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+--- Thread: Setting advice request (/Thread-Setting-advice-request)
Setting advice request - sleepyp - 01-15-2020
Hi,
Can you please provide some setting advice for me?
There were no CAs present in my sleep study, only hypopneas at 29.1 per hour.
The AHI was about 75% higher in REM stage and in supine position, 35 vs 20 and averaging at 29.1.
I wear a cervical collar and have been focusing on side sleeping as best I can.
So far I've been on auto 8-20cmH2O with EPR3 which was showing CAs in 3CAI range. Last night I tried EPR2 and still have a similar amount of CAs.
My graph for last night and a previous night is below.
What advice would you offer please?
[attachment=19032]
[attachment=19033]
RE: Setting advice request - Sleeprider - 01-15-2020
I think this therapy is going to work great for you with one minor tweak. Just reduce the EPR setting from 3 to 1 or 2. Reduce EPR to zero if needed for now, and I'm sure you can add it back later as you adapt. New users on CPAP often have problems with EPR, which acts like bilevel pressure with lower exhale and higher inhale pressure. This bilevel pressure often helps reduce hypopnea, but it also greatly increases your ventilation rate, which reduces CO2. This in turn results in the CA events. Once you reduce EPR, we can fine-tune pressures, probably lower, and I'm sure you will find both comfort and efficacy very soon.
RE: Setting advice request - sleepyp - 01-15-2020
Cool, thanks for note of hope! I've been at this since last September and do feel better, but still not what I'd describe as rested/refreshed.
I'll try EPR completely off for the next 3-4 nights and see what the new average looks like.
Really appreciate your help and guidance.
RE: Setting advice request - sleepyp - 01-16-2020
I realise that one night is not statistically significant.
However, I thought I'd share this as an initial result.
This is the whole night OSCAR view.
[attachment=19061]
Observations from me:
Pressures went higher, maxing at 12.3
Flow limits increased over my previous 4 day average
Hypopneas increased over my previous 4 day average
Tidal Volume decreased while the respiratory rate remained constant with 12 being the median. The max is RR is 27 which is assume is the awake periods?
CAs reduced significantly from an average of 3.5CAI to 0.86CAI. Higher pressures don't seem to produce any more CAs.
[attachment=19062]
I went through each CA event and they all look like this. Erratic breaths followed by stop, followed by return to 'normal' breathing patterns. From my research on here this looks like I'm either awake or rolling over and temporarily stop breathing.
Do you agree?
The previous 4 nights has some CAs that look like this, but many of them looked like I just stopped breathing.
My guess is that I should wait a week at these settings to see these results settle and become statistically significant, then add 1cmH2O EPR back in per week or two while observing CAs. After a month of two I'd be back to EPR3. Do you agree with this assessment?
RE: Setting advice request - Sleeprider - 01-16-2020
To quote the "Fonz", exactamundo! Your response was predictable and the important metric here is not the numbers but how you feel. I will trade a few CA events for feeling better. The use of EPR or pressure support, will reduce the overall pressure you need to treat obstructive events. That is the cool thing about owning a Resmed machine. The more difference between inhale and exhale pressure, the lower the flow limitation, and the lower the needed pressure for therapy. It is really a balancing act, and we really can't emphasize enough that we watch event rates, but listen to how we feel.