Influence of EPR-Level on Central Apnea

[richb]

[quote='richb' pid='118911' dateline='1434984428']
"At this point I am going to try machine adjustments (with Dr approval) first.

Has richb ever set 'FLEX' to 0 or other 'default' setting on his machine?

My machine is bi-pap with separate inhalation and exhalation settings. I have follow up appts with techs and Dr. The Dr does not think these CAs are too harmful other opinions are welcome. my average AHI is around 28 nearly all CAs.

[tedburnsIII]

[quote='richb' pid='118911' dateline='1434984428']
"At this point I am going to try machine adjustments (with Dr approval) first.

Has richb ever set 'FLEX' to 0 or other 'default' setting on his machine?

My machine is bi-pap with separate inhalation and exhalation settings. I have follow up appts with techs and Dr. The Dr does not think these CAs are too harmful other opinions are welcome. my average AHI is around 28 nearly all CAs.

I did not know that CA's were included in computation for AHI/RDI purposes.
Had the impression it's in a different category.

In any event, if you have an average of 28 central apneas an hour while on BPAP, especially, and this is credible, and they want it down to <5 less with BPAP, I don't know what to say....

http://www.daveburrows.com/cpap/sleepstu...pstudy.pdf



I don't know much at all but I am willing to learn, though it does not apply to my condition.

If richb indeed has CSAS- my vague recollection is to generally associate an ASV machine? Is that correct, or not?

[tedburnsIII]

What are the minimum and maximum exhalation pressures on your BPAP machine, richb?

And what do those figures represent?

Actual pressure needed to exhale or a REDUCTION in the inhaled pressure as similar to RESLEX on my machine where the exhalation pressure is at a selected setting 1, 2, or 3cm less than the incoming (inhaled) pressure (at least that is my understanding of the RESFLEX feature on my CPAP)? Or might it be something not mentioned?

[richb]

What are the minimum and maximum exhalation pressures on your BPAP machine, richb?

And what do those figures represent?

Actual pressure needed to exhale or a REDUCTION in the inhaled pressure as similar to RESLEX on my machine where the exhalation pressure is at a selected setting 1, 2, or 3cm less than the incoming (inhaled) pressure (at least that is my understanding of the RESFLEX feature on my CPAP)? Or might it be something not mentioned?

As vshline previously posted: In bi-level CPAP machines, the term EPR is not used. Pressure Support is the pressure difference (the amount of pressure boost) between EPAP and IPAP. EPAP + PS = IPAP

The AirCurve 10 VAuto is a fine machine, a very versatile machine. Can be set in fixed-pressure CPAP mode or S mode (bi-level synchronized to our Spontaneous breathing, meaning our natural self-initiated breathing), or VAuto mode. VAuto mode is like S mode except EPAP self-adjusts within a range, similar to the AutoSet.

My machine is set to auto with min at 8 and max at 18. It has a PS pressure support level of 4. It generally is graphing between a IPAP of 8 and an EPAP of 12. The PS of 4 generally equates to a relief setting of 4.

[tedburnsIII]

Is maximum pressure support that of '4' on your BPAP machine?

Don't understand the last paragraph of your post:

My machine is set to auto with min at 8 and max at 18. It has a PS pressure support level of 4. It generally is graphing between a IPAP of 8 and an EPAP of 12. The PS of 4 generally equates to a relief setting of 4.

[richb]

Is maximum pressure support that of '4' on your BPAP machine?

Don't understand the last paragraph of your post:

My machine is set to auto with min at 8 and max at 18. It has a PS pressure support level of 4. It generally is graphing between a IPAP of 8 and an EPAP of 12. The PS of 4 generally equates to a relief setting of 4.

A bipap machine is different from a cpap machine with exhalation pressure relief. In a bi-pap machine both inhalation and exhalation pressures are pre set. When using auto settings a range of pressures are set and a pressure differential is set. That is the PS. The PS level is similar to dialing in a flex or EPR setting. In my case that differential is now set at 4.

---

Is maximum pressure support that of '4' on your BPAP machine?

Don't understand the last paragraph of your post:

My machine is set to auto with min at 8 and max at 18. It has a PS pressure support level of 4. It generally is graphing between a IPAP of 8 and an EPAP of 12. The PS of 4 generally equates to a relief setting of 4.

This is a bipap machine.

[tedburnsIII]

Where would EPAP exceed IPAP? Is that frequent in BPAP?

Please forgive my naivete.

[richb]

[quote='tedburnsIII' pid='118988' dateline='1435013471']
Where would EPAP exceed IPAP? Is that frequent in BPAP?

Please forgive my naivete.

Ipap would be inspiration positive airway pressure. In standard CPAP the Inspiration Pressure is the same as during exhalation. Newer machines have a feature that allows Expiration pressure relief EPR. This allows Expiration pressure to be lower by an adjustable amount mostly for comfort. Bi-Pap machines have both inspiration and Exhalation pressure to be set. Expiration pressure is either the same or lower than Inspiration pressure. So, EPAP is never lower than IPAP. I hope that helps.

[richb]

Been doing more research on Central Apnea. One study http://www.journalsleep.org/Articles/290911.pdf suggests that Centrals are often masked during Sleep Studies. When a subject is put on CPAP or BIPAP the OA and HA events just about disappear and the Centrals show up. The paper suggested that this condition is Complex Sleep Apnea. The paper also suggested that treatment was difficult. I don't know if this condition applies to me as yet.

[tedburnsIII]

[quote='tedburnsIII' pid='118988' dateline='1435013471']
Where would EPAP exceed IPAP? Is that frequent in BPAP?

Please forgive my naivete.

Ipap would be inspiration positive airway pressure. In standard CPAP the Inspiration Pressure is the same as during exhalation. Newer machines have a feature that allows Expiration pressure relief EPR. This allows Expiration pressure to be lower by an adjustable amount mostly for comfort. Bi-Pap machines have both inspiration and Exhalation pressure to be set. Expiration pressure is either the same or lower than Inspiration pressure. So, EPAP is never lower than IPAP. I hope that helps.

I don't understand in bold, above, where "EPAP is never lower than IPAP" with BPAP machines.