[CPAP] Optimal AHI

[Sleeprider]

Mike, your median pressure is a bit over 12 with settings of 8-16 with EPR at 3.0. I'm thinking your minimum pressure of 8.0 is a bit on the short side, and if you keep EPR at 3, would suggest 10 might work out a bit better.

As an alternative to increasing minimum pressure, I'm going to suggest you reduce EPR instead. Let's stay with 9-16. but put EPR at 1. I think this will result in the lowest AHI.

The organization for graphs that is most useful is described in the first link in my signature line.

[Gideon]

I see pressure climbing almost immediately to what I think is 11+ with settings of 8-16 and no EPR
I see a fair number of CA events so I'll ask again, (sorry if I missed it) does your wife have any mention of Central Apnea or Complex Apnea from her sleep study? Was the sleep study at home or in lab?

Except for the CA portion I would raise the minimum pressure to 10 but would not expect that to do much because it is below the minimum pressure the machine is holding all night. If these are "real" CA events we need to be cautious, if we don't know we still need to be cautious. ROT Higher pressures tend to make CA worse. whereas higher pressures make obstructive events less.

The intent, without further info would be to slowly (.2cmH2O) every third night or longer and watch closely to see what happens.

[Gideon]

SleepRider I read EPR was Ramp Only, otherwise cutting the EPR would have been my 1st choice. I don't know, can EPR be set for Only in the Ramp? I think so because of the consistency of the pressure

[MikeV99]

Thank you for the suggestion. I'll change the setting to 1. 

I think the last image I posted followed your instructions. I spent most of the afternoon with a learning curve. Did I miss something? 

Thank you again.

Mike

[MikeV99]

I see pressure climbing almost immediately to what I think is 11+ with settings of 8-16 and no EPR
I see a fair number of CA events so I'll ask again, (sorry if I missed it) does your wife have any mention of Central Apnea or Complex Apnea from her sleep study?  Was the sleep study at home or in lab?

Except for the CA portion I would raise the minimum pressure to 10 but would not expect that to do much because it is below the minimum pressure the machine is holding all night. If these are "real" CA events we need to be cautious, if we don't know we still need to be cautious.  ROT Higher pressures tend to make CA worse. whereas higher pressures make obstructive events less.

The intent, without further info would be to slowly (.2cmH2O) every third night or longer and watch closely to see what happens.

She had a sleep study in a lab in June 2014 and May 2016. Nothing in the reports that I have mentions either Central or Complex Apnea. Sounds like she needs to touch base with her sleep study doctor?

Thanks

[Gideon]

Not necessarily, It would be very unusual for a sleep study to miss CA. I'll let SleepRider override me if he disagrees.
Having some CAs is not unusual, We can re-evaluate if the numbers climb.

Set the minimum to 10 as both of us has suggested. Then we look again.

[Spy Car]

As a relative newcomer, I hardly feel qualified to offer a contrarian opinion but looking at the graphs it looks like the EPR is off except for the ramp period. In my personal case, when the EPR is off my events rise in a fashion not dissimilar to what's posted here. I do far better on EPR 3.

Also, it looks like 97% (or so) of the events are happening with a pressure of about 13, so raising the minimum to 10 with no EPR doesn't strike me as the answer.

I'd be tempted to turn the EPR on and see how that goes. It would likely provide better comfort and might drive down the numbers.

Bill

[Gideon]

SpyCar you are correct. It is a cautious 1st step. I would not be surprised if we ended up near 12+. But
We are seeing fairly good results that could be a bit better.
Just a bit of patience.

[Sleeprider]

Just to make sure we're all on the same page, the image I was commenting on is below.  This shows settings at 8-16 and EPR at 3.  My suggestion for starters was to reduce EPR. This was intended to both address the obstructive component and CA component.  What I missed is that EPR was only on during Ramp.

OA appears to be real based on a persistent flow limitation in the graphs. So I agree an increase in minimum pressure is needed to address the OA. The amount of flow limitation has me wondering if perhaps a bilevel approach might help, which in this case means having EPR full time. In theory we cold move the minimum pressure to 10, and use EPR at 3 full time and that would provide the "pressure support" to reduce the hypopnea and flow limitation. The auto function would allow IPAP to rise to 16 max, allowing a maximum pressure of 16/13.

Good catch Fred and Spycar, I missed this.

[MikeV99]

OK - EPR on full time @ 3 and see what happens next couple of nights.

Thanks