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Thank you Bonjour, I will do as you said. When I had a pressure up to 14 my results were awful too. But I understand that there are more than a variant to adjust. So now, 6-11. REP 1.
(02-26-2019, 11:41 AM)bonjour Wrote: You did good. Observations.
reducing EPR from 3 to 1 substantially reduced your Central Apneas but did not eliminate them, and increased your flow limitations.
You still have an unacceptable Obstructive AHI and we need to reduce that. That we treat by raising your EPAP pressure.
I want to manage your obstructive apneas to an acceptable level (< 5 Obstructive) AHI and see what happens to your central apneas.
Increase your Max Pressure from 10 to 11 then post the results. We will likely repeat this, perhaps several times. Then we will readdress your central apneas.
Note that the first qualification for getting an ASV CPAP machine is to reduce your Obstructive AHI to below 5. Don't be surprised if we have you turn off EPR at some point.
Hi,
here is my last night. I woke up with my mouth open and a sore nose. I suffer from rhinitis and sometimes even with my treatments it gets worse. Last night was one of them. Other than that everything went rather well. Just take note that Sleppy head shows an off ramp but it is on. At PR 4.4. It is auto so supposed to climb up to 6 when I fall asleep.
Sabee
(02-27-2019, 09:55 AM)bonjour Wrote: Looking good with some progress but raise Max pressure to 12 tonight, still working on eliminating the obstructive
Hi,
here is my last night charts. I had to stop because of too much pain in my nose. I have dry rhinitis and it can be rather painful. I took a look at my charts and I find there are more CA than OA but don't understand much of that.
Do you feel the pressure was too much? Was that what was causing your pain?
What I see is that your Obstructive Apnea has finally dropped into an acceptable range, and with that, your Central Apnea climbed to an unacceptable value.
I have to deal with your ability to use the machine all night. but I would like to see a full night or two of this setting.
What this is showing is that these settings successfully treat your Obstructive Apnea, but not your central. But we need to determine if this is a one night excursion (especially since you had trouble with your dry rhinitis. BTW you may want to try increasing your humidification to help with that.
After that, I want to try an EPR of 0 (turn it off) followed by on the next night with dropping your max pressure by 1.
Then a choice on your part if it goes the way I think it will. Do we go for the most comfortable settings on your current machine, which will be a compromise between the Obstructive and central apneas with having the higher AHI that you were experiencing, or do we try for an advanced ASV machine which will treat both and has provided many users with AHI of near 1.
What we have done is titrate out the obstructive apnea (to less than 5) demonstrating that your current machine does not treat the central apnea that is present. This says that your current machine is failing to properly treat YOUR apnea and you need a different approach.
Central Apnea is where your brain is not signaling for you to breathe. That is you make no effort to breathe.
SleepRider will slip in here soon with his opinion.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter
Fred is correct. The pressure here is not extraordinary and even with only EPR at 1 the CA events are predominating. Pressures less than 8.0 leave you with a lot of snores, so I think if you can tolerate that as a minimum pressure, that will help. You can see at 00:45 to 00:55 snores and flow limitation is present and you quickly reach higher pressures. I think we need to see if the current pressure will continue to prevent the OA you showed previously, but this is encouraging. CA is randomly present and I suspect is more a function of sleep disruption than actual central apnea. If you check the events tab you can see the duration of those events. I suspect most are very close to the 10-second threshold.
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.
(03-01-2019, 10:09 AM)bonjour Wrote: Do you feel the pressure was too much? Was that what was causing your pain?
What I see is that your Obstructive Apnea has finally dropped into an acceptable range, and with that, your Central Apnea climbed to an unacceptable value.
I have to deal with your ability to use the machine all night. but I would like to see a full night or two of this setting.
What this is showing is that these settings successfully treat your Obstructive Apnea, but not your central. But we need to determine if this is a one night excursion (especially since you had trouble with your dry rhinitis. BTW you may want to try increasing your humidification to help with that.
After that, I want to try an EPR of 0 (turn it off) followed by on the next night with dropping your max pressure by 1.
Then a choice on your part if it goes the way I think it will. Do we go for the most comfortable settings on your current machine, which will be a compromise between the Obstructive and central apneas with having the higher AHI that you were experiencing, or do we try for an advanced ASV machine which will treat both and has provided many users with AHI of near 1.
What we have done is titrate out the obstructive apnea (to less than 5) demonstrating that your current machine does not treat the central apnea that is present. This says that your current machine is failing to properly treat YOUR apnea and you need a different approach.
Central Apnea is where your brain is not signaling for you to breathe. That is you make no effort to breathe.
SleepRider will slip in here soon with his opinion.
I don't remember having a full night sleep in all my life. It is always cut in 2, 3 or more parts. When I wake up and in pain I have to take the mask off. And often when I wake up I start an insomnia period of one our 2 hours. Then I fall asleep so quickly, I don't feel it coming. Sleep has always been a bete noire for me.
I treat my rhinitis with humidifier in the house, humidity in the Airsense at 8 and with NeilMed Gel and spray. My doctor prescribed me Mometasone, a kind of anti-inflammatory. I notice that when the pressure is lower I dont have many Centrals. Can they be caused by the pressure? Is the pain caused by pressure? I feel like it is but I can't be sure. When I don't have the mask I don't have pain. When I tried the P10 I had pain for days after leaving it. Even in the sinuses. I think my respiratory system is a bit capricious.
I don't think I can afford a 3000$ machine, I'm not done with paying the one I have (Resmed 10). I will have to stand a bit of OA I think. But is going from 35 to 10 could be not so bad?? And as I feel the centrals are caused by the pressure...I don't take large inspirations after a Central. I just seem to keep in my breath for soothing reasons. Pain? pressure? Oxygene? I feel my brain does it on purpose not by a kind of defective function.
Now as I am sure I won't provide more than 4 to 5 hours of sleep (which for me is a good stretch) Do I try 2 more nights with the same numbers and after that I cut the EPR? And the day after that I drop the pressure by 1? Or do I try to cut the EPR off tonight? If I can drop the pressure by turning the EPR off, I'll gladly do it.
Thank you so much for your help, I really am at a lost .
(03-01-2019, 10:29 AM)Sleeprider Wrote: Fred is correct. The pressure here is not extraordinary and even with only EPR at 1 the CA events are predominating. Pressures less than 8.0 leave you with a lot of snores, so I think if you can tolerate that as a minimum pressure, that will help. You can see at 00:45 to 00:55 snores and flow limitation is present and you quickly reach higher pressures. I think we need to see if the current pressure will continue to prevent the OA you showed previously, but this is encouraging. CA is randomly present and I suspect is more a function of sleep disruption than actual central apnea. If you check the events tab you can see the duration of those events. I suspect most are very close to the 10-second threshold.
So I keep the EPR at 1, set the minimum at 8, keep the max at 12 and send my charts to you again? I feel a bit like I take too much time from the team. But surely I'm about to be OK on my own. (I hope)
(I hope)