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Sudden Unexplainable Change
#41
Seeing that most of your OA events occur in clusters suggests they may be due to positional issues such as chin tucking or rolling on your back which tend to narrow your airway resulting in more resistance to flow. It would be helpful to move your flow limit. graph into the view. You can do so by using the mouse to compress the height of the other graphs slightly just as you would move the gridlines in an Excel worksheet. I suspect we will see spikes in your flow limitations that correspond to the cluster of OAS.

Edit: I saw after posting this that the positional issue has already been mentioned. Sleeprider suggested some fixes.

It appears to me that you may benefit from a pressure increase, especially since CAs do not appear to be a problem. But I suggest you follow Sleeprider's advice with respect to pressure changes.

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#42
No diaagreement with Melman. I would start increasing pressure in 0.5 cm increments to reduce OA. If you have not implemented positional therapy, you might want to consider it. Your current pressures are not high, so onward and upward.
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#43
Thanks Melman and Sleeprider.

Is it any different on a Mac to compress the height of the graphs as I was having a hard time doing that.  

I'm not sure what positional therapy is, when I googled it I found ZZoma a device that's often used as a cpap alternative that supposed to make it comfortable to sleep on your side or using a tennis ball to keep from sleeping on your back?  I did end up purchasing the cpap fit buckwheat pillow and I love it.  I always seemed to move around a lot during sleep starting when I was a child and as an adult my bed is always a mess with blankets and pillows so maybe there is an underlying problem.  I tend to sleep with a few pillows for my side and one I like to hug so I don't know what more can be done for positional therapy other than some type of device like ZZoma or a tennis ball.

What pressure would be considered high and is there a certain pressure level that you would not increase it to without seeing a doctor?  

Thanks!

Scott
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#44
Hi all,
I have just read through this long thread which I don't do very often for the long ones but this one has a lot of great information.
I was hoping to swing back to the discussion on EPR and hopefully get some clarification.
From what I have read here it seems that there are some situations where EPR is not required and possibly detrimental to the therapy, ie. in a case where an OA begins and the pressure is actually 3 or more cm below where it needs to be.
I would like to ask the experts if they use EPR with auto settings or should the EPR be turned off if auto is being used.

Thanks
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#45
(04-07-2017, 08:22 AM)doickle Wrote: Hi all,
I have just read through this long thread which I don't do very often for the long ones but this one has a lot of great information.
I was hoping to swing back to the discussion on EPR and hopefully get some clarification.
From what I have read here it seems that there are some situations where EPR is not required and possibly detrimental to the therapy, ie. in a case where an OA begins and the pressure is actually 3 or more cm below where it needs to be.
I would like to ask the experts if they use EPR with auto settings or should the EPR be turned off if auto is being used.

Thanks

EPR is best to think of in terms of bilevel therapy.  In bilevel (BiPAP/VPAP), OA is managed by keeping EPAP high enough to prevent OA.  Pressure support, (EPAP+PS=IPAP), is used to manage flow limitation, hypopnea and RERA.  So if you use a CPAP with EPR, your EPAP is your CPAP pressure-EPR. 

You are using auto CPAP at 7-15. If you are using EPR at 3, then the way we would express your pressure is 7/4-15/12.  In other words, is 4 cm enough to control obstructive apnea?  I would bet not.  So you have the choice of reducing EPR (effectively raising EPAP), or increasing minimum pressure.

At low pressures EPR is probably detrimental to most people's therapy for OSA.  As pressures rise, it becomes more comfortable.  Consider my bilevel pressure of 18/9 over PS 3.  My starting pressure is 12/9, and can go to 18/15 in auto mode.  That's a big difference from your starting pressure of 7/4.  EPR matters when you are treating OSA, and your EPAP pressure should not be so low that it allows your airway to collapse letting OA occur.  Again, either reduce EPR, or increase minimum pressure so it matches your prescription.
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#46
(04-06-2017, 09:57 PM)scottdooley Wrote: Thanks Melman and Sleeprider.

Is it any different on a Mac to compress the height of the graphs as I was having a hard time doing that.  

I'm not sure what positional therapy is, when I googled it I found ZZoma a device that's often used as a cpap alternative that supposed to make it comfortable to sleep on your side or using a tennis ball to keep from sleeping on your back?  I did end up purchasing the cpap fit buckwheat pillow and I love it.  I always seemed to move around a lot during sleep starting when I was a child and as an adult my bed is always a mess with blankets and pillows so maybe there is an underlying problem.  I tend to sleep with a few pillows for my side and one I like to hug so I don't know what more can be done for positional therapy other than some type of device like ZZoma or a tennis ball.

What pressure would be considered high and is there a certain pressure level that you would not increase it to without seeing a doctor?  

Thanks!

Scott

Positional therapy is shorthand for maintaining the alignment of your airway, and potentially avoiding supine sleeping.  I prefer that most people sleep in the position where they are most comfortable, and for many of us that means on our backs, sides or whatever feels good.  I don't advocate tying tennis balls to your pajamas, which I don't wear anyway.  So to me, and Melman, positional therapy means using a special pillow or soft cervical collar to prevent the chin from tucking towards the chest.   A slight pressure on the jaw from a pillow, neck roll or soft collar can keep the airway open, improve nasal breathing, and avoid leaks in a lot of people.  Melman is the expert in this as he used it to reduce apnea from over 20 to less than 1.
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#47
Thanks.  Ive been having good results with pressure at 9.4.  Ive gotten an AHI from .5 to 1.5 to 2 max except for one off day of a 7 (I dont know if its related but I think I forgot to use my inhaler as I have asthma.)


My question is should I keep increasing the pressure until I get zero AHI.  What is considered high pressure is 10 or 11 okay?

Thanks
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#48
There are diminishing returns to increasing pressure. The purpose of CPAP is twofold; to reduce AHI to a therapeutic level that minimizes or eliminate health effects and sleep disturbance, and to improve quality of sleep. Increasing pressure to chase fewer and fewer events can cause higher leaks and more sleep disruption. Try not to do something you would not do without the data, but use the data to make an informed choice. Make sense?
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