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[Treatment] Seeking treatment guidance
#21
RE: Seeking treatment guidance
Ratchick, thanks for the suggestion on wearing the mask during the day.  I had done that a while ago to get used to the mask initially but I think I will start doing that again with the higher pressure.

I've attached last night's chart.  It's going to take a little more time to get my min pressure to 7.  It looks like each time I woke up was after some flow limits.  I also had some leak issues last night which I haven't had before.  Looks like flow limits resulted in pressure going up which caused the leaks at higher pressure.  I have a nose cradle type mask and it was leaking out the top/side.  I just tested tightening the mask a little more with higher pressure and it seems like that will hopefully be the fix.  I know not to overtighten but I think I had the mask a little loose which was ok at lower pressure but now is a problem.

I did also have 11 centrals and 1 hypopnea in the span of an hour from 9-10am.  Overall AHI for the night is 2.5 but for that one hour it's 12.  This seems to be a bit of a pattern in that early in the night I have less centrals and then have most of them during the last part of my sleep.  Just curious if this is a typical type of pattern and why that would be?  Also wanted to just double-check that this number of centrals in that hour was not a concern.  Sorry if I am being overly anxious about the centrals, still just learning what is typical and what everything means.  Thanks.


Whole night:
   

9-10 am:
   
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#22
RE: Seeking treatment guidance
OK now that last section may have sleep wake junk with the CA.

Keep things in perspective, the overall night data had the CAHI at 2.26. This is really not that much.

The pressure chart has a start pattern during every segment of Ramp being active. If I'm correct, turn it off and see if CA change. Ramp likely is introducing pressure swings and might increase CA.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#23
RE: Seeking treatment guidance
I would try changing your setting to CPAP mode with fixed pressure of 7 cm, 3 EPR. I have a feeling you are sensitive to the pressure changes so lets try and get used to 7 cm 3 EPR first and then can reimplement APAP later if it seems worthwhile.

Post a zoomed in example showing time section 9:20 to 9:23, bring mask pressure up below flow rate before doing so. Those flow rates don't appear to be typical central apnea and might be able to tell a bit more from close up view.

No need to worry about central apnea unless you start having AHI of 5+. The odd bad night with higher AHI isn't going to have any serious effects so no need to really worry about any of your results. They are what they are and they will improve as we get the settings fine tuned and you continue to adapt to CPAP. The biggest problem right now is your broken sleep and being calm and relaxed is going to help that as much as cpap settings will.
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#24
RE: Seeking treatment guidance
Ok, so here are two zoomed in views.  One from roughly 9:17 - 9:23, the other from 9:20 - 9:23.

I will make the suggested changes and go to CPAP only with EPR 3.  Ramp is active at a lower pressure right now but I've been inching that up every day so that eventually it will be the same as the min pressure and I can get rid of it.  I just don't want to make too many changes at once.

And thanks for the reassurance on the centrals.  I agree my biggest problem is my broken sleep and staying calm is just as critical as the settings.  Compared to where I was 6 months ago, after working on my general stress level and going through the CBT for insomnia program, I am dramatically better than before actually in terms of being relaxed going to bed and even though I'm still waking up a bunch of times, it was worse before and now I can just calmly meditate in bed and I'll fall back asleep again.  Hopefully once I adapt to the pressure a little more and we get the settings where they should be, the sleep fragmetation will improve.

Thanks!

9:17 - 9:23
   

9:20 - 9:23
   
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#25
RE: Seeking treatment guidance
Those centrals look somewhat real, I am guessing they are a type of sleep transition central as they appear to happen when falling back to sleep post arousal (the odd shaped high amplitude breathing before them). If so they may improve as you continue to adapt to CPAP and start having fewer arousals.

3 weeks is still early, we just need to find some promising settings and then let your body continue to adjust.
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#26
RE: Seeking treatment guidance
The charts for the last 2 nights are posted.  First night was 6.4 min, with max of 7.  I didn't go to 7 min directly this night as I was going up gradually.  It's a pretty narrow range though.  Last night was min and max both at 7.  I got a few centrals both nights.  I actually felt worse in the morning the last 2 days.  Last night, was probably due to just not getting enough total sleep though.  Should I keep the setting of CPAP 7 or does it make sense to either reduce the pressure or EPR to see if the centrals go away.

Geer1, your explanation of how things work in this thread was helpful: RE: Brain fog, lack of energy -- why did dropping my EPR make such a difference?

Step 1 was to find a good EPAP pressure to reduce the majority of obstructive events.  The good thing for me is it seems like I don't get a lot of obstructive events even at low pressure.  So that means balancing between centrals and flow limits I think.  Also, how do RERAs fit into this?

Anyway, let me know how you think I should proceed.

Thanks.

   

   
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#27
RE: Seeking treatment guidance
RERA's are arousals caused by breathing issues that don't meet criteria of hypopnea or apnea. These machines do a poor job of flagging RERAs but you do have the odd ones flagged and the one at 5:15 seems like an extremely obvious one. There were other potential arousals at 6:45 and 7:45 to give a couple unflagged examples.

In your case I think restriction is a bigger problem then centrals so EPR likely helping other than perhaps you needing to adapt to it. For example on the 20th your centrals only occurred in a brief period but you had a couple periods of obvious flow limitations and other periods of probable flow limitations (for example 7:15 to 7:45 where your flow rate amplitude declined significantly eventually ending in arousal, with the leak present it appears like you may have started to mouth breath/leak).

Part of me wonders if you need higher pressure as these restrictions could be being caused by partial collapse of airway. For now I would say stick with things for a while then depending on average results during this time can decide whether to try higher EPAP or dropping EPR a notch. 1-2 nights is not enough data to draw a conclusion, CPAP especially in UARS cases is usually a slow process.
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#28
RE: Seeking treatment guidance
Ok, thanks.  I will stick to the current settings for a bit and then report back.

Thanks!
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