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09-30-2024, 12:16 PM (This post was last modified: 09-30-2024, 12:22 PM by Leonidas2693.)
Data Help for a guy in need
Hey everyone,
First time posting here and looking for a kind soul to take a look at my data and offer up any advice they may have. Im almost 6 months in and just cant seem to figure things out.
Main Problem: I cant stay asleep through the night and on the rare occasion that i do, I feel like death in the morning.
Some things that may help you help me:
-The higher my EPR the worse my CA's
-Aerophagia. I seem to get this at most pressure settings but if my EPR is too low i get it. Which is why I don't really know what to do because this conflicts with what helps my CA's.
I have tried a TON of setting combinations so let me know if you want to see other data charts for specific settings.
Your CA are treatment emergent and will reduce as your body become use to the therapy. I would slowly move the EPR up as time goes on. Start with EPR full time EPR 1. You many need to wait 2 to 3 weeks and then move the EPR to 2. Again, let your body get use to the setting and move to EPR 3. When you get to 3 you may want to start autoset with a min and max but for now keep it where the 2nd charts static number (9.4).
Thank you for responding. I have added a chart from two nights ago with a range of 9-10 with EPR at one.
Would this still be considered treatment emergent CA's? Im five months in shouldnt they have gone away by now? Could I just be very very sensitive to EPR and cant use it?
Im willing to try anything so I will try your recommendation.
It sounds like you have been moving your setting quite a bit. You really need to stay for a while at a setting or very close to the setting and let your body adjust. If you keep moving around a lot your body can't adjust and CA are common.
first order of business is to always zoom in to verify if the CAs are true CAs or just post-arousal CAs, which are quite common. That said, with the limited information you've made available, it's more likely they're true CAs, but always best to confirm.
It's not uncommon for EPR to set on CAs, because increasing pressure support (EPR is essentially pressure support) will increase ventilation (removal of CO2), theoretically speaking, and CO2 is responsible for your drive to breathe.
Aerophagia can be caused by arousals themselves, so it's not necessarily a pressure issue, but the latter is more probable. It's true that you should increment your changes slowly, particularly if you're showing signs of sensitivity, which typically implies you have a low CO2 buffer. This conversation can be a pandora's box, but for now I think there is some lower hanging fruit for you.
Make sure you're breathing through your nose; if you can't, that might be the sign of a greater issue, but nasal breathing results in greater end-tidal CO2 and therefore, in extension, typically less apneic spells. In other words, mouth breathing can exacerbate the consequences of an already thin CO2 reserve. I'm assuming you may have already attempted this, but turning EPR off for now, or at least staying at a fixed setting for it, is advised, as we want to minimize the perturbations and isolate the problem.
This is kind of obvious, but you're probably still waking up because your pressure is insufficient / not optimized. From a distance, I can see that you still show a lot of dysregulated breathing, and your flow-limit graph shows unresolved obstruction, which is the elephant in the room, but you're right to entertain the idea that it might not be that.
Yes I have definitely been changing my settings pretty frequently. I guess its kind of back to square one and I will stick with my settings for a few weeks.
I am struggling bad so i really appreciate your input already.
As far as CA's, i have both. The ones that are by themselves are usually right after a large spike in my breathing which i take it are arousals then a CA. When my CA's are clustered together there usually is not a spike before them in my breathing.
I currently use mouth tape and a chin strap because of very bad mouth leaks. I think im more of a jaw relaxes and drops open than an actual mouth breather (not sure if that matters)
To make matters more complicated, I usually have 50-100% blockage in one or the other nostril depending on the night (I have tried nearly everything to fix that). I had given up solving this problem because I read that as long as one nasal passage is clear I should be fine?
With all of that being said, you would recommend constant pressure with EPR off? Is there any other data/information I can provide that would better help you? I have attached both types of CA's that i experience.
first order of business is to always zoom in to verify if the CAs are true CAs or just post-arousal CAs, which are quite common. That said, with the limited information you've made available, it's more likely they're true CAs, but always best to confirm.
It's not uncommon for EPR to set on CAs, because increasing pressure support (EPR is essentially pressure support) will increase ventilation (removal of CO2), theoretically speaking, and CO2 is responsible for your drive to breathe.
Aerophagia can be caused by arousals themselves, so it's not necessarily a pressure issue, but the latter is more probable. It's true that you should increment your changes slowly, particularly if you're showing signs of sensitivity, which typically implies you have a low CO2 buffer. This conversation can be a pandora's box, but for now I think there is some lower hanging fruit for you.
Make sure you're breathing through your nose; if you can't, that might be the sign of a greater issue, but nasal breathing results in greater end-tidal CO2 and therefore, in extension, typically less apneic spells. In other words, mouth breathing can exacerbate the consequences of an already thin CO2 reserve. I'm assuming you may have already attempted this, but turning EPR off for now, or at least staying at a fixed setting for it, is advised, as we want to minimize the perturbations and isolate the problem.
This is kind of obvious, but you're probably still waking up because your pressure is insufficient / not optimized. From a distance, I can see that you still show a lot of dysregulated breathing, and your flow-limit graph shows unresolved obstruction, which is the elephant in the room, but you're right to entertain the idea that it might not be that.
CPAP Friend-
Sorry, not sure if im supposed to reply with quote or not so ill just reply again. I had added two zoomed in pics of my CA's in my reply before this one, and have added three nights of charts at 9.4 fixed pressure with EPR off. All three nights i did get aerophagia and all three i did wake up ( i am aware it was probably leaks that woke me up in the one).
