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[Diagnosis] Round 2 Sleep Test
#31
RE: Round 2 Sleep Test
With last night's AHI up a little, you had a bit of RERA/hypopnea stuff:

[Image: poYlEC1.jpg]

Interestingly, the machine thought there was only one thing of importance.  IMO there's 6.

So we could bump up a little if you feel like it, but only to like 6/EPR 3.  Let's ease along and take it slow.
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#32
RE: Round 2 Sleep Test
(03-28-2022, 08:58 AM)Rubicon Wrote: With last night's AHI up a little, you had a bit of RERA/hypopnea stuff:

[Image: poYlEC1.jpg]

Interestingly, the machine thought there was only one thing of importance.  IMO there's 6.

So we could bump up a little if you feel like it, but only to like 6/EPR 3.  Let's ease along and take it slow.
Last Night i didn't sleep as good as in 5/EPR3.  I forgotten to place my SD card back to the machine.  Hence, there is only this little information i can get from the machine.  I shall continue a few couple of nights in 6/EPR3 and see how it goes.  I am curious just 1 pressure up double my CA but unfortunately can't tell the accuracy without the graphs.
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#33
RE: Round 2 Sleep Test
Are you using a cervical collar? This may or may not work for you. See the small clusters of obstructive events? including the flow limits in your close up.
These could be a sign that you are tucking your chin and typically do not correct with pressure.
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#34
RE: Round 2 Sleep Test
(03-28-2022, 06:10 PM)Gideon Wrote: Are you using a cervical collar?  This may or may not work for you.  See the small clusters of obstructive events? including the flow limits in your close up.
These could be a sign that you are tucking your chin and typically do not correct with pressure.

Thank you so much for your advice.  Unfortunately no cervical collar or anything around my neck because it itch and i will develop Hives.  I sleep on my side to start with and i will have a bolster tuck below my chin to sort of lift my chin however during the night, the bolster might ended up somewhere else.  I may consider a change of pillow, I am sleeping with a Tempur original that might probably too low and might not have a good lift.  Having say that, i am trying not to feel cautious with how the way i sleep.  I might end up with anxiety.  I am already feeling it with all the diagnoses, speaking with the doctors, continue with APAP, ASV or no ASV etc.  hahaha
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#35
RE: Round 2 Sleep Test
The CAs likely increased because the only real change you made was increasing EPR. By increasing pressure to 6 but leaving EPR at 3 Your EPAP stayed the same at 4 cm and your EPR increased from 1 to 2.

EPAP prevents obstruction and EPR treats flow limitation when EPAP isn't capable of preventing it. EPR also makes CO2 driven central apnea worse which appears to be what happened last night. Imo you want to use 1 EPR at most and potentially may do better without EPR.

If you try pressure = 6 cm, EPR = 1 cm it should give results more inline with previous 5 cm pressure.
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#36
RE: Round 2 Sleep Test
(03-28-2022, 09:21 PM)Geer1 Wrote: The CAs likely increased because the only real change you made was increasing EPR. By increasing pressure to 6 but leaving EPR at 3 Your EPAP stayed the same at 4 cm and your EPR increased from 1 to 2.

EPAP prevents obstruction and EPR treats flow limitation when EPAP isn't capable of preventing it. EPR also makes CO2 driven central apnea worse which appears to be what happened last night. Imo you want to use 1 EPR at most and potentially may do better without EPR.

If you try pressure = 6 cm, EPR = 1 cm it should give results more inline with previous 5 cm pressure.

I didn't make any EPR change when i move the pressure to 6.  Everything remain the same as when i was in pressure 5 except the pressure move to 6.  I am trying to move thing slowly one at a time to observe the change/result.  What i am curious is, everything in the setting remain constant but just move 1 pressure up, the result change so drastically.  

In my previous experience, i did tried to set ERP to zero and move the pressure up, the CA remain high the leaks were so bad!  The higher pressure disturbed my sleep too.
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#37
RE: Round 2 Sleep Test
EPR = Pressure - EPAP.

The lowest pressure the machine can supply is 4 cm so EPAP is always at least 4 cm. If you use 5 cm pressure and 3 EPR then you only get 1 effective EPR because 5 - 4 = 1. Although you had EPR set to 3 you were only effectively getting 1 EPR.

When you changed the pressure setting to 6 the EPR became 2 because 6 - 4 = 2. In order to keep EPR to 1 you would have had to change EPR setting from 3 to 1.

Higher EPR will almost always aggravates CA more than higher pressure does, I imagine 1 is the max you can use. High enough pressure can also aggravate CA depending on the case. The question right now is if there is a sweet spot where a slightly higher pressure (6-9 cm range) treats the majority of obstructive issues better than 5 cm did without aggravating the CA. The best way to test that theory is to keep EPR at 1 and slowly increase the pressure by 1 cm every few days and note if results are getting better or worse.
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#38
RE: Round 2 Sleep Test
IMO we need to look at each night's sleep from 3 different perspectives:

1. Your sleep-disordered breathing is bad;
2. Your sleep quality is bad; or
3. Your sleep-disordered breathing and your sleep quality is bad.

Looking at raw data helps immensely in being able to differentiate the contribution of each. Without seeing that we can speculate but why? Tonight we'll have real data again. And right now we're in desensitizing mode anyway.

You're absolutely correct, just adding 1.0 cmH2O shouldn't have done a lot (we were trying to address RERAs, we were only, and needed to only, add IPAP). The expected result would be to see a small decrease in FL. We're trying to fine tune an AHI of 1.0.

As previously noted, your demographics put in a high risk group for sleep problems (the literature says 50%. I tend to round up and just say you all do). So if we were to speculate IMO your sleep was bad. And no matter how you look at it, CPAP doesn't fix bad sleep. So let's forget about last night and move on.
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#39
RE: Round 2 Sleep Test
(03-28-2022, 11:40 PM)Geer1 Wrote: EPR = Pressure - EPAP.

The lowest pressure the machine can supply is 4 cm so EPAP is always at least 4 cm. If you use 5 cm pressure and 3 EPR then you only get 1 effective EPR because 5 - 4 = 1. Although you had EPR set to 3 you were only effectively getting 1 EPR.

When you changed the pressure setting to 6 the EPR became 2 because 6 - 4 = 2. In order to keep EPR to 1 you would have had to change EPR setting from 3 to 1.

Higher EPR will almost always aggravates CA more than higher pressure does, I imagine 1 is the max you can use. High enough pressure can also aggravate CA depending on the case. The question right now is if there is a sweet spot where a slightly higher pressure (6-9 cm range) treats the majority of obstructive issues better than 5 cm did without aggravating the CA. The best way to test that theory is to keep EPR at 1 and slowly increase the pressure by 1 cm every few days and note if results are getting better or worse.
I learn something today.  Thanks Geer1!
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#40
RE: Round 2 Sleep Test
(03-29-2022, 03:35 AM)Rubicon Wrote: IMO we need to look at each night's sleep from 3 different perspectives:

1.  Your sleep-disordered breathing is bad;
2.  Your sleep quality is bad; or
3.  Your sleep-disordered breathing and your sleep quality is bad.

Looking at raw data helps immensely in being able to differentiate the contribution of each.  Without seeing that we can speculate but why?  Tonight we'll have real data again.  And right now we're in desensitizing mode anyway.

You're absolutely correct, just adding 1.0 cmH2O shouldn't have done a lot (we were trying to address RERAs, we were only, and needed to only, add IPAP).  The expected result would be to see a small decrease in FL.  We're trying to fine tune an AHI of 1.0.

As previously noted, your demographics put in a high risk group for sleep problems (the literature says 50%.  I tend to round up and just say you all do).  So if we were to speculate IMO your sleep was bad.  And no matter how you look at it, CPAP doesn't fix bad sleep.  So let's forget about last night and move on.
Thanks Rubicon for your review.  Shall i move on with pressure 6/EPR1 tonight for say 5 nights?  I think i need a systematic approach and see what is going on.  If i keep switching the setting, it just move aimlessly.
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