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[Pressure] help with settings, nightly wallomping
#1
help with settings, nightly wallomping
Would like some input/ thoughts around my numbers...

My local hospital really don't want to be involved as long as I clock in under AHI 5, legal limit. (From 15.9 @ sleep test).
AHI has been steady @ plus minus 3 the last year and last months started to go over 4, a few times also over 5.

I'm known as quite the wallopper, males in our family have a way of jumping from one position to another. I often wake a little bit when i do this and,, also holding my breath when i jump. 

I have tried quite a few different settings and current settings seems to be the most comfortable, maybe I should stop complaining. Nah, 3-5 is not really a good nights sleep.

all thoughts appreciated.
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#2
RE: help with settings, nightly wallomping
Welcome to the forum.

As you stated your number are fairly good.  At this stage you should be chasing and eliminating symptoms, not chasing numbers.

Your charts are lacking.  Obstructive Apneas, Hypopneas, Flow Limits, and Snoring all contribute to the Autoset's reaction.  You have not provided the snoring chart (yes I know you had none in this chart) and more importantly the Flow Limit chart.  See Sleepyhead Organization in my signature.

EPAP, your exhale pressure is what we raise to manage obstructive apnea. on CPAP the EPAP is the pressure (Inhale pressure/IPAP) - EPR
Pressure Support or manipulation of EPR is what we can use to manage Hypopneas and Flow Limits.  Without PS/EPR we can only raise pressure.

CPAP machines are not designed to manage Central/Mixed/Complex apneas, so we simply try to avoid them and balance that with managing obstructive apneas.

You do not appear to be using EPR, so let's try EPR 2 (full time) and raise your min Pressure by 2   from 5.4 to 7.4.  (your min will actually still be 5.4)  I see hints of flow limitation in your flow rate chart, not too much.  (your Flow Limit chart was not provided.)

Your obstructive apnea id clustered into 2 groups.  This tends to say you have positional apnea in these areas.  This is typically caused by the tucking of the chin and is solved by the use of a loose fitting soft cervical collar.  You do not have enough that you have to take care of it but you asked about possible changes.

Fred
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#3
RE: help with settings, nightly wallomping
I think you can narrow your pressure range between 6.0 and 12.0. I would actually recommend 7.0 as a minimum pressure since that is just under your current median anyway. You are averaging about 1 CA event per hour and I'd like to see if you can tolerate your EPR (exhale pressure support) set to 1 full time. This might help reduce the hypopnea and flow limitation, and should be more comfortable. If you add EPR at 1, then with a minimum pressure of 7.0, your inhale/exhale pressure will be 7.0/6.0. As long as it doesn't significantly increase CA it is worth a try to see how you like it and it might improve results.

The occasional OA event looks a bit positional to me, so I agree with Bonjour that might be improved by a soft cervical collar, but the problem is not very severe.
Sleeprider
Apnea Board Moderator
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#4
RE: help with settings, nightly wallomping
Okay, thanks.
I'll give it a week at 7,2 with EPR 1, maybe 2 in the weekend.
Tucking of chin sounds familiar, there is an issue with the thyroid gland, quite tender so reluctant to try cervical collar.
Will try to come back next week, then with better charts.
Best regards, Alf
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#5
RE: help with settings, nightly wallomping
(01-15-2019, 01:48 PM)scaniadriver Wrote: Okay, thanks.
I'll give it a week at 7,2 with EPR 1, maybe 2 in the weekend.
Tucking of chin sounds familiar, there is an issue with the thyroid gland, quite tender so reluctant to try cervical collar.
Will try to come back next week, then with better charts.
Best regards, Alf

The collar should not contact the area near the thyroid. The idea is to support the jaw and chin, not to contact the central neck or soft tissues in front of it.  Anything that impinges on the throat is not the fit we are talking about.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#6
RE: help with settings, nightly wallomping
one week @7,2 with EPR=2
Cannot claim to notice much of a difference from 5,4 and EPR=0

Guess my next step will be to get my hands on a soft cervical collar.
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