AHI is under 3 (the last 3 nights averaged about 1).
But the centrals still outnumber obstructives. Hypops are pretty low, and always have been.
So as far as AHI, things are trending in the right direction. Centrals are a little scarier than obstructives, because obstructives have a removable cause, while centrals make you wonder if you have a systemic issue with your breathing feedback loop. So I am a little concerned about that.
11-19-2014, 06:42 PM
You're doing fine... What is your median pressure? The one that the machine is happy with most of the time? Keep narrowing the range until you surround that point by 2 or 3. The other issues are ramp time and epr. If using ramp, don't let it drag on too long. 10 minutes is plenty long enough. EPR in some cause a few centrals, so I've been told. So if you're using epr you might think about lowering it, or eliminating it. But even if you do nothing, your results are very good. Good job!
Thanks so much, RG.
It seems like all of this is a delicate balance, and must be personalized. But the results are defined by so many hard to control variables that it seems one must make small changes and then see how that does over a large number of nights, like a week or two.
I don't use ramp (I can't tell when the machine even starts without purposefully creating a leak around the NPs) as nothing about the pressure really bothers me, except if it gets so high that the sound of the CO2 vent wakes me (I am eligible for the P10 after the end of the month, so that would likely cure that problem anyway).
I do like EPR at 3; I do notice the back pressure just for a tic when I begin to exhale, but it really is not bothersome, although I would notice it more if EPR was reduced. I think they need a better algorithm; instead of waiting for me to begin to exhale, it should try to anticipate that and relieve the pressure just before I exhale.
What about lowering EPR would/could be beneficial?
11-19-2014, 10:54 PM
Actually, if you drop that epr to 2, that "not bothersome" tic you're talking about may disappear. ..and if you are one of those "sensitives" who through a few CA's once in awhile because of the epr, then that might be helped as well.
11-19-2014, 11:53 PM
(11-19-2014, 09:14 PM)TyroneShoes Wrote: It seems like all of this is a delicate balance, and must be personalized. But the results are defined by so many hard to control variables that it seems one must make small changes and then see how that does over a large number of nights, like a week or two.
Yes, but even then you have to be careful in evaluating causes because things will just change on their own and not be a result of any settings on the machine. This is especially true when we start CPAP therapy. Lots of changes as the mind and body adapt.
Quote:I think they need a better algorithm; instead of waiting for me to begin to exhale, it should try to anticipate that and relieve the pressure just before I exhale.
That feature is available on Respironics BiPAP machines. It's called Bi-Flex.
Quote:What about lowering EPR would/could be beneficial?
It may make a difference. You just have to try it and see.
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(11-19-2014, 11:53 PM)Sleepster Wrote:(11-19-2014, 09:14 PM)TyroneShoes Wrote: I think they need a better algorithm; instead of waiting for me to begin to exhale, it should try to anticipate that and relieve the pressure just before I exhale.
With Respironics 'Flex, the pressure starts to transition back to the (higher) inhalation pressure before we start inhaling.
'Flex is Flow-based exhalation pressure relief. The faster the rate of exhalation, the greater the pressure relief.
The pressure rises back to the inhalation pressure as we stop exhaling.
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11-20-2014, 09:17 PM
That's great, but I am not sure how transitioning to a higher pressure before I start INhaling solves the issue of it not transitioning back to a lower pressure in BEFORE I start EXhaling.
11-20-2014, 11:05 PM
Is the tic a problem or not?
11-21-2014, 12:16 AM
EPR is just a comfort feature, raising it or lowering it is based on what you feel more comfy with.
Why are we talking EPR and Flex? I thought this was a resmed not a respironics?
It can't anticipate when you will exhale because your respiration rate is changing. It can know when you stop exhaling to raise pressure back up which is what it does. How it helps is to keep your airway open.
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