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Finally changed to a OSCAR supported device. Help me analyze my therapy please.
#21
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
The main difference between the two nights is that with EPR 1 your 95% flow limitations increased from 0.01 to 0.08 and leaks were notably higher. All other respiratory statistics, tidal volume, minute vent and respiratory rate, were identical. With lower EPR, your AHI was about half, mainly a reduction in CA events, and both hypopnea and obstructive events were slightly higher. Your median pressure, especially EPAP was higher and there was more fluctuation in pressure. These are pretty typical results from reducing EPR.

I think it may be helpful to get several more nights of results with EPR 1, then try EPR 2. EPR has a significant effect on therapy, and with some individuals it can increase ventilation enough to cause you to experience some CA events. Sometimes that is not a bad trade-off. CA events tend to be short in duration and do not cause oxygen desaturation so are generally less disruptive to sleep. We can actually treat CA events that emerge from therapy by modifying the breathing circuit to increase the volume of your exhale and CO2 that is rebreathed. Don't let this worry you too much. Our objective is not the lowest AHI, it is to maximize comfort and quality of sleep. Ultimately you may decide to keep a higher EPR and accept more CA events as a trade-off for more comfort.
Sleeprider
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#22
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
(10-13-2020, 07:51 AM)Sleeprider Wrote: We can actually treat CA events that emerge from therapy by modifying the breathing circuit to increase the volume of your exhale and CO2 that is rebreathed.  

Thank you for the detailed answer! The only thing that I didnt understand it the quoted text above. How do you modify a breathing circuit ? I tried googling but couldnt find anything. 

(10-13-2020, 07:51 AM)Sleeprider Wrote: Don't let this worry you too much. Our objective is not the lowest AHI, it is to maximize comfort and quality of sleep.  Ultimately you may decide to keep a higher EPR and accept more CA events as a trade-off for more comfort.

Thinking-about Thats an interesting thought. I always had an aim to lower my AHI as much as possible since I saw a lot of people get below 1/h. Since with my current numbers I still feel tired in the morning and during the day, I thought that getting them lower would be better. 

Alright, cool. So then I try with EPR 1 for a couple more days and see how I feel in general. After that I try with EPR 2 and give that a go for a couple days. Will report back after that Smile
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#23
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
First put a dotted line on the leak rate. To do that take your mouse and put near the word leak rate on the right side of the graph. Next right click and go down to dotted line. Now choose "leak rate upper threshold". That will put a line on the graph and any thing above the line is a large leak. Of course the leaks get worse as it near the line, over the line it does cause problems with your therapy (any leak is not optional). Compare the part where the leak is over the line with the events. Those events could have been made less or eliminated without leaks.

You do have less Centrals and I hope they will lessen as you get use to the pressures - they many times do. With that being said the low EPR setting gives less Centrals but you get more flow limitations. Take a look at the flow limit. chart and compare it with the ones you posted earlier. More flow limt. mean more sleep interruption. And we help that when EPR is raised. I would give it a couple of days with these settings and if the Centrals are down go up one on the EPR for a couple days and finally go to 3 EPR when the centrals again get under control.

As stated earlier the EPR=3 is where we want to be - it is the best for comfort and a good night sleep.

If Fred comes back - he is one of the very best on this site, he may give a different suggestion.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#24
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
(10-13-2020, 08:08 AM)vrapche031 Wrote:
(10-13-2020, 07:51 AM)Sleeprider Wrote: We can actually treat CA events that emerge from therapy by modifying the breathing circuit to increase the volume of your exhale and CO2 that is rebreathed.  

Thank you for the detailed answer! The only thing that I didnt understand it the quoted text above. How do you modify a breathing circuit ? I tried googling but couldnt find anything. 

(10-13-2020, 07:51 AM)Sleeprider Wrote: Don't let this worry you too much. Our objective is not the lowest AHI, it is to maximize comfort and quality of sleep.  Ultimately you may decide to keep a higher EPR and accept more CA events as a trade-off for more comfort.

Thinking-about Thats an interesting thought. I always had an aim to lower my AHI as much as possible since I saw a lot of people get below 1/h. Since with my current numbers I still feel tired in the morning and during the day, I thought that getting them lower would be better. 

Alright, cool. So then I try with EPR 1 for a couple more days and see how I feel in general. After that I try with EPR 2 and give that a go for a couple days. Will report back after that Smile

Regarding your first question, the technique is called Enhanced Expiratory Rebreathing Space (EERS). Here is our wiki http://www.apneaboard.com/wiki/index.php...ace_(EERS)  It's a fairly simple "do-it-yourself" modification that moves the exhale vent from the mask farther up the tube, to safely create a dead-air space.  A number of members have done this, and it usually results in a significant reduction in treatment emergent CA events, along with an increase in tidal volume and minute vent.

I view CPAP therapy qualitatively rather than quantitatively. While comfort normally follows efficacy, it is possible to create conditions that result in comfort trade-offs.  For example, some people may need higher pressure to fully resolve obstructive apnea, but that pressure results in discomfort that disrupts sleep quality, or aerophagia. In your case, the use of EPR is comfortable but results in some CA events.  We frequently compromise between efficacy and comfort and live with what works best for a given individual.  That said, I think we can achieve both comfort and efficacy in your case, but it may involve some "outside the box" thinking to resolve treatment emergent CA, that enables the use of bilevel pressure (EPR) that controls your flow limitations, pressure fluctuations and improves comfort.
Sleeprider
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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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#25
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
Treating Central Apnea is a balancing act unless you are treating with an ASV machine.  By balancing Central Apneas I mean 
  • Central Apnea is described as Consistently Inconsistent, it jumps all over the place
  • "Treatment" of Central Apnea on CPAP/APAP/BiLevel wo Backup is principally by avoidance. And that avoidance is avoiding the condition of hypocapnia, low CO2 levels, which may occur in a few "lucky" individuals when a CPAP flushes sufficient CO2 out of the system to below your apneic threshold resulting in a Central Apnea.
  • First solution is to reduce that flushing by reduction of PS or EPR, then Pressure Fluctuation and pressure
  • Second, as SleepRider alluded to, we increase the amount of CO2 that you inhale by rebreathing exhaled CO2 via a technique called EERS/Enhanced Expiratory Rebreathing Space.
  • Balance is a balance between Obstructive and Central Apneas since treatments for each with a CPAP are polar opposites.
EPR is very important within its limits for the treatment of Hypopnea, Flow Limits, RERAs, and UARS.  Increased EPR (or PS on a BiLevel), the difference between EPAP and IPAP is what treats these best.  (Flex from PR just does not do the same even though it is supposed to be the equivalent to EPR, it is not.)   
As noted above this is in conflict with the treatment of Central Apnea.

Thus the task at hand is to either find the best balance for you, or if the CA is severe enough move down the path toward ASV which is designed to treat both Central Apnea and Obstructive events
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#26
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
I love this forum, thank you very much everyone. Thats a lot of very useful information. So I will get back to this topic then after I try out EPR on 1 and 2 for a couple of days.
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#27
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
(10-13-2020, 09:01 AM)Sleeprider Wrote: I view CPAP therapy qualitatively rather than quantitatively. While comfort normally follows efficacy, it is possible to create conditions that result in comfort trade-offs.  For example, some people may need higher pressure to fully resolve obstructive apnea, but that pressure results in discomfort that disrupts sleep quality, or aerophagia.  In your case, the use of EPR is comfortable but results in some CA events.  We frequently compromise between efficacy and comfort and live with what works best for a given individual.  That said, I think we can achieve both comfort and efficacy in your case, but it may involve some "outside the box" thinking to resolve treatment emergent CA, that enables the use of bilevel pressure (EPR) that controls your flow limitations, pressure fluctuations and improves comfort.

I definitely get what you meant by this now. I had 2 really bad nights since I switched to EPR1, constant leaks, waking me up, even my wife said that it started waking her up and she usually sleeps through everything. 

On two of the nights the numbers were better than what I had before switching to EPR1 but I just felt awful. Especially today, so the 14.10. screenshot, really really good numbers and not even any leakage problem but I woke up feeling absolutely destroyed. I will consider sleeping one more night with EPR1 before switching to EPR2.


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#28
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
We are seeing a pretty significant increase in flow limits, which I believe are much more disruptive to sleep than the CA your are avoiding by reducing EPR. I think it would be great to step up to EPR 2 and try that for a bit.
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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#29
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
Just two more cents: maybe you wish to activate mode "soft" to let your machine react less aggressively.
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#30
RE: Finally changed to a OSCAR supported device. Help me analyze my therapy please.
(10-15-2020, 08:11 AM)Sleeprider Wrote: We are seeing a pretty significant increase in flow limits, which I believe are much more disruptive to sleep than the CA your are avoiding by reducing EPR.  I think it would be great to step up to EPR 2 and try that for a bit.

I switched to EPR2 yesterday and I felt a lot better today in the morning. This whole week since I switched to EPR1 was really rough, I was again waking up feeling the same as before CPAP. With EPR2 I felt much better. I still woke up feeling tired and I am sleepy through the whole morning but its much better than the nights before. The centrals went up now but lets give it a couple of days in these settings to see if they will disappear and how I will feel :Smile
Thank you for all your help so far


(10-16-2020, 04:12 AM)multicast Wrote: Just two more cents: maybe you wish to activate mode "soft" to let your machine react less aggressively.

I did some googling on this and found what it is but I cant find info if this has any impact on the actual therapy or would it be just a small change comfort wise ? 



There is one thing that kind of bothers me since I switched to this device. The machine itself is super quiet, more quiet than the one I had before. But each inhale is pretty loud  Thinking-about
I had the same exact problem with my previous cpap machine but only with the Dreamwear Nasal Cushion mask, when I switched to the Resmed n30i that noise was not that bad. 

I tried 4 masks with this machine and they all have the same thing, only the Bleep DreamPort is still really silent with it but unfortunately I lost one small plastic piece of it and I cant use it  Dont-know   ( I am located in Europe and they only sell in the US, so ordering from the US means that I pay a lot on shipping, which makes no sense for just one small part ).


I tried it on different pressure settings and the noise becomes louder only after it goes over 8, under that its still pretty silent. It could be that my old machine was also like this but I think that at the end I was using it in CPAP mode at pressure 7 so it wasnt as loud. My wife also started telling me that during the night its pretty loud which sucks.


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