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Sudden Unexplainable Change
#1
Greetings,


I have been using resMed Airsense 10 since February 16h.  The Airsense wirelessly uploads data and I have a MyAir app that shows results based on usage hours, mask seal, events per hour and taking mask on and off.  Almost every night I would have a score of 100, lowest 98 and the most important thing, the number of sleep events (AHI) was always under 5, usually about 1 event.

All of a sudden on Thursday March 9th I had 13.7 events per hour.  I figured it was a one off, but then on Friday I had 6.6 events per hour, Saturday 9.9 events and then last night 10.8 events per hour.  After going a month with 1-2 apneas I have had 4 consecutive nights of 6-14.

I am concerned and definitely feel the weight of the last four days on my energy, I feel out of it.  It shows over 60 obstructive apnea events last night.  I really need to get this under control as I am being forced to a 48 work schedule in a few weeks.

I am new to this forum (have been using CPAP since 2015), I am posting some screen shots of the daily data.  I can show you anything else that you may need to look at.  If you could please take a look at this and help me figure out what might be causing this I would greatly appreciate it.  I've enclosed a link to photobucket where I posted the screenshots to. 

http://s1106.photobucket.com/user/scottjdooley/library

Thanks

Scott



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#2
Hi Scott, welcome.  You have some pretty impressive OA that occurs in clusters, and appears to disrupt your sleep and cause a break in therapy.  There are two possible suspects here.  First, I think you may be sleeping better, and this is allowing your chin to sag towards your chest cutting off your airway.  This form of positional apnea is common, and can be resolved by using a special pillow or soft cervical collar to keep your head, neck and body better aligned.  It can happen on your back or side.  Support under the neck is key to alignment, and some people also need the nudge from a collar to keep their chin up.

Second possibility is when you added 1-cm of EPR, that actually reduced a critical pressure called EPAP (expiratory positive air pressure).  When you exhale, your machine drops from 8 to 7 cm.  It is the EPAP pressure that must support the airway, and without an auto machine, it may be you crossed a threshold that keeps your airway patent.  EPR does make CPAP more comfortable, so just raise your pressure by 1 to 9 cm, and your EPAP will again be 8 cm.

You are using an Elite model and might want to update your profile to show Elite instead of CPAP. The Resmed CPAP does not provide this efficacy data.  Also take a look at the links in my signature on how to organize and post data.  You can minimize the calendar (triangle in the date line), hide the right sidebar (F10) and the Pie Chart (file/preferences/appearance), and much more useful information will replace those fields.


[Image: Screen%20Shot%202017-03-12%20at%201.15.2...9ytz6e.png]
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#3
Hi scottdooley,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy and also with getting your pressure dialed in to better meet your needs.
trish6hundred
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#4
Thanks Sleepy rider your post was extremely helpful.  It's funny that you say that I may be sleeping better.  Lately the only change I've made is I have been doing a lot more exercise than I normally do, so maybe I have been sleeping better because of that.  When you mention the EPR setting, my previous machine was a RemStar SE System One and it had a flex feature.  I thought Flex and EPR were the same and I noticed that Flex was set for 1 by my sleep clinic so that's why I reset the AirSense Elite (thank you) to 1 (since I bought it online I had to set it myself).

This is what the RemStar manual says about Flex:

The Flex comfort feature allows you to adjust the level of air pressure relief that you feel when you exhale during therapy.
Once you press the SELECT button to choose this setting, the number will blink. Use the LEFT/RIGHT button to toggle between the available settings: 1, 2, or 3. The setting of “1” provides a small amount of pressure relief, with higher numbers providing additional relief. Press the SELECT button again to choose

the setting. If your provider has locked this setting you will see an “L” before the number and you will not be able to change it. 

So is flex the same as EPR may I ask?  

I actually recently had started sleeping with a cervical foam support but it often falls off.  I wasn't sure if I should be sleeping on my back or my side and had read that sleeping on back can make things worse for some people so last night I tried the tennis ball trick - while it seemed to keep me off my back sleeping on my side didn't resolve the issue so I think I'll try what you suggest.

Thanks,

Scott
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#5
(03-12-2017, 03:53 PM)scottdooley Wrote: So is flex the same as EPR may I ask?

They both reduce EPAP (the exhale pressure) by a tad. There are subtle differences but they're not relevant.

Since you were doing well before turning EPR on, I suggest you follow Sleeprider's advice and turn it off.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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
Flex and EPR are not nearly the same. 

EPR lowers the pressure during the entire exhale cycle by 1 to 3 cm of pressure.  EPR ends upon spontaneous inhale.  If you have an apnea, the pressure stays low.

Flex provides pressure relief up to 2 cm at the beginning of exhale, an it returns to CPAP pressure before exhalation ends.

This figure shows the mask pressure (blue) compared to the respiratory flow rate (black) with EPR at 3 cm. An apnea in this image shows the pressure does not rise until the apnea is over.  Resmed EPR can result in pressures lower than the titrated pressure that prevents OA.

[Image: wxNRuZuh.png]


Flex relief is at the beginning of exhale, but returns to CPAP pressure before exhale ends.  Flex has the advantage that the prescribed pressure is not affected, but it does not have the same comfort effect.  

[Image: c-flex-technology.jpg]
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#7
I found that a buckwheat chaff pillow helped me to reduce chin tucks while sleeping on my side. Your graphs look like mine before I got the pillow. The pillow is conformable so you can create an indentation where you want it for your head and a ridge to support your neck while lying on your side. It works for me to prevent chin tucks. you can get one from amazon for $49. Just search CPAP pillow. It may seem like it would be uncomfortable but it's actually the most comfortable pillow I've ever had.

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#8
(03-12-2017, 04:58 PM)Sleeprider Wrote: EPR ends upon spontaneous inhale.  If you have an apnea, the pressure stays low.

Does the EPAP pressure on a ResMed S9 VPAP (or now the A10 AirCurve) have the same behavior?
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#9
(03-12-2017, 06:10 PM)Sleepster Wrote:
(03-12-2017, 04:58 PM)Sleeprider Wrote: EPR ends upon spontaneous inhale.  If you have an apnea, the pressure stays low.

Does the EPAP pressure on a ResMed S9 VPAP (or now the A10 AirCurve) have the same behavior?

We have an Airsense 10 Autoset and Aircurve 10 Vauto in our household, so I can say that the APAP at 3 EPR and the Vauto at PS 3 cm have identical waveforms for pressure. In the image for the Resmed above, you can see EPAP and IPAP pressure increasing at the OA onset. The Autoset and VAuto algorithm work exactly the same in this regard as well.
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#10
(03-12-2017, 06:50 PM)Sleeprider Wrote: We have an Airsense 10 Autoset and Aircurve 10 Vauto in our household, so I can say that the APAP at 3 EPR and the Vauto at PS 3 cm have identical waveforms for pressure.  

Previously I had a PRS1 BiPAP Pro. With Bi-Flex on and set to its maximum value of 3, I could feel three distinct pressure levels. The highest was of course the IPAP when I was inhaling. The lowest was when I was exhaling. But if I paused at the end of the exhale I could feel an intermediate pressure level that was a bit higher than the exhale pressure. As soon as I started to inhale I could feel the pressure level rise to the IPAP value. I could also verify these feelings of pressure by feeling the air flow coming out of the exhalation ports on my mask. I felt three distinct levels of air speed.

My guess is that what I felt was the pressure drop from IPAP to below EPAP at the onset of the exhale. Then as the exhale stopped the pressure rose to EPAP. Then when I inhaled it rose again to IPAP.

The ResMed S9 VPAP and the AirCurve10 VAuto that I've used since then don't do this.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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