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[Treatment] What Went Wrong Here?
#1
What Went Wrong Here?
Day Three on APAP. 
Last night I experienced a number of mask leaks. I was experimenting with sleeping with a wedge pillow/cervical collar and a left side lying position. I'm not sure the mask is a good fit. Some of the brief disturbances were most likely me adjusting the mask.
I'm not happy with the number of events, especially central. I had no central events during my titration test in the lab. Should I turn the EPR down? Any advice would be appreciated.

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#2
RE: What Went Wrong Here?
Those CA events are pretty clustered so likely positional, your 99.5% is 17.74cm but I can't see what EPR setting you are on. I am one of the few others here that like to suggest trying cpap mode to see if you take to it, so I'd set it to cpap mode at 18cm with EPR on at 3 and see how you feel for an hour or so before bed, if it feels good try it for a night or two then post charts Smile Also, wedge pillows can be very difficult to get setup properly, so for now I'd just use a flat pillow under your head and another one (mallable-adjustable) to prop up your head between your shoulder and face.
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#3
RE: What Went Wrong Here?
Thanks for your thoughts!
I had a suspicion that the wedge pillow was causing me to slide and end up in a distorted position. I'll substitute a flat pillow and a head cushion that maintain neutral neck alignment.
As soon as I can tolerate CPAP mode at 18 I will likely switch over. I'm going to figure the mask placement out. It was good for the first two days. I think the head gear may be too large. The attachments are close to the tightest they can possible go.
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#4
RE: What Went Wrong Here?
Improved report last night. Not perfect, but better. Slept on left side, wedge pillow replaced by flat pillow. No mask leaks.
Any recommended adjustments?
Thanks!  

   
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#5
RE: What Went Wrong Here?
Good! I would lower max pressure down to 15cm and raise min pressure to 10.6cm.
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#6
RE: What Went Wrong Here?
Did you have a lot of CAs in your sleep study?  If not, your CAs are treatment-emergent and will lessen as time passes and you adjust to your therapy.  That will leave you with a much lower AHI. Smile
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#7
RE: What Went Wrong Here?
My sleep study was an at-home which didn't measure CA's. I had none whatsoever during my titration test. 
My EPR is set at 3. Do you recommend that I lower it?
Thanks!

Sounds like a plan.
I really appreciate your time and recommendations.
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#8
RE: What Went Wrong Here?
You can try a low EPR if you want. It might lower CA, but it'll also affect the other events with increases, like flow limits, Hypopnea, maybe even Obstructive Apnea. It's a teeter totter thing, push one side down with control edits, the opposite goes up. Then if you see that action, then it's trying to balance things to be lowest attainable in both Central and Obstructive sides.
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