Expiratory Relief and Preliminary Report Analysis

[Gideon]

Fats the therapeutic value of EPR is not with Central Apneas, it is mostly with Flow Limitations, an obstructive event.

There are 3 levels of obstructive events
Flow Limitation
Hypopnea
Apnea
The difference is in the level of obstruction.

[Fats Drywaller]

(deleted; was misunderstanding) ... never mind; will look it up and read up on it. Thanks.

[Gideon]

Pressure variance is typically bad for Central Apnea. Increased variance causing more Central Apnea. This variance can be caused by either a pressure range such as 6 to 20 or by EPR. Higher pressures tend to increase Central Apneas on CPAP so we try to find the sweet spot that balances between OSA and CA using lower non varying pressures.

Most of the "misdiagnosed" have about 1/3 Central Apnea which is below the 50% level required to diagnose as Central/Mixed/Complex Apnea. But it really impacts the patient. The summaries should note the presence of a mixed apnea component but they very rarely do.

Fats your concept of EPR and PS being similar is correct. Both can be used for comfort and/or therapeutic value for obstructive events.

Sorry about the educational hijack

[Fats Drywaller]

Got it, thanks.

Apparently some docs are less at fault than I had been assuming, but I have to wonder what the rationale was behind that decision of 50% for mixed apnea, and how these things are determined. It seems arbitrary, as with the magic threshold of AHI > 5.

P.S.: Relax; it's not a hijack. The OP asked for details about EPR.

[Sleeprider]

I'm going to make this simple. Set your Airsense 10 Autoset at a minimum of 7.0, maximum 20 and go ahead and set EPR to 3. This is the most comfortable EPR setting for most people and generally avoids flow limitations and hypopnea. If central apnea shows up in significant amounts, we will back off, but at this point we will assume you have obstructive sleep apnea. The minimum pressure of 7.0 is set because in using EPR at 3, your inhale exhale (IPAP/EPAP) pressure will start at 7/4 and can go as high as 20/17. That's a wide range and we will optimize later, but the point is you won't have your EPAP pressure stuck at 4 like would happen with a lower minimum pressure (4/4, 5/4, 6/4, 7/4, 8/5 etc). That's my suggestion for starting, and it's easier to fine tune from there.

[DrAHI]

Makes sense.
Thank you very much!

[DrAHI]

Dear all,

I attached the home sleep study report for the test I took recently.

Can anybody please take a look and give me some feedback?

I am currently waiting for the doctor to see the full report and write a prescription.

Thank you!

[ColoradoMom]

Your sleep study shows an AHI of 61.4 (primarily obstructive apneas) which puts you in the severe category. Your oxygen levels are concerning. Your O2 levels were under 80 for 2 hours and under 88 for 372 minutes. To add perspective in the US the criteria for receiving a prescription for nighttime supplemental O2 is being under 88 for 5 minutes over the course of an entire night.  Your lowest O2 saturation was 59.2, which is quite low. 
If I were in your shoes I would not wait for the doctor to get around to reading the sleep study. Call the doctors office tell them you have the sleep study results and you are concerned. Your doctor may not have even looked at the report yet, so make certain the doc is made aware of the low O2 levels and high AHI shown on the sleep study.

[DrAHI]

Thank you for your feedback.

What you said certainly reflects how I feel ( a six letter adjective...).

Good news is, I already ordered the APAP machine, so now it's pretty much about starting the therapy with the right settings.

[Gideon]

You also want an O2 meter that will integrate with SleepyHead.
I have not seen that significant oxygen desats. Than your apnea.

Ask about getting a daytime continuous Oxygen test to eliminate your desats from also being a problem.

Which APAP and when do you get your hands on it. I'm munch more concerned with your oxygen levels than I am your apnea

On your posted SleepyHead charts in addition to normal charts ( s÷ signature optimization link) include your tidal volume, minute volume, plus inspiration and expiration timing and details.

I'm also wondering if you may need an advanced Bilevel. Intended for COPD WITH MORE breath control.

Fred