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Need help with fine tuning pressure! - Printable Version

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Need help with fine tuning pressure! - LWilder - 11-05-2018

I was diagnosed with mild sleep apnea (AHI 5) and have been using my cpap for about 6 weeks. I'm still very sleepy during the day and not waking up refreshed at all. I mostly have CA's each night and it seems like a lot of them are SWJ. I have tried different pressures and using EPR but nothing seems to help the CA's go away. Any help will be very appreciated! The attached SleepyHead data is from last night and is a pretty typical night for me.


RE: Need help with fine tuning pressure! - Sleeprider - 11-05-2018

You have a few hypopnea and considerable flow limitation. It is the FL which is causing your pressure to rise. We don't know the cause of your CA events yet, but could be sleep disturbance or mild complex apnea. We're going to find out...

Your pattern is typical of Upper Airway Resistance Syndrome (UARS), and I would bet your sleep study was all or mostly hypopnea. I think you would benefit from using the exhale pressure relief EPR feature on your machine. This will specifically target FL and H events, and should increase comfort. There is a slight risk it will increase the incidence of CA, but it's worth a try. This article explains why using EPR to achieve bilevel pressure may be beneficial. http://www.apneaboard.com/wiki/index.php?title=Flow_Limitation/UARS_and_BiPAP

The only changes needed is to go into settings, and under Comfort, turn EPR to ON, Full Time, and set it at 2 or 3. A higher setting is more pressure relief on exhale. Give it a try, and please check back. Let us know if you need help accessing the settings. A clinical manual is available free from the forum https://www.apneaboard.com/adjust-cpap-pressure/change-cpap-pressure-settings-adjusting-your-machine-with-a-clinician-setup-manual


RE: Need help with fine tuning pressure! - LWilder - 11-05-2018

Thank you for your reply! I have wondered if I might have UARS as well. I have tried using EPR. I have attached two nights using EPR. It definitely helps lower my FL but the CA's are still there.


RE: Need help with fine tuning pressure! - Sleeprider - 11-05-2018

H and FL are lower with EPR, and it appears your minimum pressure was set to 12 at that time. I think you might use EPR but try a pressure range of 9.0-14.0 and see if that helps with CA. If you are concerned about the CA events, you might be able to reduce or eliminate them using Enhanced Expiratory Rebreathing Space (EERS), http://www.apneaboard.com/wiki/index.php?title=Enhanced_Expiratory_Rebreathing_Space_(EERS) This is somewhat experimental, but has worked as discussed in this thread. http://www.apneaboard.com/forums/Thread-Effectiveness-of-adding-EERS-Data-attached


RE: Need help with fine tuning pressure! - Gideon - 11-05-2018

Nice chart, now all we have to do is reduce the CA.  This is done on a CPAP by either reducing EPR which we are NOT going to do now and or by reducing pressure.

I would drop your min pressure by 1 cmw with no other changes, then repeat in a day or 2 until the charts show a negative change, either an increase in CA or an increase in other Apneas.  Also of note with this chart is that it shows a nearly constant pressure.  Before all is said and done you could be at a constant pressure say Min 9 and Max 9 with an EPR of 3.  Constant pressure is a method of dealing with CA on a CPAP, not all the time but frequently.  


 Time and trials will tell.


RE: Need help with fine tuning pressure! - Gideon - 11-05-2018

To clarify I made my post then was interrupted so I didn't see SR's post until after I posted mine.  

I'm targetting the same place SR is sending you, but I usually choose a slower approach.


RE: Need help with fine tuning pressure! - LWilder - 11-06-2018

Last night I tried 9-14 with an EPR of 3. I got about the same results. My chart looks a little different because I tried taking a nap earlier in the day and didn't fall asleep. I zoomed in on just my sleep for the night. Also I woke up briefly because my son woke me up. Should I stick with this range for a few nights and see how I do?


RE: Need help with fine tuning pressure! - Walla Walla - 11-06-2018

I kind of like Bonjour's idea of using a fixed pressure of 9cm. But I would turn off the EPR. I think it would answer the question of can the CA events be controlled by machine settings.


RE: Need help with fine tuning pressure! - Gideon - 11-06-2018

Based on a few things, first EPR initially controlled your Flow Limitations and while I would be likely to change it later lets only change one thing at a time.  
I would like to remove the variation caused by the auto algorithm doing what it is supposed to be doing for now. I would like you to set both your Min and Max pressures to 10 cmw.  Pressure fluctuation commonly induces CA events in some patients, it seems likely that you are one of those lucky ones.  This may be followed up with either a pressure reduction (I do like to take it slow) or a reduction in EPR depending on results..Fred


RE: Need help with fine tuning pressure! - LWilder - 11-07-2018

Here is last night's data. I used a steady pressure of 10 with an EPR of 3. I had more CA's than I usually do. Any suggestions?