CorruptAlligator - CPAP Problems

[CorruptAlligator]

Ah yes......the good ole days. I remember them well. 

Yes, the good ole days when we didn't have to hang around on Apnea boards, or try to figure out how to fix our broken bodies.

[CorruptAlligator]

Hello, my CA events seem to be making me wake me up during the early morning, but do not know what is caused by.  Would you all recommend a Cervical Collar for this situation?  What other possibilities could it be and the solutions?  Could CA events be cause of a heart condition?

[Sleeprider]

Your CA events are benign and are not the cause of your arousals, rather your arousal are why you have CA events. It appears you have periodic chin-tucks through the night where flow limitation and a cluster of hypopnea happen at 00:30, 03:45 and 06:15. The best way to address these is probably to increase minimum pressure to 8.0 or 9.0 and just be aware that the likely mechanism is a chin tuck. It is really infrequent and at this level a collar could help, but is really your choice to make.

[Gideon]

Your hypopneas are clustered, and are occurring during periods of elevated flow limits. Your EPR is at 3 otherwise I'd suggest increasing it.
Your events are not frequent enough to say you must wear a collar, we do try to avoid that when not outright called for. Feel free to try one, but it will not affect the CAs, only the flow limits and hypopneas.

Your pressure is running up, IMHO unwarranted. and possibly causing your CA events
Set Max Pressure to 10 for now to limit these unneeded excursions and limit the pressure fluctuations that may be causing some CA events.
Set Min pressure = 8 to try and cut down the FL and hypopneas.

[Crimson Nape]

I have gone back and merged all your threads into one. This will keep all previous history in one place. I have renamed your thread, "CorruptAlligator - CPAP Problems". Please use this thread for all further CPAP related posts.

[CorruptAlligator]

Your hypopneas are clustered, and are occurring during periods of elevated flow limits. Your EPR is at 3 otherwise I'd suggest increasing it.
Your events are not frequent enough to say you must wear a collar, we do try to avoid that when not outright called for.  Feel free to try one, but it will not affect the CAs, only the flow limits and hypopneas.

Your pressure is running up, IMHO unwarranted. and possibly causing your CA events
Set Max Pressure to 10 for now to limit these unneeded excursions and limit the pressure fluctuations that may be causing some CA events.
Set Min pressure = 8 to try and cut down the FL and hypopneas.

My Autosense doesn't go high than EPR of 3.  Thanks for all the feedback guys, and also for merging my questions.

[CorruptAlligator]

Your hypopneas are clustered, and are occurring during periods of elevated flow limits. Your EPR is at 3 otherwise I'd suggest increasing it.
Your events are not frequent enough to say you must wear a collar, we do try to avoid that when not outright called for.  Feel free to try one, but it will not affect the CAs, only the flow limits and hypopneas.

Your pressure is running up, IMHO unwarranted. and possibly causing your CA events
Set Max Pressure to 10 for now to limit these unneeded excursions and limit the pressure fluctuations that may be causing some CA events.
Set Min pressure = 8 to try and cut down the FL and hypopneas.

Hi, I tried those setting, and the CA events hasn't really changed. I'm thinking about increase my maximum back to 15. Any further feedbacks are appreciated.

[Gideon]

How do you feel?

You are in a real balancing act between flow limits/RERAS and CA events. Your OA events are nil. Flow limits, RERAS, and hypopneas are best treated with pressure Support or EPR which is maxed out at 3 on your machine. Your only option is to increase min pressure. Because of your flow limits your actual high pressure will go up to whatever max you set.
Central apneas respond in a negative way to the above. You want to reduce EPR, minimize higher pressures and minimize pressure excursions to manage the CA events.

A ResMed ASV would resolve everything but with an AHI and a RDI of less than 5 you don't qualify for an ASV .

A BiLevel, the VAuto would resolve the obstructive events and maybe, by setting the trigger sensitivity to high/very high, resolve the CA. If you had one I'd have you try it

The immediate question is, addressing the balance, do you feel better with EPR=2 and does that cut the CA

[CorruptAlligator]

How do you feel?

You are in a real balancing act between flow limits/RERAS and CA events.  Your OA events are nil.   Flow limits, RERAS, and hypopneas are best treated with pressure Support or EPR which is maxed out at 3 on your machine.  Your only option is to increase min pressure.  Because of your flow limits your actual high pressure will go up to whatever max you set.
Central apneas respond in a negative way to the above. You want to reduce EPR, minimize higher pressures and minimize pressure excursions to manage the CA events.

A ResMed ASV would resolve everything but with an AHI and a RDI of less than 5 you don't qualify for an ASV .

A BiLevel, the VAuto would resolve the obstructive events and maybe, by setting the trigger sensitivity to high/very high, resolve the CA. If you had one I'd have you try it

The immediate question is, addressing the balance, do you feel better with EPR=2 and does that cut the CA

I wasn't feeling as good with minimum pressure raised to 8, so I dropped it back to 7 and set max back to 15, and my AHI went back down (see attachment image).  Minimum pressure of 7 feels right.

I think my EPR should be at 3 because it did reduce my AHI from when my EPR was 2.  So, I know my minimum and EPR at this point, but don't know the max.  I can try bringing down max to 10?  Any feedbacks are welcome guys.

[Gideon]

That's a real good chart. I'd leave it there for a couple days. If you want bring max pressure down, your pressure is rising because of flow limits and EPR helps with that.
This needs to be based mostly on how you feel. Getting higher numbers and feeling better is great.