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High AHI/CA with EPR of 2
#1
High AHI/CA with EPR of 2
Merry Christmas Everyone.

I'm using a new Airsense 11 and continue to have high CA's when I set EPR to 2 which is more comfortable for sure. Is there anything to try or do I just need to live with an EPR of 1? While I did have more CA's with higher EPR's on my Airsense 10, they seem to be worse on the Airsense 11 for some reason. Thanks for any insight.


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#2
RE: High AHI/CA with EPR of 2
I don’t THINK that 1cm EPR would have that much effect. I’m wondering if it is positional apnea instead of centrals and the machine is mislabeled the events.

EPR only lowers the exhale by 1, 2 or 3 cm and you are talking about only 1 cm.

Are you using a different pillow or sleeping on your back during the 2 cm setting?

Positional apnea can’t be fixed by pressure change. If it is positional apnea you need to know why you are getting in that position and stay out of it. I have a link on collars that you can look at in my signature.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: High AHI/CA with EPR of 2
Interesting, my guess is that your body doesn't like the timing. In a similar way some people can treat their central apnea by using very high trigger sensitivity with a vauto. Unfortunately I assume there are still no timing controls available on these new autosets.

I would be curious to see the same zoomed in view with mask pressure chart visible.

Also curious if you ever have high central days at lower EPR or only when you try using the higher EPR?
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#4
RE: High AHI/CA with EPR of 2
(12-27-2021, 04:46 PM)Geer1 Wrote: Interesting, my guess is that your body doesn't like the timing. In a similar way some people can treat their central apnea by using very high trigger sensitivity with a vauto.  Unfortunately I assume there are still no timing controls available on these new autosets.  

I would be curious to see the same zoomed in view with mask pressure chart visible.

Also curious if you ever have high central days at lower EPR or only when you try using the higher EPR?

Only when I use EPR of 2 or 3 do I get all the CA's. With an EPR of 1 I'm normally below 1 AHI but once in awhile I'll have a 5 AHI which isn't a big deal. I sleep almost exclusively on my back always with the same pillow.
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#5
RE: High AHI/CA with EPR of 2
Sounds like some of the familiar consistently inconsistent CA trait. Whichever EPR setting is most comfortable is the one to choose.
Dave

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#6
RE: High AHI/CA with EPR of 2
(12-27-2021, 11:06 PM)LBTRS Wrote: Only when I use EPR of 2 or 3 do I get all the CA's. With an EPR of 1 I'm normally below 1 AHI but once in awhile I'll have a 5 AHI which isn't a big deal. I sleep almost exclusively on my back always with the same pillow.

Interesting.

It is worth noting that at EPR of 1 you still have near constant periodic breathing (can tell by your fluctuating tidal volume chart) indicating a central phenomenon just not bad enough to cause central apneas. The issue might be CO2 related and the extra EPR just pushes you over the edge but could potentially be something timing wise as well. It is interesting that at EPR of 0/1 your numbers are fine and at 2+ can be quite high.  

Your flow limitations at EPR of 1 are pretty much non existent and there isn't anything that makes me think you need higher EPR so I would stay stick with EPR 1 or potentially 0. Only way you are consistently going to get higher EPR/PS is with ASV.

I doubt pillow or positional apnea is playing a role, all the detailed views and TV pattern look like textbook central apnea.
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#7
RE: High AHI/CA with EPR of 2
Thanks. Looking back I seem to have dealt with this since the start of my CPAP journey. For some reason, I'm finding it harder to exhale against the pressure and was the reason I tired a higher EPR. I'm going to see if I can sleep with EPR off tonight and see what happens.

Really appreciate the assistance. I'll let you know how it goes.
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#8
RE: High AHI/CA with EPR of 2
The key right now is to find out if you get satisfactory results with EPR 0 or 1. Your other options like say ASV can allow easier breathing but if they induce and then have to fight off that many central apnea it will be arguable if the benefit will outweigh the negative and you might end up using similar low PS anyways.
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