Seven weeks in, could use some support

[ScoobyDoo]

Here's one of my better charts, before Rx was increased to 5 cmH20 minimum. Reviewing my history, now I see that that AHI over 5 with 4 minimum cmH20 was somewhat rare. Since min pressure changed to 5 cm, AHI is over 5 about 50% of nights. So lower pressure does seem to be better. 

When I mentioned to doctor in my post-titration consultation that many believe EPR can exacerbate CA, he was again dismissive and said they are unrelated. I'm starting to think he's in the uninformed/old school camp

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I would agree with reducing EPR.  Preferably to 0 if you can work down to it.  For some individuals EPR can really exaggerate their CA events.  It seems that you are already at a low pressure and I wouldn't advice increasing your min pressure due to the high volume of CA events you are experiencing.  I would also agree with the opinion that you will very likely need an ASV machine based on what is on your charts so far.  Do you have any charts with a below 5 AHI result you can post here?

I would be very interested to see what Sleeprider's opinion is on these charts...

[Marillion]

It would not be the first (or tenth?) time I have heard of a doctor like that. We have seen quite a few examples where increased EPR leads to increased CA events. I myself am prone to that result...so I can state through personal experience that they can be connected.

Let's see what happens when you manage to reduce your EPR. I would reduce it by 1, leave for a few days and then reduce again and repeat until you get to zero EPR being used. Allow at least 3 days between changes.

Though with the excellent result you just posted, your EPR was at 3...so it is by no means a certainty that reducing EPR will consistently reduce your CA events. But lets wait and see.

[ScoobyDoo]

@tedvpap, I'd like to understand what leads you to believe my CA flags may be OSA that are mislabeled, can you explain please? My Sleepyhead OSA flags are rare, the vast majority of 50 nights show zero OSA, so I'm curious how/why the increased pressure to 6 suddenly cleaned up my OSA...

Rule 1 is to address the OSA.  Your data shows that OSA may not be addressed.  
Your zoom shows signs of OSA even when labeled as CA and CSR.  
Have you ever tried a higher pressure?  5 is lower than most people feel comfortable with.
Set the min to 7 and show the data.

Thanks for showing the data.  The slight increase in pressure cleaned up your OSA but certainly increased the CA.
Now you should work your way to a lower EPR and hope that eliminates the CA.

[tedvpap]

Here's one of my better charts, before Rx was increased to 5 cmH20 minimum. Reviewing my history, now I see that that AHI over 5 with 4 minimum cmH20 was somewhat rare. Since min pressure changed to 5 cm, AHI is over 5 about 50% of nights. So lower pressure does seem to be better. 

When I mentioned to doctor in my post-titration consultation that many believe EPR can exacerbate CA, he was again dismissive and said they are unrelated. I'm starting to think he's in the uninformed/old school camp

I would agree with reducing EPR.  Preferably to 0 if you can work down to it.  For some individuals EPR can really exaggerate their CA events.  It seems that you are already at a low pressure and I wouldn't advice increasing your min pressure due to the high volume of CA events you are experiencing.  I would also agree with the opinion that you will very likely need an ASV machine based on what is on your charts so far.  Do you have any charts with a below 5 AHI result you can post here?

I would be very interested to see what Sleeprider's opinion is on these charts...

That is great.  Surprised to see severe apnea easily addressed with such a low pressure.
Even though your EPR is set to three, since your pressure is so low your EPAP does not go below 4 so essentially your pressure difference is less than 3.  So if you ever do need to use a higher pressure, decreasing the EPR should avoid your CA issue.

[pholynyk]

I agree with the above comments; keep on lowering the EPR, but don't raise your minimum pressure. Reducing the EPR is increasing your Expiry pressure already. You will see it in your charts.

[tedvpap]

@tedvpap, I'd like to understand what leads you to believe my CA flags may be OSA that are mislabeled, can you explain please? My Sleepyhead OSA flags are rare, the vast majority of 50 nights show zero OSA, so I'm curious how/why the increased pressure to 6 suddenly cleaned up my OSA...

Rule 1 is to address the OSA.  Your data shows that OSA may not be addressed.  
Your zoom shows signs of OSA even when labeled as CA and CSR.  
Have you ever tried a higher pressure?  5 is lower than most people feel comfortable with.
Set the min to 7 and show the data.

Thanks for showing the data.  The slight increase in pressure cleaned up your OSA but certainly increased the CA.
Now you should work your way to a lower EPR and hope that eliminates the CA.

Your original post showed some OSA along with CA.  CA events should be ignored when not fully asleep but the machine does not know so it scores everything.  Since you were not diagnosed as having a CA problem, then the CA events are either caused by treatment, or they are false.  You said that you are a very light sleeper so you are prone to awakenings and therefore false CA events.  
That is why I like to solve the OSA issue first to see if there is still a CA issue or not.
The additional data shows that your CA events are caused by treatment and decreasing EPR appears to address them.  That is great news.

[tedvpap]

@tedvpap, I'd like to understand what leads you to believe my CA flags may be OSA that are mislabeled, can you explain please? My Sleepyhead OSA flags are rare, the vast majority of 50 nights show zero OSA, so I'm curious how/why the increased pressure to 6 suddenly cleaned up my OSA...

Rule 1 is to address the OSA.  Your data shows that OSA may not be addressed.  
Your zoom shows signs of OSA even when labeled as CA and CSR.  
Have you ever tried a higher pressure?  5 is lower than most people feel comfortable with.
Set the min to 7 and show the data.

Thanks for showing the data.  The slight increase in pressure cleaned up your OSA but certainly increased the CA.
Now you should work your way to a lower EPR and hope that eliminates the CA.

Your original post showed some OSA along with CA.  CA events should be ignored when not fully asleep but the machine does not know so it scores everything.  Since you were not diagnosed as having a CA problem, then the CA events are either caused by treatment, or they are false.  You said that you are a very light sleeper so you are prone to awakenings and therefore false CA events.  
That is why I like to solve the OSA issue first to see if there is still a CA issue or not.
The additional data shows that your CA events are caused by treatment and decreasing EPR appears to address them.  That is great news.

Does this answer your question or did I misinterpret?

[ScoobyDoo]

Thanks for following up. Yes, that makes sense. 

I set the min pressure back down to 5 and have been slowly reducing EPR. I also went back to dreamwear nasal instead of P10 for a better baseline measure with history. AHI is improving a bit and apparently less periodic episodes. I'll post an update in a few days. 

Does this answer your question or did I misinterpret?

[ScoobyDoo]

Hello again to All,

So I've gradually lowered the EPR to off and it's been there for 4 nights. AHI and CA are improved but seemingly far from optimum, and somewhat wildly inconsistent from night to night under the same conditions. Also still lots of periodic-ish patterns, even within the best/most stable segments (as shown in zoomed shot). 

Any further suggestions or advice? All inputs much appreciated. 

At the post-titration consult with my doctor he essentially said there's nothing else he can do for another 6 weeks, which is my insurance requirement before they can take me to another level (e.g., ASV).

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[ScoobyDoo]

I'm reviewing my full history (11 weeks now) and noticing that nearly all my best nights were all with pressure less than 6 cmH20, and usually worse with higher pressures! Now I'm wondering if reducing the max and/or range would help?

Unfortunately Sleepyhead is showing large gaps in the pressure history... bug?

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