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[Treatment] Zzyzx - Looking for Tips
#11
RE: Started APAP on 5/14, Looking for Tips
Overall things are looking pretty good, I would try min pressure up one more notch to 9 cm otherwise I think just give it a while and focus more on if you feel you are getting good sleep.
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#12
RE: Started APAP on 5/14, Looking for Tips
Here it is at 9. I'll give it a while and report back how I'm doing. Thanks!


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#13
Question 
AHI Sneaking Back Up?
Greetings,
I posted back early June for advice on pressures when I got started. (thread here) At that time, the advice was to go to 9-15 with an EPR of 3. For a few weeks, my AHI was around 1. Now, this last week, though, it's gone up between 4 and 7 the last few days. Anyone have advice on this?

I will attach some screenshots from OSCAR.

Best,
Zzyzx


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#14
RE: Zzyzx - Looking for Tips
Zzyzx - To maintain continuity in your treatment history, we prefer to keep all posts on the subject in one thread. I have merged your two into one and renamed the thread, "Zzyzx - Looking for Tips".
Crimson Nape
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#15
RE: Zzyzx - Looking for Tips
Thanks Red.
Central Apnea is consistently inconsistent. You have a cluster of OA indicating positional apnea immediately followed by a cluster of CA. The OA would cause you to breathe deeper in recovery which would cause a series/cluster of CA because of your reduced CO2 from flushing during the recovery breathing.

Important fact is that during your diagnostic sleep study you has as much complex apnea, as OA. You can consider complex as centrals. These are likely ideopathic or unknown cause.

When you see a series of days/ weeks of central Apnea try lowering EPR. That will help the CO2 induced Central Apnea but do little for the ideopathic or complex apnea.

Your treatment will be a balancing act between obstructive and Central Apnea. If the CA gets worse an ASV maybe in your future.
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#16
RE: Zzyzx - Looking for Tips
(08-07-2021, 08:20 AM)Crimson Nape Wrote: Zzyzx - To maintain continuity in your treatment history, we prefer to keep all posts on the subject in one thread.  I have merged your two into one and renamed the thread, "Zzyzx - Looking for Tips".
Alright, sorry about that. Thanks.

(08-07-2021, 08:51 AM)Gideon Wrote: When you see a series of days/ weeks of central Apnea try lowering EPR.  That will help the CO2 induced Central Apnea but do little for the ideopathic or complex apnea.  
I'll try adjusting it down. Thanks! Also, one question, is EPR just a comfort thing? I'm not sure I really noticed much as far as a difference in comfort with it off, so I might just try turning it off completely if that's the case.
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#17
RE: Zzyzx - Looking for Tips
EPR is so much more than just a comfort thing. It is in reality a very, very effective therapeutic tool used as a BiLevel for treating hypopneas, flow limits, UARS, RERAs.

It is marketed as a comfort feature.
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#18
RE: Zzyzx - Looking for Tips
Your original data showed worse apnea on back and this data shows some signs of positional apnea which is more common with back sleeping. Is it possible you are sleeping on your back more now?

When looking at the overview tab one thing that stuck out to me was that your usage and timing have improved/stabilized. This leads me to believe you are sleeping better then before even if your AHI is similar or sometimes even a bit worse.

Although you are having some central apnea it seems like they often occur post arousal and may not the driving issue. I am not opposed to trying EPR of 2 though because it might help a bit with the centrals and it will also increase EPAP 1 cm which will help with obstructive apneas. I would also pay attention to positional aspects and make sure using thin pillow etc so not distorting airway. Not sure if a cervical collar is warranted but it is something you could consider down the road if you keep seeing clusters of obstructive apnea.
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#19
RE: Zzyzx - Looking for Tips
On the other hand...cervical collars are pretty darn cheap and easy to find (cvs, amazon). Most seem to find them comfortable enough, and not a drag to use. It might be worthwhile to try one just as an experiment. People have been talking about possible chin tucking all through this thread.
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#20
RE: Zzyzx - Looking for Tips
I might look in to that cervical collar. Since my last post, I've been to both an ENT and an allergist. I've been having some pretty severe allergies and have begun allergy shots. I also have a deviated septum and swollen turbinates which is worsening the allergies. I have a septoplasty and turbinate reduction scheduled for 10/18, so hopefully that will also show me some improvement. In the meantime, my allergies have been worse and my AHI has been hovering around 7-10 on bad nights but then going back to 1-4 on good nights. Is there anything you think I should adjust in the interim, or just wait for the surgery to see if things improve?

I have attached a more recent screenshot from OSCAR if it helps.

Thanks again,
Zzyzx


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