please help me make sense of my central apneas

[p4ncaketim]

thank you! I will try that. Is EPR purely for comfort, or can that make my treatment more or less optimal? def looks like the pressure needs to raise after a full night w the mask on last night. attached photo. really appreciate you sticking with me to finding the right setting for myself.

[Sleeprider]

EPR is actually the same as bilevel. If you were to look at the mask pressure chart from your Airsense 11 and an Aircurve bilevel side-by-side they would look identical That is why I keep using bilevel notation in your pressures. The Airsense EPR is pressure support, limited to 3-cm resulting in bilevel IPAP/EPAP pressure channels. We use this pressure support/EPR to directly treat flow limitation and upper airway resistance. This gives a a useful tool to treat flow limits, snores, RERA and hypopnea. This is discussed in the Flow Limitation wiki https://www.apneaboard.com/wiki/index.ph...limitation

If you compare your charts with or without EPR you will see a difference in the flow limitation quantified in the respiratory statistics and visible in zoomed views of your flow rate. It is EPAP that controls OA, and you can see in your chart that each OA coincides with an EPAP pressure near 8.0, so regardless of the amount of EPR we use, it will be our objective to keep both IPAP and EPAP above 8.0 to prevent this. Click on the Optimizing Therapy link in my signature. I recommend you read the whole thing, but note the section on EPR, and Titration of Bilevel Therapy. In bilevel we increase EPAP for obstructive apnea, and IPAP or pressure support for hypopnea, RERA and snoring...Resmed's words, not mine.

[p4ncaketim]

thank you for this info! i have read it all. interesting as most of the time i read about epr, people say it's best to have it off if you can. turns out it's actually helpful!

[Sleeprider]

The people that say, "leave it off" are unaware of how to use it in lieu of bilevel.  I can understand that the old Philips Flex algorithm and some others are pretty useless, but this has bilevel therapy potential, and it needs to be recognized as such.  Resmed is actually walking a thin line in providing bilevel in a CPAP platform, so we'll just keep it to ourselves, that it's not just comfort.  A "comfort" algorithm, returns pressure to CPAP before inspiration begins. A bilevel algorithm triggers IPAP coincident with spontaneous inspiratory effort, and that is the Resmed EPR.  The real secret sauce to Resmed is that the same device hardware serves everything from CPAP, Auto CPAP, VPAP-S, Vauto, ASV, ST and ST-A with just a change in firmware. So every CPAP is also an advanced bilevel therapy device with a different algorithm in the firmware.  It's all the same chassis, motor and other components.

[p4ncaketim]

hey! finally had a decent night of data to track. the chart is a bit wonky from a nap i took and the f40 mask is giving me a bit more leaks than the f20. nonetheless, it looks like there rare some indicators to increase the pressure even more from 11/8 right?

[Sleeprider]

Higher pressure may help, but the clusters of OA are an indicator of positional apnea https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[p4ncaketim]

easy enough read to understand! thank you for linking that. i have seen this pattern before when i don't mouth tape. i never really saw this pattern at higher pressures when i do mouth tape. What do you think - should i increase the pressure back to 12/9 and capped at 15 or should i do another night of 11/8 capped at 14 to get more data? I roll around a bit in my sleep so it's hard to determine in which position this is occurring in.

[Sleeprider]

If you're comfortable at a higher minimum pressure, that should help with any OA and stabilize your pressure.

[p4ncaketim]

man, there are no two nights alike. the amount of central apneas i have is wild to me. from what i'm seeing, the obstructive apneas are best resolved at a pressure above 14. is there any downside of running apap at 13.5 to 15 with 3 epr? i'm asking as you have been suggesting a range of 3cm of pressure in apap settings. my hope for this smaller range is that it decreases leaks from larger pressure increases and eliminates obstructive, hypopneas, and reras from a higher baseline. 

I have re read that optimizing therapy page a few times in your bio. not moving to the cervical collar yet, however, i did by a cpap pillow hoping for some benefit.

[Sleeprider]

Many people do better with fixed pressure rather than auto pressure. The trick is to find the one that prevents most OA. Give it a try by setting minimum and maximum pressure the same. You will probably have the same number of events, possibly fewer CA, but I don't think in your case it will increase obstructive events at all. 11.6 min, 11.6 max, EPR 3. There is nothing sacred in my book for automatic pressure increases.