RE: Trying to gt ahi and leak rate under control
This is the first quantification of the events you're experiencing. My comments were provided as a general guideline, and so they still apply, however I wrongly speculated CA was the main problem, mostly because that is a common side effect when CPAP users begin bilevel PAP.
Your events are predominately OA, so an increase in minimum EPAP pressure is the first step. This should reduce OA events.
Once OA is at a satisfactory level, we can review the CA and H and see what the next step should be. If CA is higher than H, then the suggestion will be to decrease pressure support. If H events are predominate, then pressure support may need to be higher. Clearly, getting some charts on the forum would help a lot.
RE: Trying to gt ahi and leak rate under control
Here's a screenshot. Any thoughts on lowering my AHI. I know the leak rate is terrible.
RE: Trying to gt ahi and leak rate under control
Sirto, you are using a bilevel machine which is kind of unusual for a new user unless they showed some mixed events in a titration study.
Quote:My sleep study showed an AHI of 73 and I am now at around 7. But, I can't get below that number consistently. I will occasionally get a 3 but only once in a while. My leak rate is high, typically 20 - 35 lpm (at 70% per sleepyhead).
If you have a copy of your sleep study or titration, can you provide some insight on the breakdown of events (central, obstructive, hypopnea)?
Your events resemble mild complex apnea with equal central and obstructive events. I think we can come up with a strategy to minimize those events using accepted titration principles. Basically that means using EPAP pressure to resolve obstructive events. Your machine is not designed to treat central apnea, so we hope that as your sleep becomes less disturbed through more even pressure, and perhaps less pressure support, we can bring the rate of CA down as well.
Just a few side-notes about your therapy results. You have virtually no flow limitation or snores, so your machine does not get advanced warning of potential pending obstruction until it actually occurs. The remedy for this is to increase EPAP pressure through settings. Leaks are a significant problem, mainly in the form of leaks from your mouth. The use of nasal therapy may not work out for you unless that can be brought under control. Sometimes you can train the mouth to stay closed, but many people have used a soft cervical collar to provide slight pressure to the back of the jaw to good effect. This not only helps keep the mouth shut, but the pressure from below and behind does not aggravate obstruction like a chinstrap which can pull the jaw back. Other than leaks, and the lack of FL and snores, your therapy looks good (normal) in terms of respiratory rate, volume and inspiratory/expiratory timing.
I think you should start with setting the minimum EPAP pressure to 11.0. We will be looking specifically to reduce OA from that change. Your maximum EPAP pressure was nearly 14, so this is a conservative start, and I would not rule out trying 12 if needed. Looking ahead, if we don't see a reduction in the CA events, I will ask you to reduce PS from 3 to 2, and perhaps to 1. It's best to make changes slowly and one at a time in self-titration so we can judge the effect and make good decisions and judgements as to what is working and what doesn't. Good luck!
08-19-2017, 11:00 PM
(This post was last modified: 08-19-2017, 11:11 PM by sirto.)
RE: Trying to gt ahi and leak rate under control
Sleeprider Wrote: Sirto, you are using a bilevel machine which is kind of unusual for a new user unless they showed some mixed events in a titration study.
Quote:My sleep study showed an AHI of 73 and I am now at around 7. But, I can't get below that number consistently. I will occasionally get a 3 but only once in a while. My leak rate is high, typically 20 - 35 lpm (at 70% per sleepyhead).
If you have a copy of your sleep study or titration, can you provide some insight on the breakdown of events (central, obstructive, hypopnea)?
Your events resemble mild complex apnea with equal central and obstructive events. I think we can come up with a strategy to minimize those events using accepted titration principles. Basically that means using EPAP pressure to resolve obstructive events. Your machine is not designed to treat central apnea, so we hope that as your sleep becomes less disturbed through more even pressure, and perhaps less pressure support, we can bring the rate of CA down as well.
Just a few side-notes about your therapy results. You have virtually no flow limitation or snores, so your machine does not get advanced warning of potential pending obstruction until it actually occurs. The remedy for this is to increase EPAP pressure through settings. Leaks are a significant problem, mainly in the form of leaks from your mouth. The use of nasal therapy may not work out for you unless that can be brought under control. Sometimes you can train the mouth to stay closed, but many people have used a soft cervical collar to provide slight pressure to the back of the jaw to good effect. This not only helps keep the mouth shut, but the pressure from below and behind does not aggravate obstruction like a chinstrap which can pull the jaw back. Other than leaks, and the lack of FL and snores, your therapy looks good (normal) in terms of respiratory rate, volume and inspiratory/expiratory timing.
I think you should start with setting the minimum EPAP pressure to 11.0. We will be looking specifically to reduce OA from that change. Your maximum EPAP pressure was nearly 14, so this is a conservative start, and I would not rule out trying 12 if needed. Looking ahead, if we don't see a reduction in the CA events, I will ask you to reduce PS from 3 to 2, and perhaps to 1. It's best to make changes slowly and one at a time in self-titration so we can judge the effect and make good decisions and judgements as to what is working and what doesn't. Good luck!
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Sleeprider,
My sleep study showed the following:
IP PS OA CA H AHI time at pressure, min
15 4 7 6 26 12 189
16 4 1 0 2 6 30
They prescribed IP 16 PS 4 based on only 30 minutes.
Based on your recommendation I purchased a soft cervical collar and have used it for three nights so far. The results are promising. The leaks are lower though still high on two of the nights. AHI was 2.7 on two nights and 6.4 on the other. The higher one is around where I have been lately but the 2.7 is about the lowest I've had since I started with my therapy. I'm attaching the last two night's worth of data. Please let me have your recommendations.
RE: Trying to gt ahi and leak rate under control
I'm encouraged to see the CA events significantly reduced here. Your results on the 18th are significantly better from the perspective of both events and leaks. Remaining events are obstructive, and we see an unusual behavior on the part of the machine, that the pressure does not increase where OA is occurring. I think the priority now is to control leaks. Once you are able to keep leaks under control incremental increases in minimum EPAP may eliminate the remaining obstructive events. Take it slow, and focus on getting the leaks reduced. The trend is in the right direction, and hopefully will continue without further intervention.
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