Does the machine tell the truth?

[duece12345]

here is my data from last night, maybe someone can take a look?  Woke up this morning feeling pretty groggy.  like I slept about 2 hrs VS the 7-8 that I did.

[Sleeprider]

Deuce, you have pretty high flow limitation, which puts you in good company with others on the forum. When you organize charts, it will help if you include that chart instead of leak rate, as flow limitation is the bigger problem here. Flow limits often start with upper airway restriction, and it limits the flow rate through your airway. If you zoom in on the respiratory flow chart to where the individual waves are visible, you will see distinct flattening of the inspiratory wave. Flow limitation is a major driver of pressure increases in the Resmed Autoset, and that is why your pressure is near the maximum much of the time. Flow limits result in hypopnea when you can't move enough air, and frequent respiratory effort related arousals (RERA) which are visible in your flow rate chart as spikes in flow rate. This condition is very disruptive to sleep.

The solution for this flow limitation is to increase EPR and pressure. I think you need a minimum CPAP pressure setting of 7.0, and you should consider increasing the maximum pressure to 12.0. You are currently using EPR full time at a setting of 1. I suggest you increase EPR to 2, and observe for an increase in CA events. If they remain at the current level, then increase EPR to 3. The use of higher pressure and EPR will relieve the flow limitation and hypopnea, and reduce the arousals that are disrupting your sleep. The risk of using more EPR s an increase in CA events.

[3rdMarDiv]

I have gotten past general CPAP use to where I am comfortable with the machine and all that comes with it. I and am now able to concentrate on getting a good nights sleep in general. Looking at your chart, to me, I see a lack of deep sleep and the possibility of detecting REM sleep is obscured by overall erratic sleep. Looks like light sleep, near waking sleep and awake sleep. Terrible!

From a perspective of eliminating OA's, CA's and Hypos it looks like you have overcame the general nuisances of just using a CPAP machine and are able to cope with it well.

Again, as SD said, you have other elements that are disrupting your biological need for Deep and REM sleep. I'm sure someone else on this site ca work with you at figuring that out and you will be able stabilize into a more predictable nights sleep. To me, your chart looks very unhealthy to a peaceful and productive nights sleep.

I have observed that any small hiccup like a Hypo, CA or OA can knock you right out of deep sleep. But, you should, hopefully go into a strong light sleep and not where you are going.

I should have asked, are you sleeping during the day? For me, a half hour nap is going to disturb my getting a really good night sleep. If I were to cumulatively get an hour of day sleep, that would really impact my quality of sleep.

This is an interesting thread that I will be interested in seeing how the experts solve...

[duece12345]

Deuce, you have pretty high flow limitation, which puts you in good company with others on the forum.  When you organize charts, it will help if you include that chart instead of leak rate, as flow limitation is the bigger problem here.  Flow limits often start with upper airway restriction, and it limits the flow rate through your airway. If you zoom in on the respiratory flow chart to where the individual waves are visible, you will see distinct flattening of the inspiratory wave.  Flow limitation is a major driver of pressure increases in the Resmed Autoset, and that is why your pressure is near the maximum much of the time. Flow limits result in hypopnea when you can't move enough air, and frequent respiratory effort related arousals (RERA) which are visible in your flow rate chart as spikes in flow rate. This condition is very disruptive to sleep.

The solution for this flow limitation is to increase EPR and pressure.  I think you need a minimum CPAP pressure setting of 7.0, and you should consider increasing the maximum pressure to 12.0.  You are currently using EPR full time at a setting of 1. I suggest you increase EPR to 2, and observe for an increase in CA events. If they remain at the current level, then increase EPR to 3.  The use of higher pressure and EPR will relieve the flow limitation and hypopnea, and reduce the arousals that are disrupting your sleep. The risk of using more EPR s an increase in CA events.

Wow thanks for the response!
i will certainly make the changes.  I often have a lot of “CAs”.  Should I just forgo the increase EPR and just increase pressure instead?  Isn’t the EPR just a comfort function.

[SarcasticDave94]

IMO: EPR can act as therapy as it is basically a limited pressure range on "EPAP" BPAP. In certain therapy needs, setting to 1 vs 2 vs 3, where each may affect your therapy results differently (AHI and other data).

[Sleeprider]

I'd like to see you make the EPR changes and track what happens to CA. In terms of your quality of sleep, CA events don't seem to have as much effect as the flow limits and hypopnea. I think it deserves a try. We have used EPR with many different members, and obtained quantifiable better results. As Dave said, your machine with EPR is a limited bilevel like the Aircurve 10 series. EPR can be a great comfort feature, but the fact it actually provides pressure support for inspiration is why we use it so successfully. This Apnea Board wiki article shows some more information you will find useful. http://www.apneaboard.com/wiki/index.php...imitations

[Gideon]

BiLevel delivers therapy at 2 different pressures, one for inhale and one for exhale, the difference is called Pressure Support.
CPAP/APAP delivers therapy at 1 pressure, but with ResMed devices utilizing EPR can provide the same benefit of BiLevel up to the limit of 3 cmw (EPR = 1, 2, or 3). Shhhhh, this is a secret don't tell anyone, but it is why ResMed typically outperforms many other CPAP brands.

Per ResMed, EPR is ONLY a comfort setting.

Pressure Support is the preferred way to treat Hypopneas, Flow Limitations, RERAs, UARS, and even snoring so EPR provides excellent therapy up to its limit of 3 cmw (BiLevels can go considerably higher)

[duece12345]

Well y’all certainly know what you are talking about.  I’ll do what you say and report back. Thanks!

[Robylla]

I have Resmed Air 10 for her and the basic info in the morning is definitely not reflective of the night's sleep. If I wake for a bathroom visit half way through the night, my AHI can often be over 7. Then when I get up it can be under 2. I think my AHI is fluctuating with leaks and have come to the conclusion that a perfect mask with a perfect fit is the key ......... I am still searching! Thank goodness I found OSCAR and even though haven't figured how to upload the data to the board, I am learning to interpret the data myself.

[duece12345]

I'd like to see you make the EPR changes and track what happens to CA. In terms of your quality of sleep, CA events don't seem to have as much effect as the flow limits and hypopnea.  I think it deserves a try. We have used EPR with many different members, and obtained quantifiable better results. As Dave said, your machine with EPR is a limited bilevel like the Aircurve 10 series.  EPR can be a great comfort feature, but the fact it actually provides pressure support for inspiration is why we use it so successfully.  This Apnea Board wiki article shows some more information you will find useful. http://www.apneaboard.com/wiki/index.php...imitations

Here is some data from the last 2 nights.  The changes have pretty much taken care of the hypopneas.  Also made some significant improvement in flow limit from my previous weeks of therapy.  Ill monitor for more CAs as the days go by.  Still think I will benefit going to EPR 3?

BTW, thank everyone for this forum, what a great resource!