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Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
#11
RE: Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
It can take a long time to fully recover from the years of apnea likely suffered before you started CPAP. Overtime that should improve.

We are always here, ready when you need us.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#12
RE: Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
(11-08-2019, 10:55 AM)sherwoga Wrote:
(11-08-2019, 10:38 AM)bonjour Wrote: I would ignore the cluster of centrals at the end of your night.  Ther are likly because you are waking up and we frequently call the SWJ, Sleep Wake Junk.
Your numbers are good which means don't chase them seeking the elusive zero.  Rather make changes based on how you feel, comfort and symptoms.

Okay.  I can report some significant improvement in how sleep I feel throughout the day, especially when I awake (very refreshed) and through most of the day.  I did still get very sleepy in the evening hours long before bedtime.  But, I overwhelmed with the improvement.
I do continue to be sleepy, very much so later in the day.  
Last night I turned the EPR "Off".  (You had previously suggested changing it from 3 to 1 and as noted above, that change was very significant improving my sleep.) For last night, with the EPR off I noticed NO differences in my breathing effort, inspiration or expiration.  I see no negative consequences in the data, but attach my Daily view for last night for your review.  
Also, the pressure range on my CPAP is set from 8 to 18 (minimum to maximum).  That is a large part of the full capability of the pump (4 to 20 cm in 0.2 cm increments).  My 95% Pressure numbers run in the 10 to 15 range (See attached Monthly mode Statistics screen capture).  Do you have any recommendations for minimizing the pressure range?  Will doing so help with "how I feel? with my comfort and symptoms".


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#13
RE: Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
Your pressure is being driven by Flow Limits.  And you have a couple of RERAs, not enough to worry about but they also are an indication of Flow Limits.  To deal with the flow limits I would have you set your EPR to 3 (don't) but we know what will happen there.  For you it is better to balance toward fewer centrals (EPR=0).  

Narrow pressure band,  There is some logic and reason to do so.  It is, on CPAP and BiLevel machines, the next step to reducing Centrals.  18+ is 'safe' territory for you, remember that.
Drop Max to 16, I don't expect you to feel much different. then try reducing 1 cmw every couple of nights until you reach 13 and let it sit there for a couple of nights to settle in.  See if that improves how you feel?

There is a way to manage both your Centrals and the Flow Limits.  That is to incorporate EERS, a mask modification that will very slightly increase the CO2 in your blood and thus eliminate your Central Apnea.  This will allow the use of EPR or Pressure Support (PS) to treat your Flow Limitations.  While EERS is not a mainstream solution, and your doctor has likely not heard of it, it is effective in treating the type of Central Apnea that you have.

It will take time for your body to recover from the years of apnea that you likely had prior to CPAP.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#14
RE: Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
(11-13-2019, 10:40 AM)bonjour Wrote: Your pressure is being driven by Flow Limits.  And you have a couple of RERAs, not enough to worry about but they also are an indication of Flow Limits.  To deal with the flow limits I would have you set your EPR to 3 (don't) but we know what will happen there.  For you it is better to balance toward fewer centrals (EPR=0).  

Narrow pressure band,  There is some logic and reason to do so.  It is, on CPAP and BiLevel machines, the next step to reducing Centrals.  18+ is 'safe' territory for you, remember that.
Drop Max to 16, I don't expect you to feel much different. then try reducing 1 cmw every couple of nights until you reach 13 and let it sit there for a couple of nights to settle in.  See if that improves how you feel?

There is a way to manage both your Centrals and the Flow Limits.  That is to incorporate EERS, a mask modification that will very slightly increase the CO2 in your blood and thus eliminate your Central Apnea.  This will allow the use of EPR or Pressure Support (PS) to treat your Flow Limitations.  While EERS is not a mainstream solution, and your doctor has likely not heard of it, it is effective in treating the type of Central Apnea that you have.

It will take time for your body to recover from the years of apnea that you likely had prior to CPAP.

On 11/12 I turned off EPRS on my own and slept well with good indices.  I reported the same with Daily data and that I observed no negative impacts.  The quote is the response I got from moderator Bonjour.

On 11/13 I intended to get a "couple of nights" data at EPRS off and Max Pressure unchanged at 18, i.e. before implementing the first recommended Max Pressure change from 18 to 16.  My thinking was that since multiple nights at each new setting was recommended, I would do the same for settings used for only one night as of the 12th.  But I awoke struggling to breathe against a mask pressure of 17.9.  It was almost as if I was being held under water or was running a race and couldn't catch my breath.  I think my respiration rate was rapid, or at least it felt that way.  I was experiencing some pain in my abdomen as well that I thought might mean that air was being forced into my stomach.  So that night I went ahead and implemented the recommendation (changing Max Pressure to 16) early in the sleep session.  

On 11/14 I again experienced the struggling to breathe with the Max Pressure now at 16 (now for the second sleep session) and the operational mask pressure at the time at about 15.9; however, it was nowhere near as severe.  I made no further changes and had a pretty good night overall.  But I continued the next day to be very sleepy and got more so as the day wore on.  

On 11/15, still with EPRS off and Maximum Pressure at 16, I had a great night.  Daily view is attached.  My reason for writing is that I don't understand why with such a low number of events my AirSense 10 Autoset increased my Mask Pressure.  It is not doing it in response to events obviously since there aren't any.  Can someone explain what is going on.

Also, it was stated that my "pressure is being driven by Flow Limits".  Is the answer to my question above related?

In the meantime, I plan to implement the next lowering of the Max Pressure to 15 tonight.


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#15
RE: Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
The situation is unchanged from what Bonjour said in his last post. Your pressure is driven by flow limitations, and that continues to be the case. While removing EPR has improved CA, you continue to have a very unbalanced inspiration/expiration time and flow limitation appears worse, and the flow rate chart has a "hair brush" appearance, especially on the lower (expiration) side. I look forward to Fred's input on this but my impression is that you are better off with EPR and that EERS is the better approach here, and you may tolerate even lower maximum pressure.
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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#16
RE: Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
(Yesterday, 09:07 AM)Sleeprider Wrote: The situation is unchanged from what Bonjour said in his last post. Your pressure is driven by flow limitations, and that continues to be the case.  While removing EPR has improved CA, you continue to have a very unbalanced inspiration/expiration time and flow limitation appears worse, and the flow rate chart has a "hair brush" appearance, especially on the lower (expiration) side.  I look forward to Fred's input on this but my impression is that you are better off with EPR and that EERS is the better approach here, and you may tolerate even lower maximum pressure.

Any specific sources and/or part numbers for equipment to assemble an EERS?  I've called both listed DME suppliers in Massachusetts and been told I would need an Rx.  Local DME has been mixed in their response.
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#17
RE: Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
The parts are available online from a number of sources. The whisper swivel vent/valve, and Corr-a-Flex tubing and silicone. The biggest problem is finding what you need in small quantities. CORR A FLEX is cheap at $20 per 100 feet, but you only eed 6 to 12 inches. I think sending a PM to those that have built systems (Slowriter, Foxfire, Joeywallaby) might help. or even starting a thread to ask for ideas on sourcing materials. I would like to see these fabrications split into their own thead anyway. http://www.apneaboard.com/forums/Thread-...#pid316312
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
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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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#18
RE: Help refining CPAP settings to control Obstructive Events and Central Events/Are Cent
As SR has said nothing has really changed, you are lowering your pressure with no ill effects and we want to continue that at least until we see a bump on obstructive events A pressure of 7 is the lowest I would go (7/4 with EPR=3) for anyone without a specific reason to go lower.  

I see you with an EPR=3 AND on EERS (start with a tube length of 6 inches) to manage your Centrals.  The EERS is totally your choice, but I believe that the EERS allows you to use Pressure Support and pressure (EPAP) to treat your obstructive events while managing your central apnea. this was unheard of until recently.  The fact that this requires equipment (Mask) modification will make it unacceptable to some and both I and SR will understand that.  Without EERS you have a choice of where to balance between Obstructive and Central evets, never fully treating either.  It's not a bad approach and is what has been traditionally before.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
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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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