Changed to Airsense 11, few CA's

[Stubert]

Hi,

I now changed to Airsense 11 auto, after trying Löwenstein Prisma Smart Max and Prisma 25S (Bipap). In the long run they never game me stable long term sleep.
After changing to the Airsense 11 things start to get better.

I dialed apap settings in, during 4 weeks and an EPR of 3, as I needed to get rid of my flow limitations. Overall a decent sleep, but have some arousals and CA's.
My tidal volume is where I think it should be, as I'm 190cm height and ideal weight should be around 90kg. I try to dial settings in as close to the P95, to avoid rollercoaster pressure during the night.

Can anybody tell me why I get so many arousals? Is it CO2 blowoff or too little pressure?

Are the CA's mostly related to awakenings and not really an issue?

Thank you!

[Stubert]

One more CA

[Expat31]

Hi,  

Hello and welcome. 

I see just two potential issues.
 
Your minimum pressure at 11 may be overkill, as your obstructive and hypopnea apnea are already well controlled. 
You may want to reduce this minimum to a level just before such events start to reappear. It a trial and error procedure. 
Try 10 to see how it goes.

Concerning centrals, a high pressure is not going to reduce them. 
Here the best thing is to reduce EPR, and so help keep a lid on C02 washout.
 
Your flow limitations are pretty good now, so you have room to manoeuvre on reducing EPR. 
Try EPR 3. 
The only potential downside, is that exhalation pressure increases and may be slightly more uncomfortable breathing, but on the other hand you get improved therapy control. 

You win, to lose, you win. It's a balancing act and only you can decide. The test, as always, is how you feel.

Regards.

[Stubert]

Thank you, I get your point about overkill min pressure.
By reducing EPR to 2 and lowering pressure to 10 I will keep same EPAP of 8, have a slight smaller tidal but I will give it a try.
Will post update 

[Expat31]

OK, let's see what this gives. 
When you post next, can you just send only these graphs (no zooms) ?

1. Events
   
2. Flow rate
   
3. Pressure
   
4. Tidal volume
   
5. Respiration 
   

You mentioned earlier tidal volumes, was there any particular reason for this?

Thanks

[Sleeprider]

This therapy looks great to me, with a very low rate of random CA events. Pressure range could be lower as you are at 11-15 and have less than 1-cm of variation. EPR is not the source of the CA events. My random thoughts are 9-12 pressure and keep EPR as-is, but focus is on comfort, so whatever works best for you.

[Expat31]

We have conflicting advice here. 

To avoid any confusion, I will exit this thread.

[Sleeprider]

I don't think it's conflicting. I agree pressure range is high, and am unsure if EPR reduction would benefit, but with good therapy like this, it's probably best to make one change at a time and adjust for comfort. I'll just say I really appreciate what you're doing to help other members.

[Stubert]

Great to have the support of both you guys!

Did the last night with pressure 9-13 and keeping EPR 3. 
You are right, the EPR does not trigger the CA's, and they dropped a bit last night.
I feel a little better this morning and have memories of less wakeups. Overall more comfort. I might try and raise minimum to 9.4, to avoid the OA's (if they are correctly tagged)?

[Sleeprider]

Results look good and the first OA comes after an arousal or movement. Overall, this seems to be more comfortable, and is equally effective. 9.4 is a pretty minimal increase and accomplished what the lower 9-13 pressure was intended to do. I would hold on making changes and see what direction things go.