[Treatment] JuanManuelFangio32 - Therapy Thread

[JuanManuelFangio32]

New member here! I was recently diagnosed with sleep apnea (AHI of 8) and received my CPAP last week. Looking forward to learning from everyone's experience!

My setup: ResMed AirSense 11 AutoSet with ResMed F20 full face mask. Doctor started me at 12-20 cmH2O pressure range.

Initial challenges: First night had significant leak issues, but I've resolved those through strap adjustments and using the machine "mask fitting" test function.

Current status: My AHI is still above 5, but it's predominantly central apneas (CA). Obstructive apneas (OA) are below 2. AdaptHealth has called twice to check-in but hasn't provided much useful guidance beyond "give it time" and "call your doctor if it doesn't improve."

Recent issue: Started experiencing morning stomach bloating after a few days of use. Last night I couldn't tolerate it anymore and decided to make my first adjustment - set EPR to full-time at level 2. No bloating this morning, but the data shows a slight increase in OAs while CAs decreased.

Next steps: Considering reducing EPR to level 1 tonight. Would appreciate any insights from more experienced users on the best approach from here.
I've created a SleepHQ account to share my data - https://sleephq.com/public/teams/share_l...e0606cdb78 . Looking forward to geeking out on this stuff with you all![url=https://sleephq.com/public/teams/share_links/a5068be4-76d4-4973-b9f6-dee0606cdb78][/url]

[CPAPfriend]

Still lots of disordered breathing, and your pressures are too low. You might want to consider switching to bilevel. CAs are context-dependent, and many in your data are post-arousal from obstruction and presumably respiratory effort.

[JuanManuelFangio32]

Still lots of disordered breathing, and your pressures are too low. You might want to consider switching to bilevel. CAs are context-dependent, and many in your data are post-arousal from obstruction and presumably respiratory effort.

Thanks for your reply @CPAPfriend! I'm trying to learn please don't mind my questions - How good breathing looks like v.s. "disordered breathing"?
And given the OA number is relatively low - wouldn't that mean pressure is high enough to prevent obstruction already?

[Sleeprider]

It would be helpful to see zoomed images of 3-4 minutes of your flow rate during CA events. Your 95% flow limits are relatively high at 0.07, and they will increase with lower EPR. Please screenshot the Oscar charts as they provide better detail. CA events are generally not very disruptive to sleep compared to flow limitation. We can work on it.

[jdougc]

Welcome to the forum,
Are you on any medications that affect your breathing or sleep?
Do you have any health issues that  affect your breathing or sleep?
Do you sleep on your side or back?

Ramp pressure is too low at 4 cmH₂O, raise it to at least 7 cm
 Most use Oscar software here, download it

Your Flow Limitations are too high and causing your pressure to increase throughout the night.

Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea
https://pubmed.ncbi.nlm.nih.gov/38530665/

[byroncheung]

It would be helpful to see zoomed images of 3-4 minutes of your flow rate during CA events. Your 95% flow limits are relatively high at 0.07, and they will increase with lower EPR. Please screenshot the Oscar charts as they provide better detail.  CA events are generally not very disruptive to sleep compared to flow limitation. We can work on it.

Appreciate your response @Sleeprider!

Does that sleepHQ link work for you? You should be able to look at my data interactively, zoom in etc : https://sleephq.com/public/teams/share_l...7a94122d18

But I'm attaching zoom in of some CA last night from OSCAR in case you can see it on sleepHQ somehow : https://imgur.com/a/4uOQk4p . Let me know if you want more screen shots / what plots you want to look at!

[Sleeprider]

The statistics really under-state your flow limitation. You have flattened and downward sloping inspiratory peaks all through the night. The relatively few CA events occur following arousal and probably a roll-over and are not respiratory related. I really want to see you increase the EPR to setting 3 to resolve the flow limitation issue. The cluster of OA was probably positional apnea. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[JuanManuelFangio32]

The statistics really under-state your flow limitation. You have flattened and downward sloping inspiratory peaks all through the night.  The relatively few CA events occur following arousal and probably a roll-over and are not respiratory related.  I really want to see you increase the EPR to setting 3 to resolve the flow limitation issue. The cluster of OA was probably positional apnea. 

thanks for these info @Sleeprider!

Sorry if this is a noob misunderstanding - why would increase EPR to 3 resolve the flow limitation? Wouldn't that reduce the pressure on exhale, with less pressure airway would be opened less?

Would you suggest me to try cervical collar to help with positional apnea?

[Sleeprider]

Excellent question. EPR at 3 is like using a bilevel or BiPAP machine with pressure support. you don't have a problem with obstructive apnea, and the minimum expiratory pressure (EPAP) is the tool we use to hold the airway steady against that. What you do have is airway resistance that slows the flow of air during inspiration, and that can result in respiratory effort related arousals (RERA). While these might not be flagged by your machine, it simply means you're working too hard. With EPR, the pressure drops during expiration, but during inspiration, the pressure increase, or support, can offset the airway resistance that causes airflow to actually stop responding to your inspiratory effort, or even reduce. Analogy is to suck on a paper straw. It collapses more and more as the suction increases. EPR acts to increase pressure as that respiratory suction increases and allows a normal full breath that appears on a flow rate graph as a nice rounded shape. That means you didn't have to work for it, resulting in better rest and less arousal. Once you have solved flow limitation, you'll never go back.

[JuanManuelFangio32]

Excellent question. EPR at 3 is like using a bilevel or BiPAP machine with pressure support. you don't have a problem with obstructive apnea, and the minimum expiratory pressure  (EPAP) is the tool we use to hold the airway steady against that.  What you do have is airway resistance that slows the flow of air during inspiration, and that can result in respiratory effort related arousals (RERA). While these might not be flagged by your machine, it simply means you're working too hard.  With EPR, the pressure drops during expiration, but during inspiration, the pressure increase, or support, can offset the airway resistance that causes airflow to actually stop responding to your inspiratory effort, or even reduce.  Analogy is to suck on a paper straw. It collapses more and more as the suction increases.  EPR acts to increase pressure as that respiratory suction increases and allows a normal full breath that appears on a flow rate graph as a nice rounded shape.  That means you didn't have to work for it, resulting in better rest and less arousal.   Once you have solved flow limitation, you'll never go back.

Great explanations! Thanks @Sleeprider!