[Treatment] BlancINegre Therapy Thread

[blancinegre]

Hello everyone,
I'm new to the forum.
I was diagnosed with sleep apnea in May 2023 with these values in the polysomnography study:
Sleep structured in four NREM-REM cycles, with a predominance of superficial sleep (NREM phase II 59.5%) with a decrease in the rest of the sleep phases, and an increase in intrasleep wakefulness and sleep fragmentation. Sleep onset latency was within normal limits, with a total sleep time of 307.5 min, and a sleep efficiency of 71.5%
129 obstructive hypopneas were recorded, which gives us an apnea-hypopnea index of 25.2 (No CA's present in the study)
The average 02 saturation during sleep time was 96.
The diagnosis was presence of a moderate sleep apnea hypopnea syndrome.

Start treatment with CPAP at a constant pressure of 8 and after titration, the doctor raised it to 10.
In December 2024 I was changed to APAP with pressures 5-12 because with constant pressure I had many awakenings and aerophagia.
I use APAP all days an average of 7 hours daily.
I still have a lot of awakenings so I want to improve my sleep as much as possible.
I have been testing EPR, increasing it to from 1 to 3, raising minimum preasure to 7 before this to have full treatment benefit but it increases my CAs and I have a worse sleep using EPR.
I currently have EPR off for this reason.

Attached are Oscar screenshots from three recent nights of my treatment. 

Any help would be greatly appreciated, and please let me know if any additional information or screenshots I should provide.

           

[blancinegre]

Hi,
I'm reading some forum posts and it could be that my problem is UARS?
My flow limitation numbers are not good and I can see flattened inspiratory peaks in the Flow Rate chart.
I am attaching a file with an zoomed view of tonight's OSCAR flow chart.

Any thoughts/recommendations?

Thank you very much for the help!

          

[Deborah K.]

Since you had no CAs in your sleep study, yours are treatment-emergent and will lessen as time passes.  You can safely ignore them.

You would do well to use Apap mode again and set a pressure range of 9 to 15.  This is because your median pressure is over 9 and you were bumping against the 12 upper pressure limit you had set.

Your flow limits are high so you should try EPR full-time, set at 3 again.  If that's uncomfortable, start with 2.  Flow limits are apneas that are too short to be reported, but can interfere with good therapy and need to be lowered.

I don't know enough about UARS to comment.  Perhaps someone will be able to address that for you soon.

Again, welcome, and best wishes for achieving great therapy and comfort!  

[blancinegre]

Thanks Debora K.,
I'm going to follow your recommendations for 2 or 3 nights. 
Back to APAP mode min 9 max 15 - EPR3.

I'll give it a try and I'll publish OSCAR's screenshots to see the evolution along with my feelings.

Thank you very much for your assistance and recommendations.

[blancinegre]

Hello,
Here are my results after 3 nights with these settings: APAP mode with pressure 9-15 and EPR3.

First two nights:
AHI has increased, mostly due to centrals.
Sleep quality had been worse with more arousals and not restful.

Last night: Less AHI, less centrals, better sleep than the first two nights but with several arousals and not restful.
In general over the 3 nights, 95% Flow limitation index has decreased, I think due to the use of EPR.

Should I keep these settings for some time or make any changes?

Thanks in advance!