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+--- Thread: I'm New and I'm Tired...zoom of CA's (/Thread-I-m-New-and-I-m-Tired-zoom-of-CA-s)
I'm New and I'm Tired...zoom of CA's - Hilobarbie - 03-02-2015
Someone asked me to provide a Zoom of the CA's. I was reading how to use the program and discovered how to zoom, so here is the link://imgur.com/Z2VyYB2]
![[Image: Z2VyYB2.png]](http://i.imgur.com/Z2VyYB2.png)
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RE: I'm New and I'm Tired...zoom of CA's #2 - Hilobarbie - 03-02-2015
this is a different segment of CA's
//imgur.com/XcTAtD8]
![[Image: XcTAtD8.png]](http://i.imgur.com/XcTAtD8.png)
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RE: I'm New and I'm Tired...zoom of CA's - quiescence at last - 03-02-2015
Are you considering changes to your pressure?
Looks like you'll land at the 9 min 15 max range.
I wonder if you changed EPR to 1 if it would help some with the CAs. Changing only that for a week or so would give you an idea if that is part of the equation.
QAL
RE: I'm New and I'm Tired...zoom of CA's - Hilobarbie - 03-02-2015
(03-02-2015, 12:46 PM)quiescence at last Wrote: Are you considering changes to your pressure?
Looks like you'll land at the 9 min 15 max range.
I wonder if you changed EPR to 1 if it would help some with the CAs. Changing only that for a week or so would give you an idea if that is part of the equation.
QAL
Actually, I don't know enough to determine what might help. I just changed the EPR to 1, as you suggested. So....can you explain what that will do? I tried finding some info, but digesting it with brain fog is not easy. So, I reduced the exhale pressure which should make it easier to exhale? Some things I read said they turned it up or they turned it OFF or whatever they did felt better but caused more CA's. Nothing is blk or White. I'm guessing this is one if those things that may need adjusting from time to time to fit the individual needs.
RE: I'm New and I'm Tired...zoom of CA's - DariaVader - 03-02-2015
(03-02-2015, 06:59 PM)Hilobarbie Wrote: Actually, I don't know enough to determine what might help. I just changed the EPR to 1, as you suggested. So....can you explain what that will do? I tried finding some info, but digesting it with brain fog is not easy. So, I reduced the exhale pressure which should make it easier to exhale? Some things I read said they turned it up or they turned it OFF or whatever they did felt better but caused more CA's. Nothing is blk or White. I'm guessing this is one if those things that may need adjusting from time to time to fit the individual needs.
a higher EPR is associated with causing pressure induced CA. Reducing overall pressures may also help with pressure induced CA. For inherent CA neither of those is not going to help.
Higher EPR gives greater exhalation relief, and reduces renovascular resistance. As you said, it is something that needs to be set according to individual needs. example. When pressure is 12 and EPR is 2, exhalation pressure is 10.
I didn't catch what your AHI is running and how many CA events you are having in a night, but if I remember correctly those numbers are in the moderate apnea range, and that you also have symptoms of OSA (snoring, gasping, etc) If that is the case, you probably have complex apnea, and you may need a ASV type machine to get the relief you need.
RE: I'm New and I'm Tired...zoom of CA's - Hilobarbie - 03-03-2015
(03-02-2015, 06:59 PM)Hilobarbie Wrote:(03-02-2015, 12:46 PM)quiescence at last Wrote: Are you considering changes to your pressure?
Looks like you'll land at the 9 min 15 max range.
I wonder if you changed EPR to 1 if it would help some with the CAs. Changing only that for a week or so would give you an idea if that is part of the equation.
QAL
Actually, I don't know enough to determine what might help. I just changed the EPR to 1, as you suggested. So....can you explain what that will do? I tried finding some info, but digesting it with brain fog is not easy. So, I reduced the exhale pressure which should make it easier to exhale? Some things I read said they turned it up or they turned it OFF or whatever they did felt better but caused more CA's. Nothing is blk or White. I'm guessing this is one if those things that may need adjusting from time to time to fit the individual needs.
I made it for less than two hours before I had to remove the mask. My cheeks filled up with air until the air flapped my lips to escape. It was initially more comfortable and natural feeling breathing though.
RE: I'm New and I'm Tired...zoom of CA's - quiescence at last - 03-03-2015
so if you look at those 2 hours, and it is anything like the previous nights, two things occur to me:
1. initially you feel more comfortable because the inhale and exhale are more alike. your start is at 5, so your exhale is at 4.
2. later, (my guess) is that the pressure went right up to about 10 cmH2O. at that point you are exhaling against 9 cmH2O, instead of 8 cmH2O, and it may feel harsher than before, thus the stop and remove mask.
The key is, of course, starting the machine up again, as it starts back at the lower pressure.
If you do this, over and over, at some point you are going to feel deprived at the start point of 5 cmH2O. Others have discussed this syndrome as you get more acquainted with the pressure you notice it isn't there and this registers in your awake brain that you are not able to breathe in enough. This is fiction, of course, but the feeling is hard to shake when you are experiencing it, it is dark, and nobody is stirring. I think we all gradually wish to start at a higher pressure. [Of course, your numbers actually look like you'll eventually want to start above 8 cmH2O.]
Over the next 3 or 4 days you should see the CAs reducing (even though they might actually have increased last night, and tonight).
QAL
RE: I'm New and I'm Tired...zoom of CA's - Hilobarbie - 03-03-2015
(03-03-2015, 02:24 PM)quiescence at last Wrote: so if you look at those 2 hours, and it is anything like the previous nights, two things occur to me:
1. initially you feel more comfortable because the inhale and exhale are more alike. your start is at 5, so your exhale is at 4.
2. later, (my guess) is that the pressure went right up to about 10 cmH2O. at that point you are exhaling against 9 cmH2O, instead of 8 cmH2O, and it may feel harsher than before, thus the stop and remove mask.
The key is, of course, starting the machine up again, as it starts back at the lower pressure.
If you do this, over and over, at some point you are going to feel deprived at the start point of 5 cmH2O. Others have discussed this syndrome as you get more acquainted with the pressure you notice it isn't there and this registers in your awake brain that you are not able to breathe in enough. This is fiction, of course, but the feeling is hard to shake when you are experiencing it, it is dark, and nobody is stirring. I think we all gradually wish to start at a higher pressure. [Of course, your numbers actually look like you'll eventually want to start above 8 cmH2O.]
Over the next 3 or 4 days you should see the CAs reducing (even though they might actually have increased last night, and tonight).
QAL
The cheeks blowing up and air fluttering out of my lips is what kept waking me. I also recall to deep breaths. Since an accident seven years ago I have an involuntary deep inhale event several times a day. It is much less frequent in the past year or so. I'm attaching screen shots of last night's two hours.//imgur.com/3vIGP74]
![[Image: 3vIGP74.png]](http://i.imgur.com/3vIGP74.png)
[/url]//imgur.com/PISOfQr]
![[Image: PISOfQr.png]](http://i.imgur.com/PISOfQr.png)
[/url]//imgur.com/sNHZOJy]
![[Image: sNHZOJy.png]](http://i.imgur.com/sNHZOJy.png)
[/url]//imgur.com/LDHSMt2]
![[Image: LDHSMt2.png]](http://i.imgur.com/LDHSMt2.png)
[/url]//imgur.com/03QIRdv]
![[Image: 03QIRdv.png]](http://i.imgur.com/03QIRdv.png)
[/url]Is there a way to print the daily reports?
RE: I'm New and I'm Tired...zoom of CA's - Sleeprider - 03-03-2015
Pressures are pretty low for pressure induced CA. I would first of all suggest that your overall incidence of apnea of all kinds is very low. This does not seem to require more aggressive ventilation to resolve. My suggestion is turning your EPR down to 1 if exhalation is not difficult at your therapy pressure. For some of us, the pressure swing can induce CA. You may be able to tolerate lower pressures, but with the EPR at 3, the variable pressure in each inhale/exhale cycle may be obscuring what is going on at these low pressures. The key data missing in the graphs above is leaks, and that information could change everything if leaks are excessive.
RE: I'm New and I'm Tired...zoom of CA's - Hilobarbie - 03-03-2015
(03-03-2015, 07:56 PM)Sleeprider Wrote: Pressures are pretty low for pressure induced CA. I would first of all suggest that your overall incidence of apnea of all kinds is very low. This does not seem to require more aggressive ventilation to resolve. My suggestion is turning your EPR down to 1 if exhalation is not difficult at your therapy pressure. For some of us, the pressure swing can induce CA. You may be able to tolerate lower pressures, but with the EPR at 3, the variable pressure in each inhale/exhale cycle may be obscuring what is going on at these low pressures. The key data missing in the graphs above is leaks, and that information could change everything if leaks are excessive.
I may not understand exactly, I'm just too new, but my EPR was set at 1 last night. Prior to last night it was 2, but never 3. The second graph has leak rates and the last graph I included to show the data summary box on the left. Not knowing what I'm seeing on the graphs is a disadvantage, but the leak rate spike seems to correlate with the CA's. The first graph is zoomed in, the others are not. I do appreciate your input.