Mild Clear Airway - Advice

[staceyburke]

EPR can cause treatment emergent central apnea in some people and it looks like what has happened. They get much less as your body adjusts to the therapy. Your centrals are way to much so try reducing EPR to 1 and see how you do.

[CharlieNow]

Response to SarcasticDave94 post 11-22-93 - I had a WatchPat evaluation results available in my first post  - basically AHI 8, no breakout of the apnea types.
 
Attached are last few days of use with same settings (press min 7 / max 9, EPR 1)  -  some improvement and an one odd ball day.
Any other suggestions on setting refinements?
             

[SarcasticDave94]

There does appear to somewhat have the consistent inconsistent CA trait, along with some event clusters. Leak rates are somewhat a concern as well.

Something to try? You could go EPR off and a static pressure, maybe set both min and max to the same number between 7 and 9 (your current). Give it one night, or part of one. See what the stats are.

You may want to discuss with the doc on getting the lab diagnostic so they can monitor for CA and the rest.

[CharlieNow]

Last night I tried 3 different pressure settings during 5 sessions. Two sessions were very short duration so I didn't include them - likely junk data. The remaining 3 are charted below. These may also provide questionable data because durations weren’t lengthy and sessions not comfortable. BTW I wear a chin strap and neck rest.  Even though the chart Statistics Section shows the last session setting, the actual settings for each session are as follows: 
Chart 1 = press min/max 6/8, EPR 1
Chart 2 = press min/max 8/8, EPR OFF
Chart 3 = press min/max 7/7, EPR OFF

Comments appreciated. 


           

[PeaceLoveAndPizza]

I do not think there is sufficient information in your last charts to make solid recommendations, so take these comments as suggestions.

Now that you are using devices to manage chin-tucking and mouth opening things look much better. 

I reckon that fixed pressure is not something for you to use as you need some EPR to manage flow limitations. EPR 1 is good, but EPR 2 should be better. Stacey and Dave touched on this as well.

I suggest trying a range of 7-12 EPR 2 which should give you a bit more headroom on the top end, a bit more EPR to manage flow limits, and enough range to give the machine a chance to respond to events. Something to ponder...

[BoxcarPete]

I agree, there isn't much to go on here, but I will recommend a similar setting as above. The machine is topping out at the pressure and unable to manage your flow limits accordingly. Keep in mind that flow limits are not a specific thing, it is like the machine is assigning a grade to the flow shape of four breaths compared against the prior four. There are several different types of issues that can cause your breaths to get a bad grade, so zoom in on your OSCAR chart and check out our very own wiki page for more information. EPR is technically included as a comfort feature on the ResMed APAP machines, but it works the same way as their bi-level machine up to a maximum of 3cm H2O. It is a powerful tool, but only you can determine if it helps you feel better or not. In my case, every time I saw flow limitations it was inspiration only, with normal expiratory characteristics, so I elected to leave EPR off and I'm making good progress towards resolving it without using that tool. The two things EPR will do is help some people tolerate higher inspiration pressures, and help ventilate more air on the exhale. If that sounds like you, crank it up, and increase your min and max pressures by at least the same amount, so keep your true minimum pressure (EPAP at min) where it needs to be.

[CharlieNow]

Latest chart Pressure 7-12 EPR 2. It appears that higher pressures tend to make nasal pillow leak more, and Flow Limits pick up too. Where to go from here - stay at these settings for a few more nights and see what changes?