Still need help with cpap therapy

[notam2]

Yes, its coherent with my analysis.  Relatively speaking, it feels like your bigger problem is arousals/flow limits/hypopneas rather than OAs.  I'll ignore the CAs for now since they may be drug-induced and the overall number hovers in the vicinity of 2 per hour.

I think the pap machine took your 127 hypopneas and turned them into flow limitations.  The autoset algorithm attempts to treat the flow limitations by increasing pressure, and while that's effective for most people I'm not sure if its working for you because your airway might be as open as its going to get even at a lower pressure.  So while looking at the median and 95% numbers would ordinarily make me think a pressure of at least 10 would be appropriate, I think its worth a shot for you to try 8 with EPR 3.

Edited to add: When I started pap therapy, I was using an Autoset and it had my median pressure at 14 and 95% pressure at 16.  My median EPAP was 11.  My flow limits were similar to yours.  I talked my doctor into attempting bipap.  Doctor agreed but wanted to increase my pressure even more which I refused.  Long story short, by switching to bipap my flow limits disappeared, my median pressure decreased to 13, my median EPAP decreased to 9 and my 95% pressure decreased to 13.5.  Most importantly, the arousals I was having at night disappeared.  The autoset algorithm works most of the time, but sometimes you need to manually intervene.  It goes without saying that just because this approach worked for me, your results may be different.

[weuw]

Hello,

thanks to your help I slept a lot better with pressure 10 and EPR 2 last night (1h20 deep sleep vs less than 30 min).
It's not perfect but it is a good step. Last months I managed to get sometimes 2h deep sleep (by the way the Autosleep Apple Watch is a great tool for sleep problems).

Now I think I keep going with your settings but gradually lowering pressure and rising EPR.

For next night I have three options : Pressure 10 and EPR 3 - Pressure 9 and EPR 2 - Or no change and wait a little

Regards,
Serge

PS : last night IAH was 3.7 with 2.9 central

[notam2]

Did you have any OAs last night? What were your 95% and max flow limits?

If you prefer to only change one variable at a time, then I'd suggest increasing your EPR to 3.  The best way to see if the added pressure support helps though is to keep your EPAP constant.  Right now your EPAP is 8 and your IPAP is 10.  You can keep your EPAP at 8 and increase your IPAP to 11 by doing the following two things simultaneously:

1) increase EPR to 3; and
2) increase pressure to 11.

Then compare the 95% and max flow limits of the new setting to the old setting.

Caveat: Its sometimes hard to judge the effectiveness of these settings based on a single day of data.

[weuw]

Did you have any OAs last night? What were your 95% and max flow limits?

If you prefer to only change one variable at a time, then I'd suggest increasing your EPR to 3.  The best way to see if the added pressure support helps though is to keep your EPAP constant.  Right now your EPAP is 8 and your IPAP is 10.  You can keep your EPAP at 8 and increase your IPAP to 11 by doing the following two things simultaneously:

1) increase EPR to 3; and
2) increase pressure to 11.

Then compare the 95% and max flow limits of the new setting to the old setting.

Caveat: Its sometimes hard to judge the effectiveness of these settings based on a single day of data.

I don't have details of last night because I am in vacation without Oscar software.
But Resmed told last night IAH was 3.7 with 2.9 central.

I've already tested 11 with EPR 3 but it was a mix bag. In fact I was disturbed by pressure (nose itchy).

[notam2]

Well, in that case I'd suggest going down to 9 with EPR 2 and see how it is.

[weuw]

Hi last night with EPR 2 and pressure 9.2. I have slept still a bit better. IAH was just a little higher with 4.2 but always 95% CA.

Next night I'll try 9 with EPR 3 and I'll give you my feeling.

Thanks again for all.

[weuw]

Hello !

Back to home I can now post a new screen captures of Oscar datas for last night : 
   

Detail :  
   

As you can see my AHI is still a bit high with only CA. My sleep however has improved and I feel better.

Now I am wondering how I can lower CA : is is better to continue going down pressure (8 for instance) with same EPR, or keep the same pressure with EPR 2 ?

Thanks a lot for all advices here which helped me so much.

Serge

[notam2]

I think that the most important thing for now is that your sleep has improved.  I noticed that your 95% and max flow limits yesterday were the lowest that you ever posted.  I believe that EPR 3 is what is helping most with your flow limits, and that your flow limits are what is hurting the quality of your sleep the most.  It's possible that your body just needs some time to adjust to the higher EPR setting since its likely causing lower CO2 which is triggering CAs.

Since it doesn't look like you have many OAs you can try pressure 8 with EPR 3, but I wouldn't go much lower than 8 for your pressure.  7 cmw would be the absolute lowest you could go with EPR 3 if you were curious and wanted to see what it is like. I also think you should keep EPR 3 for a week or two to see if the setting continues to keep your flow limits low.

Edited to add: If you go down to 8 with EPR 3, I would also turn off ramp.  Right now your starting pressure is 7.  Doing a 40 minute ramp to only increase 1 cmw is probably not helping very much.

[weuw]

Hello !

Last night I tried pressure 8 with EPR 3 (and short ramp). It was not a very good night, only 30 min of deep sleep. 

Here's Oscar screenshots as usual :

   

   

As you can see end of the night was terrible with a lot of CA. 

I don't understand why CA are not lowering with less pressure...

Regards
Serge

[factor]

I don't understand why CA are not lowering with less pressure...

Because your epr is set at 3.  
See Gideon said it might help. http://www.apneaboard.com/forums/Thread-...#pid404736

Did the Sleep study tell you you had Central Apnea?  I did not see that you did. So it treatment emergent.  
1)
Why not try a range like 8 - 14
Mode: Auto APAP
Min: 8
Max: 14
EPR: 2 Full time
Ramp OFF or if you must have ramp 7 and 15 min.   The goal is NO ramp.
What this will do is let the Machine work within a pressure range if needed.
You will get CO2 flushing and centrals the more you mess with the settings.  

OR do this.
2)
Look back through all of your days and find the best days.  See what the pressure was then set your pressure on that number then set the epr to 2.
Do either #1 or #2 

Then dont change it for a week.
Then report back