Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

ataylor830 therapy
#1
ataylor830 therapy
Hi All,

This isn't my first thread, which can be found here: http://www.apneaboard.com/forums/Thread-...-CSR-Scare 

I created a new thread because after many months of reviewing data and tweaking apap settings, my questions now have nothing at all to do with the original thread.

A quick summary.. I had an in-home sleep study in January '20. Found a 25 AHI, but my o2 dipped to 64 at one point, which really freaked me out. I didn't think the AHI of 25 (being considered moderate OSA) meshed with how low my o2 got, so I bought an oximeter and begin monitoring.  

Some of the tweaks I've made consists of totally turning off EPR and gradually increasing pressure, which was originally minimum of 5. I gradually was able to essentially eliminate any full apneas around pressure in the 9-10 range. But I noticed (especially once I turned off EPR) that I have clusters of flow limitations that seem to occur every 90-120 minutes or so. I believe this may be REM? My breathing and events outside of these clusters is stellar. Consistent flow rate, o2 at 95/96, and no events outside of the times during the clusters. So in an effort to reduce these clusters of flow limitations, I've actually gradually increased my min pressure to 12.6.  (spoiler, it hasn't helped to reduce these clusters too much thus far).

During these clusters, which can last from 20 or 30 minutes to even at hour at times, my flow rate and resp. rate are all over the place. I have flow limitations that can be as high as .3 - .4, but often under that. Sometimes a hypopnea will be recorded, but oftentimes no events are recorded, even though to my untrained eye it seems it should be a hypopnea. And most importantly, my o2 will dip into the upper 80s at least 1 to 3 times per night (always during a cluster). Not for a troubling amount of time, maybe 10-20 seconds at a time.  But with a min pressure of 12.6, which I feel is pretty substantial, still dipping into the 80s at all really makes me wonder what's going on.

My AHI has stayed fairly consistent when my pressure was in the 9.6 minimum all the way to now at 12.6.  (AHI for last 6 months is .26 whereas AHI for last 30 days is .19). My o2 may be slightly better/dip fewer times per night at the higher pressure but it isn't fully corrected by any means.  For several months I recorded and charted out my AHI vs minutes of o2 under 90, and there was zero correlation... which tells me the flow limitations (which don't count as an event and don't affect AHI) mean more to my o2 dipping than any official event that can be recorded.

I've loaded a few images to show what I'm talking about and can "zoom in" anywhere that someone is interested to see. Any and all feedback is super appreciated.

https://imgur.com/a/ug3VqI4
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: ataylor830 therapy
REM sounds like a pretty good guess to me, if the timing on the chart you posted is typical. And for what it's worth, respiration rates can increase during REM as well, and your chart is also showing that pattern. Finally, I know that some people have a lot more OAs during REM than non-REM, and I don't see why that might not also happen with FLs.

In the zoomed views, I'm seeing some waxing and waning in the flow rate. It may be that the deeper breathing washes out some CO2, which reduces your drive to breathe, until the CO2 builds back up and you take some deep breaths, which wash out some CO2, etc.

The usual tweak to make to reduce flow limitations is to introduce EPR. Given how REM-specific your FLs are, I don't know whether that will help or not, but you could experiment. Often people will raise the minimum by 1 if they introduce EPR of 1, 2 if 2, 3 if 3, but your OAs and Hs are so well controlled you might want to leave your minimum where it is and try EPR of 1, just to see what happens.
Post Reply Post Reply
#3
RE: ataylor830 therapy
Excellent interpretation by Dormeo...again! I agree completely. Your pressure has become optimized to prevent most events, and changes less than 1-cm, even during the periodic flow limitations. Adding back EPR slowly might prove both comfortable and effective. It sure can't hurt. I also agree the oscillating flow rate suggests you are at or near the apneic threshold at this pressure. If you eliminated EPR to avoid centrals originally, this may bring a few back. If so, a little bit of enhanced expiratory rebreathing space (EERS) may be just the thing to even that out. Really pro-level analysis by Dormeo.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#4
RE: ataylor830 therapy
Thanks, Sleeprider! And ataylor, I'll be interested to learn how it goes. Keep us posted.
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: ataylor830 therapy
Cool, thank you both!

I have never had much of a problem with centrals... never more than one or two per night. I honestly just thought EPR was mostly a comfort setting. I didn’t realize there were therapeutic benefits to having it on.

I actually thought that as I lowered EPR, it was more sensitive to, and therefore revealing, my flow limitations. I never considered it was CAUSING them! So if I can be more comfortable with as well as having benefits by enabling EPR, I’m all in!

I’ll gradually begin decreasing EPR and keep you posted. As always, I so appreciate the guidance.
Post Reply Post Reply
#6
RE: ataylor830 therapy
Sorry, I meant I will introduce and gradually INCREASE EPR. Not decrease.
Post Reply Post Reply
#7
RE: ataylor830 therapy
So I set EPR to 1 last night  and yes, the comfort is decidedly better for sure.

As numbers go, AHI of .13 and that was due to 1 single CA during one of these clusters, during which my o2 dipped to 89 for 1 second. O2 stayed above 90 the rest of the night. Most excellent!

The waxing and waning has always bothered me (curiosity wise, not physically that I can tell) and I associated it with the flow limitations. Do you think if I can reduce flow limitations by introduction of EPR that the waxing and waning will get better? 

I want to ask it a different way, also, just to make sure I understand. I interpreted sleeprider's comment to mean that introduction of EPR may help FL, but may trigger CAs...   so where I currently have waxing and waning, I may still having waxing followed by a CA, potentially? 

I'm going to read more about the EERS you suggested, Sleeprider. This is brand new to me so I'll dive in and learn more.
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: ataylor830 therapy
Many people find comfort increases with EPR, but as that pressure difference increases, they experience more instability in respiratory volume (oscillations) and even more CA events. EERS is simply a way to stabilize CO2 which is what drives respiration. With improved ventilation from CPAP and especially BPAP, CO2 may drop below the "apneic threshold". When that happens you tend to breath slower or more shallow which allows CO2 to increase resulting faster, or higher volume. This cycle tends to repeat and can increase in amplitude. Allowing some rebreathing of expired air can fully stabilize or dampen the imbalances. I should point out, this is very common in new users of CPAP, and it usually diminishes without any intervention as you adapt. So while it's an interesting read, I'm not suggesting you actually need an EERS system for this minor oscillation we saw in your flow rate.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#9
RE: ataylor830 therapy
It's good to hear that introducing EPR of 1 was comfortable and uneventful. I'd recommend sticking with it for a few more nights, then trying 2. If that goes smoothly, then up to 3 in due course. It'll be interesting to see whether it reduces FLs, given the REM pattern.
Post Reply Post Reply
#10
RE: ataylor830 therapy
(12-24-2020, 11:00 AM)Sleeprider Wrote: Many people find comfort increases with EPR, but as that pressure difference increases, they experience more instability in respiratory volume (oscillations) and even more CA events.  EERS is simply a way to stabilize CO2 which is what drives respiration.  With improved ventilation from CPAP and especially BPAP, CO2 may drop below the "apneic threshold". When that happens you tend to breath slower or more shallow which allows CO2 to increase resulting faster, or higher volume.  This cycle tends to repeat and can increase in amplitude.  Allowing some rebreathing of expired air can fully stabilize or dampen the imbalances.  I should point out, this is very common in new users of CPAP, and it usually diminishes without any intervention as you adapt.  So while it's an interesting read, I'm not suggesting you actually need an EERS system for this minor oscillation we saw in your flow rate.

How many months of use do you consider to be a new user? I got my machine in February, stumbled for maybe 2 months but have been using very steadily for 8+ hours for the last 7 months. The oscillations have been very consistent, even in early months where I had EPR set  to 2.  But to your point, in the early months I was definitely a "new" user.

ok.. so now that I'm more accustomed to treatment, and I will very gradually try to introduce higher EPR settings, I'll see how it goes. And also read up on EERS just in case.

One more question for anyone with input. Is there any way (breathing exercises or anything) to increase tidal volume? Mine has always seemed low (I'm 5'8 and unfortunately obese).  On one hand, even with low tidal volume my o2 seems acceptable with my apnea controlled. But just curious if I can actively do anything to increase tidal volume.
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Dapal's Therapy Thread. dapal 117 3,085 01-19-2021, 09:23 AM
Last Post: dapal
  My Therapy Thread: [reports+updates] MADAwake 29 530 01-13-2021, 01:15 AM
Last Post: MADAwake
  Struggling with therapy lately holysmartone 11 368 01-09-2021, 11:25 PM
Last Post: Sleeprider
  Analysis Help [chillydip therapy data] chillydip 12 207 01-07-2021, 07:48 PM
Last Post: Sleeprider
  Can BiPAP therapy cause dry mouth? BobbieM 5 251 01-02-2021, 11:45 PM
Last Post: Karlin
Grin Side Effects of CPAP therapy martyedb 7 333 12-28-2020, 10:12 AM
Last Post: SarcasticDave94
  nileriver's therapy thread (UARS) nileriver 4 180 12-20-2020, 09:04 PM
Last Post: nileriver


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.