Effort to improve treatment of OSA and IH

[Gideon]

I can handle high pressures extremely well, I could set my max at either 25 or 12 and it wouldn't make a difference. I was having high AHIs at 20 cmw on the DV54. That was not working. My machine before that was a pure analog fixed pressure only CPAP where you changed pressure via a setscrew.
When do you need a BiLevel? Assuming you don't need a backup rate, and that you have only obstructive events.

1, when you don't tolerate CPAP, This applies more to non-ResMed users as ResMed's EPR can act as a limited BiLevel.
2, When your pressures are high, it should be considered when pressure is over 15 cmw as BiLevel is capable of 25 cmw.
3, when pressure support is needed. This overlaps with reason 1. Reason one is an official reason accepted for BiLevel.

It is the pressure support that directly treats flow limits, RERAs, hypopneas, and UARS. We can achieve very similar results with a fixed inhale and exhale pressures. PR's Flex is variable and only achieves its max values when you are breathing hard. The feel comfortable part on exhales is there and fits in with reason one above. EPR and Flex also act as comfort features.

[QuietSign]

Send me a PM on where you are finding the great deals on the Vauto. That is really a great price.  I did not see where a Vauto is necessary to improve a very good night of therapy with the Airsense 10.  The Vauto allows much finer adjustment of pressure support. While you can select 1, 2 or 3 cm of EPR, the Vauto allows adjustment in 0.2 cm increments.  It also has some tricks with the trigger and cycle sensitivity that can fine-tune when transitions from EPAP to IPAP and IPAP to EPAP occur based on your breathing.  Let's look at a few more nights and see what you think.  You can see and probably hear the difference this makes in snores and other problems.  RERA does not occur without flow limitation, and on the Airsense 10 with EPR 3, I don't expect to see either.

I've included another night's worth of data below. Wondering if I should reduce pressure further?

I can handle high pressures extremely well, I could set my max at either 25 or 12  and it wouldn't make a difference.  I was having high AHIs at 20 cmw on the DV54.  That was not working. My machine before that was a pure analog fixed pressure only CPAP where you changed pressure via a setscrew.  
When do you need a BiLevel? Assuming you don't need a backup rate, and that you have only obstructive events.

1, when you don't tolerate CPAP, This applies more to non-ResMed users as ResMed's EPR can act as a limited BiLevel.
2, When your pressures are high, it should be considered when pressure is over 15 cmw as BiLevel is capable of 25 cmw.
3, when pressure support is needed.  This overlaps with reason 1.  Reason one is an official reason accepted for BiLevel.

It is the pressure support that directly treats flow limits, RERAs, hypopneas, and UARS.  We can achieve very similar results with a fixed inhale and exhale pressures.  PR's Flex is variable and only achieves its max values when you are breathing hard.  The feel comfortable part on exhales is there and fits in with reason one above.  EPR and Flex also act as comfort features.

Thanks for explaining. I read some thread by a sleep technician on another board who was criticizing the EPR feature, saying that if you reduce the exhale pressure with EPR, the airway will collapse and result in apneas. I think this assumes that the inhale pressure is set at roughly the minimum therapeutic level, so anything below it is problematic. This explanation seems to make sense to me, yet it doesn't appear to be the case (at least for me). What's wrong with the logic - does the airway not need as much pressure to stay open on exhale? I'm mostly asking for the sake of understanding - just curious.


Anyways, here's another good night's worth of sleep using a better fitting Large Knightsbridge dual strap, and some simple micropore tape. It was a great night's sleep, despite still being super late (6:30am-2:30pm). As you can see, no major leaks (once I fall asleep at least). Pressure mostly within 12-13 range most of the night. Should we tune the pressure down even more? I'm still noticing some flow limitations on the chart - is that problematic? I'm not exactly sure how to read Resmed/Oscar's flow limit chart.

   

   

[Gideon]

Contrary to common thought, it is the Exhale pressure that splints the airway. When you apply EPR you do lower the splinting pressure so it is something to be aware of. Frequently the 'pressure' on a CPAP is set too high in an attempt to eliminate flow limits, RERAs, hypopneas, all of which the PS/EPR will fix so it is usually close to a wash. Besides in the environment here you are encouraged to post the night after a change and then any errors will be corrected. In a clinical situation it is often weeks or months to get corrected. To maintain the same splinting pressure you would then set pressure so that the new min = current min + delta of EPR.

[QuietSign]

Contrary to common thought, it is the Exhale pressure that splints the airway.  When you apply EPR you do lower the splinting pressure so it is something to be aware of.  Frequently the 'pressure' on a CPAP is set too high in an attempt to eliminate flow limits, RERAs, hypopneas, all of which the PS/EPR will fix so it is usually close to a wash.  Besides in the environment here you are encouraged to post the night after a change and then any errors will be corrected.  In a clinical situation it is often weeks or months to get corrected.  To maintain the same splinting pressure you would then set pressure so that the new min = current min + delta of EPR.

I see, I too did not realize that it is exhale pressure that splints but that seems believable. I think I'll keep EPR on for now since it seems to be working ok. Subjectively, I've been feeling pretty good lately, but definitely feel tired before the end of the day. I haven't needed a nap yet although maybe that's because it's been a long weekend and I'm not doing anything exhausting. Wondering if there's still improvements to be made regarding sleep. Can I stand to lower the min pressure a bit more?

This latest night of sleep was pretty decent, but with relatively more Clear Airway apneas, which I don't really understand. I'm also trying to figure out whether the flow limit chart is indicating an issue still exists.

   
   

[Sleeprider]

Your current pressure starts at 12/9 and only increases by 1-cm to the max. I think you can probably back off 1 or 2 cm on the autoset and do fine. My objective is to keep pressure fluctuations limited to 3-cm to minimize sleep disruption. This therapy looks very good. Flow limits and AHI is essentially down to nothing, and at this point, any changes you pursue should be for comfort.

[QuietSign]

Your current pressure starts at 12/9 and only increases by 1-cm to the max. I think you can probably back off 1 or 2 cm on the autoset and do fine.  My objective is to keep pressure fluctuations limited to 3-cm to minimize sleep disruption.  This therapy looks very good. Flow limits and AHI is essentially down to nothing, and at this point, any changes you pursue should be for comfort.

Subjectively, I'm feeling pretty good when I wake up which is a huge improvement, but definitely get tired before the day is over. The doctor diagnosed me with Idiopathic Hypersomnia via a Multiple Sleep Latency Test, but mentioned the diagnosis was muddled because we hadn't treated OSA (or the flow limitations) at that point. It's a little frustrating because IH basically seems like the doctor saying they have no idea what's going on. Needing multiple naps a day sucks, and although the Resmed has definitely made improvements, it still feels like I'll need to be napping a bit each day.  Do you have any more advice related to sleep? It's perhaps possible the issue might be in another realm of health, as I've also had other health issues, but I'm hoping to understand the sleep component as best I can.


So regarding this article (http://www.apneaboard.com/wiki/index.php..._and_BiPAP ) where it talks about most people needing a PS of 5-6, but a few get away with PS of 2-3: am I basically one of those lucky few who can get away with the PS of 2-3 and don't need more than an APAP? For the sake of my understanding, what kind of data would have made you conclude that the BiPap would have been needed? You mentioned flow limits is down to essentially nothing - can you explain how to read the flow limit chart in Oscar?  

I'll lower the min pressure by 1cm tonight and see if it still works ok. I'm also in the middle of pretty significant weight loss (lost almost 20lbs so far during the pandemic due to better eating/exercise), so I hope that this might contribute to getting away with lower pressure.

[Sleeprider]

Your therapy is good or excellent and you are sleep normal to long continuous hours at night. Continued hypersomnia, without a known cause, during the day is a condition that affects a number of people, and as the name, idiopathic implies, there is not a known cause or a clear therapy once sleep disordered breathing is resolved. I assume you have had a complete blood workup and have not identified anything out of the ordinary, although you mention other health issues. Weight loss may be helpful, keeping active and whatever techniques you use to avoid the conditions that bring on sleepiness. Narcolepsy and chronic fatigue are variations. If your doctor is unhelpful, I am not any better as it is not something I know much about. Congrats on the weight loss, something I need to do.

[QuietSign]

Your therapy is good or excellent and you are sleep normal to long continuous hours at night.  Continued hypersomnia, without a known cause, during the day is a condition that affects a number of people, and as the name, idiopathic implies, there is not a known cause or a clear therapy once sleep disordered breathing is resolved.  I assume  you have had a complete blood workup and have not identified anything out of the ordinary, although you mention other health issues.  Weight loss may be helpful, keeping active and whatever techniques you use to avoid the conditions that bring on sleepiness. Narcolepsy and chronic fatigue are variations.  If your doctor is unhelpful, I am not any better as it is not something I know much about.  Congrats on the weight loss, something I need to do.

This is another night's worth of data with min pressure set to 11. Feeling pretty good. Idiopathic Hypersomnia seems like it is the doctor saying that sleep medicine has no more answers. The related health issues are largely endocrine, which is something I'll try to sort out with those respective doctors, and see how weight loss impacts it. But changing to the Resmed has definitely been a staggering improvement. I'd like to see how my subjective quality of life changes over the next few weeks/months, as I frequently hear the notion of sleep debt that needs a continued period of good cpap therapy to pay off.

Looking at the data, I'm guessing turning down the pressure by another cm would be a good idea? Any idea why there are relatively more CA apneas lately? On the plus side this is a record for how few obstructive apneas I had in a night.

   

[Sleeprider]

The number of males on this site that use TRT, including myself, is very high. If your tests show a need for that, then consider the pros and cons and decide if it's worth it to try. It is a one-way trip as you will become 100% exogenous.

[sheepless]

"It is a one-way trip as you will become 100% exogenous."

what does this mean? are you saying we become irreversibly dependent on an external source & stop producing t naturally?