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Wake after 2-4 hours can't go back to sleep
#21
First, with aerophagia, (air bloating), we want to use pressures as low as possible.  If you want to try to titrate this from the bottom up we can really dial back the pressures (your choice).  We will be looking for the lowest threshold where obstructive events can be prevented.  If you want to try that, let's go all the way back to EPAP 5.0 and IPAP 8.0 and see what we get.  If that low pressure does not let in too many obstructive apnea, and hypopnea is reasonable, that's a win.  If they are present in low numbers, we can fix that.  It's not just a guess; you have no obstructive apnea with an EPAP of 6.0, so 5.0 is a reasonable step.  Pressure support, or higher IPAP pressure is something you don't appear to need therapeutically, but it can control hypopnea and flow limitation.  Those were not  apparent in your previous results.  Dropping back to 8/5 is a reasonable step that may prevent air ingestion, and let you sleep comfortably.

Easy-Breath is simply a comfort feature.  It eases the pressure transitions from inhale to exhale and back to inhale.  Think of it as a wave-form with smooth rounded peaks and valley, instead of abrupt pressure changes with square wave-form.  Or as Resmed puts it, it mimics the wave form shape of your breathing for greater comfort.  I think comfort + effectiveness is what we're shooting for here.

[Image: AirCurve-10-VAuto_KF_01_B2B_a45ee3b2-980...8799775307]
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#22
(10-09-2017, 10:29 AM)Sleeprider Wrote: First, with aerophagia, (air bloating), we want to use pressures as low as possible.  If you want to try to titrate this from the bottom up we can really dial back the pressures (your choice).  We will be looking for the lowest threshold where obstructive events can be prevented.  If you want to try that, let's go all the way back to EPAP 5.0 and IPAP 8.0 and see what we get.  If that low pressure does not let in too many obstructive apnea, and hypopnea is reasonable, that's a win.  If they are present in low numbers, we can fix that.  It's not just a guess; you have no obstructive apnea with an EPAP of 6.0, so 5.0 is a reasonable step.  Pressure support, or higher IPAP pressure is something you don't appear to need therapeutically, but it can control hypopnea and flow limitation.  Those were not  apparent in your previous results.  Dropping back to 8/5 is a reasonable step that may prevent air ingestion, and let you sleep comfortably.

Easy-Breath is simply a comfort feature.  It eases the pressure transitions from inhale to exhale and back to inhale.  Think of it as a wave-form with smooth rounded peaks and valley, instead of abrupt pressure changes with square wave-form.  Or as Resmed puts it, it mimics the wave form shape of your breathing for greater comfort.  I think comfort + effectiveness is what we're shooting for here.

[Image: AirCurve-10-VAuto_KF_01_B2B_a45ee3b2-980...8799775307]
I am willing to try anything! looking back on previous nights, I have had obstructions, 10 on 6/11.4, 3 on 6/11.6, 4 on 5.8/11.6, and 5 on 6/11.6 with a few hypap sprinkled in.  So I'm hearing you say to turn easy breathe on, and then with the above, do you still think I should try as low as 5, or higher since I do have obstructions at 6?  I am so thankful for your help, as I do not know what to do at this point.
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#23
The exhale (EPAP) pressure controls obstructive apnea. If you have had some obstructive apnea with EPAP at 6, then you should probably not lower that, however you may lower the inhale pressure (IPAP), and that will improve CA. In order to try the lowest pressure possible, let's try 9.0 IPAP and 6.0 EPAP. All we can do is observe the results for a few days then decide if comfort and effectiveness is where you need it. We don't need zero events. Even with 10 events in 8 hours, that is only an index of 1.2/hour.
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#24
Ok! I’ll try 6/9 tonight with easy breathe.  Are the clear airway events something to be concerned about? The dr or rather np has not said anything about them.
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#25
I would not worry about these. They are very common when pressure support is high enough to lower the body's CO2 level which drives breathing. It's often called "washout". Reducing pressure support nearly always resolves it. FWIW, I get the same thing if I get above 3 cm pressure support.
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#26
(10-09-2017, 12:50 PM)Sleeprider Wrote: I would not worry about these.  They are very common when pressure support is high enough to lower the body's CO2 level which drives breathing.  It's often called "washout".   Reducing pressure support nearly always resolves it.  FWIW, I get the same thing if I get above 3 cm pressure support.

Soooo.... I used easy breath, with 6/9 settings.  Although I still woke up after 3 hours and was awake a couple hours, my events were at 1.0 per hour!  Wow, what a difference.
Should I stay the same or try to tweak more?   I just don't know why i'm waking up so much.
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#27
We're not here to encourage dial-winging. Hold steady, and congrats on the improved results....now let's add comfort and restfulness to that.
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#28
(10-10-2017, 03:18 PM)Sleeprider Wrote: We're not here to encourage dial-winging.  Hold steady, and congrats on the improved results....now let's add comfort and restfulness to that.

any suggestions on how to do that??? Wink  Dont-know    

I'm sorry I'm so ignorant here, but I am wondering why they had me on such a high pressure, if a 6/9 works???  Does that even make sense?  I read that sleep study results are helpful to so here are mine...

69 obstruction per hour during REM
AHI 12.9 
RDI 24.1
-22cm H2o
91% oxygen with some obstructive events 

Any words of wisdom?
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