[CPAP] Newbie looking for help/opinions please!

[pholynyk]

In my experience, with no CA, few OA, and lots of hypopneas, the thing to do is to increase your EPR to 3. You may want to increase your maximum pressure by 2, to 19, to compensate. In addition, your minimum pressure is quite a bit below your median pressure; it could probably be increased to 12 or 13 (with EPR at 3).

Now it's never a good idea to change more than one thing at a time, and always to wait 3 to 4 days (or more) before making new changes. I would recommend changing the EPR first, then slowly increasing your minimum, 1 cmH2O at a time, before increasing the maximum pressure. During this time, I would compare my charts from day to day looking for trends. You want to lower those hypopneas without getting any central apneas showing up.

I hear you about the foam collar problems. Mine was big enough to go around my neck, but so tall it pushed my jaw forward and made my teeth hurt. I think I've found a place locally that sell various sizes, so I'll try again.

[buckrogers76]

In my experience, with no CA, few OA, and lots of hypopneas, the thing to do is to increase your EPR to 3. You may want to increase your maximum pressure by 2, to 19, to compensate. In addition, your minimum pressure is quite a bit below your median pressure; it could probably be increased to 12 or 13 (with EPR at 3).

Now it's never a good idea to change more than one thing at a time, and always to wait 3 to 4 days (or more) before making new changes. I would recommend changing the EPR first, then slowly increasing your minimum, 1 cmH2O at a time, before increasing the maximum pressure. During this time, I would compare my charts from day to day looking for trends. You want to lower those hypopneas without getting any central apneas showing up.

I hear you about the foam collar problems. Mine was big enough to go around my neck, but so tall it pushed my jaw forward and made my teeth hurt. I think I've found a place locally that sell various sizes, so I'll try again.

Thanks Pholynyk

I'm going to try and get some more sleep and increase my EPR to 3 and see how that goes! , its so tempting though to implement all the changes at once as its very frustrating have continually rubbish sleep patterns.

Regards

Buck

[pholynyk]

Trust me. One thing at a time is better. And post screenshots anytime you see something you don't understand.

[buckrogers76]

Trust me. One thing at a time is better. And post screenshots anytime you see something you don't understand.

So!

Please see below for updated SH data which is split handily to show the period after my middle of the night break and changing the EPR to 3



[img]blob:http://imgur.com/2d700891-8ff3-499f-b2ad-712ed0b071ee[/img]

[pholynyk]

That looks promising. I think you should do three or four more nights with EPR set to 3, to make sure the reduction in hypopneas was not a one time thing. And also to make sure the CA's don't increase.

[Sleeprider]

Pholnk touched on the fact the using EPR would lower your EPAP (exhale) pressure. This does need to be compensated for by increasing the minimum pressure. Whereas before your minimum pressure was 9/8, it is now 9/6. You really need to increase the minimum pressure to 11 to keep EPAP above the threshold for OA. This will result in minimum pressure of 11/8 which I think you will still find comfortable.

It's fine to change one thing at a time, but in the case of EPR we are really changing two things. EPR changes EPAP which is critical for preventing OA events. The pressure support (difference between inhale and exhale pressure) is an effective way of treating hypopnea, but we don't want to let the obstructive apnea in.

[buckrogers76]

Pholnk touched on the fact the using EPR would lower your EPAP (exhale) pressure.  This does need to be compensated for by increasing the minimum pressure.  Whereas before your minimum pressure was 9/8, it is now 9/6.  You really need to increase the minimum pressure to 11 to keep EPAP above the threshold for OA.  This will result in minimum pressure of 11/8 which I think you will still find comfortable.  

It's fine to change one thing at a time, but in the case of EPR we are really changing two things.  EPR changes EPAP which is critical for preventing OA events.  The pressure support (difference between inhale and exhale pressure) is an effective way of treating hypopnea, but we don't want to let the obstructive apnea in.

Well another rough night! collar was kept on the whole period and settings adjusted as advised. AHI is the same as during sleep study without wearing CPAP , also in another development i seem to have developed some kind of vertigo/dizziness and blurred vision in one eye!

Anyhow SH data is posted below again and some input would be much appreciated!

Regards

Buck





[img]blob:http://imgur.com/6b702bc7-ceb3-413c-adc5-3cc0e5d08324[/img]

[ajack]

Looking back over your charts, raising the pressure isn't doing that much. It looks like there could be position clusters to me. I would make sure you aren't tucking your chin. For $10 you can get a soft foam cervical collar, to eliminate any neck airway obstruction. If needed try and stay off your back. The collar is a simple tool to determine if there are issues, without the expense of new pillows and such.

the max 17 may need to be raised and min increased more, At this stage with the charts I would guess 15 - 20, if nothing else works and then you may be better with bpap.
I would try positional therapy. some find it very successful without the need to raise pressure.

[buckrogers76]

Looking back over your charts, raising the pressure isn't doing that much. It looks like there could be position clusters to me. I would make sure you aren't tucking your chin. For $10 you can get a soft foam cervical collar, to eliminate any neck airway obstruction. If needed try and stay off your back. The collar is a simple tool to determine if there are issues, without the expense of new pillows and such.

the max 17 may need to be raised and min increased more, At this stage with the charts I would guess 15 - 20, if nothing else works and then you may be better with bpap.
I would try positional therapy. some find it very successful without the need to raise pressure.

Thanks for responding ajack! I did diligently wear my foam collar all night last night however it is to small and a bit flimsy. I have another xl one on its way in the post.
I also sleep exclusively on both sides and rarely on my back.I had a look back at my SH data when my settings were 4-14 and ramp only on Epr set at 1 and my AHI was much better. Is there anything else I could try on the settings on the machine i.e. Cpap instead EPr off or am I clutching at straws! Also how does bi pap differ and can the resmed unit fulfill this function? Sorry lots of questions but I'm desperate to get this right! Might try one final night on higher settings and see what happens!

Regards

Buck

[Sleeprider]

The chart above consistently shows flow limitations and snores associated with OA clusters. So we are dealing with obstructive apnea. If the collar is not working, then higher pressure, and specifically EPAP pressure is needed. I suggest removing the limit of 17 from maximum pressure and allow the machine to move up to 20 as needed. If OA continues, then your only remaining tool is to start reducing EPR. I hope a better cervical collar will help, but I'll at least say you're not alone in needing high pressure to resolve apenea. Bonjour, another member here uses a bilvel at pressure up to 24 cm.

Bilevel machines are capable of higher pressure up to 25 cm. They provide the equivalent of EPR, but it is not limited to 3-cm, so there are separate EPAP and IPAP pressures, or in auto mode, a minimum EPAP and pressure support. CPAP is a fixed pressure variation of the auto CPAP. The traditional CPAPs did not offer much exhale pressure relief, but all machines seem to do this to some degree for comfort. In your case, you may simply need to reduce the EPR setting, effectively raising EPAP.