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Balancing CAs and Aerophagia - Gtobot - 04-18-2022
Hey All,
I've been using my APAP for about two weeks, and I feel like I am sleeping and feeling much better. I downloaded OSCAR and I noticed that predominantly the apneas remaining are all clear airway apneas.
I tried for the last two nights to drop my EPR from 3 to 2, but it doesn't seem to help. In fact, last night my centrals were the worst they've been.
I'd love some advice. Obviously I'm relatively new, should I just keep watching for now? Should I change my pressure? Should I try to get EPR down to 1 or even 0?
Thanks for any and all help!
RE: Two weeks on APAP and trying to understand - Gideon - 04-18-2022
Welcome to the forum,
First realize the Central events tend to be inconsistent. In fact so inconsistent we call them consistently inconsistent.
You do have the right Idea.
Try EPR = 1, no other changes.
do note that Min Pressure should be no less than 4 + EPR to give the EPR room to work.
Also with your pressures, you should try a night or two with the Ramp off.
RE: Two weeks on APAP and trying to understand - Gtobot - 04-19-2022
I had noticed the last two days that my GERD was really acting up. Last night, made the connection to the change in EPR setting, as I'd felt the same way weeks back before upping EPR. So I went back to EPR 3, and changed my ramp.
Sleep was not great but I understand centrals come and go, and can get worse at the start of therapy.
Given my intolerance for a lower EPR (I feel substantially worse with it lower) is there anything else to try? Should I simply use the machine for a couple more weeks and watch?
Sleep was not great but I understand centrals come and go, and can get worse at the start of therapy.
Given my intolerance for a lower EPR (I feel substantially worse with it lower) is there anything else to try? Should I simply use the machine for a couple more weeks and watch?
RE: Two weeks on APAP and trying to understand - Gideon - 04-19-2022
You have your min = 6, it should be 7, this is adding some extra pressure fluctuation.
Set Max = 8 to remove MOST of the pressure fluctuation. I strongly suspect (you did not present the FL chart) that flow limitations are driving your pressure changes. This will artificially limit the pressure fluctuations to a narrow band.
RE: Two weeks on APAP and trying to understand - Gtobot - 04-19-2022
I will try that.
Just out of curiosity and a desire to understand better, I would have thought pressure changes were a good thing? Why do we want to limit the band of available options so dramatically? Is this a potentially permanent change, or are we just using it to gain more info?
RE: Two weeks on APAP and trying to understand - Gideon - 04-19-2022
A bit of both.
Minimizing pressure variation will help with comfort, it can in some cases reduce central apnea events.. as I said I strongly suspect that flow limitations are driving your pressure and your EPR of 3 is not enough to manage them. Normally I would increase EPR or PS (pressure support) to better manage the flow limitations. In other words I prefer to actually treat the flow limits and naturally limit the pressure variations. You don't need higher pressures, you need higher PS/EPR.
RE: Two weeks on APAP and trying to understand - Gtobot - 04-20-2022
Your suggestions appear to have helped! Thank you!
I've attached a before and after with flow limit visible. Planning to just try to stick it out here for a bit and see how it goes. Open to additional suggestions of course.
RE: Two weeks on APAP and trying to understand - Gtobot - 04-21-2022
I just reviewed my two night sleep study and found that night 1 I had 1.7 "Likely Centrals" and night two I had 3.1 "Likely Centrals."
Does this mean I need to be satisfied with centrals in the 2-3 range? Or is it possible to get them lower?
RE: Two weeks on APAP and trying to understand - Gtobot - 04-30-2022
Most of my centrals appear to be happening in the last 45 minutes of my sleep. Or at least, I get a much higher density of them there. Should those be disregarded as "sleep/wake junk" or?
What I'm noticing is that for the first 2 weeks my "clear airways" were consistently below 3. But after that, I have sometimes found them jumping into the 4s and 5s. Sounds like a treatment emergent issue? Should I just give it another couple weeks and see what happens with minimal adjustment?
RE: Two weeks on APAP and trying to understand - Gtobot - 07-06-2022
A couple months in, and my centrals and obstructives have both been trending down nicely to an average of 2.77 and .24 respectively the last 30 days.
Until last night, when I had an unusually rough sleep. My machine also flagged an episode of Cheynes-Stokes Respiration which has me concerned. I've attached the relevant screenshots with a zoom of the CSR period.
From my perspective it was a typical night, so I'm wondering both:
1. What's up with the CSR
2. Do we have any idea what could cause such a bad night?