[CPAP] Really new, left in dark by doctors

[ConorRyan2612]

Hey Gideon,

I had no centrals in my test just a mix between hypopneas and OA's. 

Few questions,

Why would a bi level help me? Is it cos you're recommending higher pressures? 

Why would raising the pressure help me?

Why would lowering the EPR to 2 help?

Just tryna figure everything out.

Thankyou

---

Also just to add, my test AHI was 8.4 so pretty mild, but felt absolutely on my ass for years.
I have very small airways (from a CT scan) that they're actually looking to make an OAT for me.
What do you know about UARS? I hear so much about needing a higher pressure? Why is that?

[Gideon]

UARS is all about resistance or Flow Limitations. The best tool to fight this is Pressure Support as this difference between inhale and exhale can be higher on a BiLevel and a max of 3 (EPR) on an AutoSet. Physics says a greater Delta Pressure, better know on BiLevels as Pressure Support (PS) helps to overcome this resistance. Hgher Pressure can help but either the CPAP or the BiLevel is extremely likely to be able to supply this higher pressure in nearly anyone. Good old physics says you need higher pressure to overcome resistence.

You have some Central Apnea in your charts and none reported in your sleep study (I do prefer to actually see the Sleep study simply because they are frequently mis-interpeted) these Centrals are likely Treatment Emergent Central Apneas which are mostly driven by your CO2 levels. Note: It is our CO2 levels being 'high' that provides our primary drive to breathe, NOT low oxygen (which can cause us to breathe faster). ALL CPAPs, in any of there flavors increase the efficiency of our breathing. The Biggest factor being PS or EPR with increase PS or EPR inceasing the flushing of CO2 out of our system to below your apneic threshold resulting in a Central Apnea with you not breathing. Now that you are not breathing your CO2 levels gradually build up and when they cross that apneic threshod going up you gradually resume breathing. (Both up and dow is gradual rulting in a typical waxing and waning of your breath form (Flow Rate) frequently with Central Apnea at the nadir's.

The reduction of EPR to 2 is to reduce this flushing and reduce the incidence of Central Apnea. We try it with all apneas on the chance it will work.

Because of the UARS I want to try the other way and increase EPR to its max of 3 and bump up EPAP a bit and see if that helps. I suspect not enough and to go beyond you need a BiLevel such as the VAuto.

Your "very small airways" backs up my UARS theory and you need to attempt to max out the AutoSet (EPR=3 plus a couple of bumps to the EPAP (Min Pressure) looking to see if that helps of the CA gets worse. IF the CA gets worse you still need the higher PS of a BiLevel but the direction would be to the more expensive ASV machine which is designed to treat Cenral Apnea

[quiescence at last]

Physics also associates pressure increased against a resistance with increased flow speed, noise, drying and irritation effects. Be open to it either making you more comfortable, or alternatively more irritated/disturbed. Never trade better scores for better comfort/rest.

Great Luck to you.

QAL

[Gideon]

QAL if I understand your statement you say Always go down the rabbit hole for better scores/numbers. I disagree.

I see optimization as 2 phases

Phases Numbers are high so focus on numbers, listening how the user feels to initially bring the AHI to well under 5, actual value varies by individual

Phase 2
The Numbers are acceptably low and Comfort is king. It is ok to sacrifice some of the numbers for comfort.

The end goal is a solid night's sleep with minimal interruptions. What this actually is can vary considerably by individual.

[quiescence at last]

Nope, exactly inverse.  Chasing numbers,  or better waveforms, should _not_ be done if comfort / rest suffer as a result.

[ConorRyan2612]

Hi, continuing my thread.

Have found a little more relief of symptoms from having min pressure 10 max 12 and EPR at 3. But I am finding myself severely congested and 'black eyed' the next morning. The best way I can understand it is imagine holding your nose and blowing out, your eyes/sinuses and head would fill up with pressure.

It's definitely on these higher settings. Never had it before when I had ipap around the 7-8.5 mark.

Any one had this experience? Does it go away? Or am I forever cursed with sinus pressure issues because of these higher pressures I need.

I have humidity on 4. Which has always been really comfortable.

[DaveL]

QAL if I understand your statement you say Always go down the rabbit hole for better scores/numbers.  I disagree.

I see optimization as 2 phases

Phases Numbers are high so focus on numbers, listening how the user feels to initially bring the AHI to well under 5, actual value varies by individual

Phase 2
The Numbers are acceptably low and Comfort is king. It is ok to sacrifice some of the numbers for comfort.

The end goal is a solid night's sleep with minimal interruptions.  What this actually is can vary considerably by individual.

Gideon that's a wonderful explanation.

sleep quality. I've followed this for some time.  However, I'm stalled.  I don't know what I don't know.

[DaveL]

ConorRyan2612 welcome to the forum!

You're in good hands. I'm grateful for the help they've given me.

Dave

[DaveL]

QAL if I understand your statement you say Always go down the rabbit hole for better scores/numbers.  I disagree.

I see optimization as 2 phases

Phases Numbers are high so focus on numbers, listening how the user feels to initially bring the AHI to well under 5, actual value varies by individual

Phase 2
The Numbers are acceptably low and Comfort is king. It is ok to sacrifice some of the numbers for comfort.

The end goal is a solid night's sleep with minimal interruptions.  What this actually is can vary considerably by individual.

Gideon that's a wonderful explanation.

sleep quality. I've followed this for some time.  However, I'm stalled.  I don't know what I don't know.