[CPAP] Trouble with leaks and pressure

[ShaunBlake]

<snip>
My only consern right now is the CA's. In my sleep study (at home) I had no CA, only OA and H. However I have had a few, short CA (1-6 pr night) since I startet using CPAP. My OA's are gone, thanks to this forum and a soft collar. 
<snip>
After having been reading about CA's on this forum, it seems like it is common With CA's in the beginning of the treatment and that they usually are short like 10-20 sec, and then wanish after a while. It seems to me I am going in the wrong direction here?

Kristin, it seems to me (in my brief 'education' and faulty memory) that CAs are more transient than any other event, and are less likely to be caused by a physical or medical condition than OAs, hypops, etc. and perhaps you had no CA events during your sleep study.  However, is it possible that they just weren't reported?  (I don't know that level of the report you were provided, and speculate that it was more a summary such as I initially received than a full titration report.)

In any case, I'm expecting (hoping, really) that you will find that they are insignificant when you follow Crimson Nape's suggestion.

[Kristin]

Click on the "Events" tab, on the left under the date, and expand it for CA events.   How long are they generally lasting in seconds?   It will be the number in parenthesis "( )".

Thank you for your reply!

       

You can see the attachments for the two dates. They generally differ.
Thanks!
Kristin

[Kristin]

<snip>
My only consern right now is the CA's. In my sleep study (at home) I had no CA, only OA and H. However I have had a few, short CA (1-6 pr night) since I startet using CPAP. My OA's are gone, thanks to this forum and a soft collar. 
<snip>
After having been reading about CA's on this forum, it seems like it is common With CA's in the beginning of the treatment and that they usually are short like 10-20 sec, and then wanish after a while. It seems to me I am going in the wrong direction here?

In any case, I'm expecting (hoping, really) that you will find that they are insignificant when you follow Crimson Nape's suggestion.

Thank you, ShaunBlake! 
I hope so too.

Kristin

[Sleeprider]

The number of CA events you have are probably not medically significant, but you would need to look at using an oximeter to make a good judgement. The duration of some of the events are longer than I would have expected. We end up with the choice of dealing with these events, or cutting back on EPR and increasing flow limit and hypopnea. With no EPR we know that you get severe flow limitation and uncomfortable breathing. I think you can experiment with EPR at 2 and see if that has a positive impact on CA without raising flow limits and hypopnea a lot.

Flow limits, leading to H and OA was the reason we implemented EPR and you can certainly make adjustment. We just don't want to end up back here.

[Kristin]

The number of CA events you have are probably not medically significant, but you would need to look at using an oximeter to make a good judgement.

-Hi Sleeprider.
I ended up ordering an oximeter yesterday. Again I ordered from US. When included shipping and taxes at arrivel it will cost me 50 % of what I would pay here. I chose an expensive one (Contec CMS50E-I believe it will work well with SleepyHead). It will be a couple of weeks before it arrives though.

The duration of some of the events are longer than I would have expected.

- The longest duration of OA's I had was 78 sec. So I wonder what is it with CA's and longer duration? I have noticed that I very often get CA's after what seems like strange breathing. It may be a normal pattern before an event or after an event. I will post an example for you to see-and comment. It seems to me as if I struggle breathing, but maybe it just is me tossing around. I don't know, but I would like to know.

 We end up with the choice of dealing with these events, or cutting back on EPR and increasing flow limit and hypopnea.  With no EPR we know that you get severe flow limitation and uncomfortable breathing.  I think you can experiment with EPR at 2 and see if that has a positive impact on CA without raising flow limits and hypopnea a lot.

- I will try EPR at 2 and see what happens. I think I will have to reduce min pressure to 9 to begin with. Is that ok?

Flow limits, leading to H and OA was the reason we implemented EPR and you can certainly make adjustment.  We just don't want to end up back here.

- I ditto that!
Thank you.

[Kristin]

Thank you everybody for your input.

Attached two closeup of the flow rate before and when having CA's. This might just be normal, but I would like to know if anybody can tell me if it is or not. This is what happens prior to and sometimes after most of the CA's.

Thank you for helping. It's appreciated!

Kristin

       

[Sleeprider]

Both of the charts start with flow limited breathing leading to a sharp inhale and breath-holding (no apnea recorded). There is then some irregular breathing with some breath hold (look for the strong vertical inhales followed by zero flow). We can only speculate this may be a REM dream state or arousal with irregular breathing. What is important to note is that during this irregular breathing your respiratory flow-rate is more than doubled from normal. This is followed by a couple short-duration CA events, then normal breathing seems to be restored.

I think the CA events are caused more by the preceding hyperventilation, than by the EPR or machine settings. This may be unavoidable, and I don't have a lot of confidence that lowering EPR is going to help here. The flow limits on some breathing is still apparent, but mitigated by the EPR. You may have been onto something when you suggested lowering your minimum pressure to 9.0. Maybe that would be a better first step.

[Kristin]

I think the CA events are caused more by the preceding hyperventilation, than by the EPR or machine settings.  This may be unavoidable, and I don't have a lot of confidence that lowering EPR is going to help here. The flow limits on some breathing is still apparent, but mitigated by the EPR.  You may have been onto something when you suggested lowering your minimum pressure to 9.0.  Maybe that would be a better first step.

Thank you, Sleeprider.

I will set minimum pressure to 9.0 tonight and continue With EPR at 3, and see what happens over the next few days.

Today I have spent a few hours searching in my Charts for CA's which don't start with this irregular breathing, and there aren't many. And I have had different min/max pressure, I have gone from no EPR to 3, and I have changed mode on the machine during the last two months. The only pattern I can find, is that the number and the duration of the CA's has increased gradually since I started using CPAP in november 2017. So I think you are right.

Kristin

[Kristin]

<snip>
My only consern right now is the CA's. In my sleep study (at home) I had no CA, only OA and H. However I have had a few, short CA (1-6 pr night) since I startet using CPAP. My OA's are gone, thanks to this forum and a soft collar. 
<snip>
After having been reading about CA's on this forum, it seems like it is common With CA's in the beginning of the treatment and that they usually are short like 10-20 sec, and then wanish after a while. It seems to me I am going in the wrong direction here?

Kristin, it seems to me (in my brief 'education' and faulty memory) that CAs are more transient than any other event, and are less likely to be caused by a physical or medical condition than OAs, hypops, etc. and perhaps you had no CA events during your sleep study.  However, is it possible that they just weren't reported?  (I don't know that level of the report you were provided, and speculate that it was more a summary such as I initially received than a full titration report.)

In any case, I'm expecting (hoping, really) that you will find that they are insignificant when you follow Crimson Nape's suggestion.

ShaunBlake; I am not confident that my sleep study was correct. It was a Level 3 report ( I am not sure what that means..) which was supposed to report CA too. The report showed OA and H pr hour and sorted by position, like supin, left side, right side. And it stated the numbers of CA was zero. I wanted to take the sleep study in the hospital, but I didn't have time to wait in queue for two years. 
Kristin

[Kristin]

                    Four days with minimum pressure at 9 to see if the change made an improvement. No other change. 
Nothing happened until last night. CA's > 20 Seconds three of four nights. The longest was 31 seconds. Last night SleepyHead apparently flagged OA,s and H as well. I would ask you to look at the closeups of the obstructive events. Is this really OA's?

other thoughts which may be wrong; Before last night I was wondering if I should change the mode back to Auto for Her, simply because I hardly have any OA's anymore. Is there any possibility that this mode can make a difference to the long CA's? 
I also want to ask if it is safe to decrease the Maximum pressure to 13? 

Thank you for helping!