Seeking Treatment Advice Please

[rosetech]

Hi All,

I'm hoping to get some advice from you learned folks for next steps to improve my treatment. 

I've been using an untouched configuration for years. Recently I've become fatigued and lack motivation. I initially thought it was a low T thing. I checked my readings on Oscar and was surprised to find leakage and a number of clear airways events.

I've grown a beard so switched from an airtouch F20 to N20i. Leaks are now eliminated but I'm still floating around AHI 2.2+. It doesn't seem high, but I feel I'm awake every hour and I get up feeling tired. Tired in a way that you know you struggled breathing overnight. When I get a reduced AHI I feel correspondingly better.

It's been over 5 years since my last sleep study where I clocked in at 63 AHI with no central aponea. These clear airways concern me reading about treatment-emergent central sleep aponea.

I've read EPR can falsely trigger clear airways so I'll spend a few days reduced to 1.

I've also read maintaining a smaller gap between min and max pressure might eliminate awakenings? Should I maybe give CPAP mode a try? I'd like to hear your thoughts on recommended pressure settings.

One final question, why is it encouraged to turn ramp off? Assuming we only ramp on turn on (in my case 10 mins), why should it concern me in themiddle of the night?

Thanks in advance!
John
   
   

[Dodies]

Try increasing min pressure to 7 or 8

[Deborah K.]

I suggest raising your minimum pressure to 8.4, which is your median pressure anyway. I would not worry about the CAs, since you had none on your sleep study. You could lower your EPR to 1, but I think keeping your flow limits down is more important. It's up to you.

[CPAPfriend]

Pressures and settings should be re-evaluated at least once per year as our needs will change with the many changing variables their subject to.

It will help to look at your overview tab, and to try to discern if any more noticeable changes occurred over the trend of your data, perhaps allow you to narrow in on the culprit.

EPR, because it's basically pressure support, can theoretically increase ventilation and, therefore, increase the number of central apneas. An important distinction to make is that central apneas and clear airways aren't always the same thing; that is, the machine cannot actually determine if your central respiratory drive is somehow not kicking in, but instead can only determine if the airway is open and that you're not breathing. In other words, if you just hold your breath with the machine on while awake, the machine will call it a clear airway. Some of the clear airways that I can see in your flowrate are actually post-arousal, due to obstruction, clear airways, and therefore have nothing to do with your central respiratory drive / central apnea as we view it. Meaning, those ones are a pressure problem, not a CO2 problem.

Changing pressures can be problematic for more sensitive patients or patients with high loop gain. As someone who works one-on-one with people, I encourage narrow APAP ranges, if APAP is preferred, particularly if they show signs of higher loop gain, as people seem to do better under such conditions. The logic is pretty simple. If your ideal average pressure is say 7cm, and then you have some, say, positional apnea and the machine cranks your pressure up to 12cm, but you only needed that pressure (if at all) for 5 mins, then the pressure profile will decay over hours, maintaining you at a higher pressure than needed. Higher pressures, as a rule of thumb, translate to increased probability of issues, so we always want to accomplish things at the lowest pressure possible. Also, if you have high loop gain, moving the pressures around all night can be problematic.

Strongest argument for no ramp is in same camp of reasoning. Changing pressures can be a problem. Hope this helps!