[Treatment] flyinnerd - Therapy Help

[Deborah K.]

You slept a lot longer and that's great!    Stay where you are for now on your settings.  We can make other changes when you are more rested unless you feel like changing your EPR to 3.  Your call.  So it looks like you did not have a lot of CAs in your sleep study.  If that's true then your CAs must be treatment-emergent.  In that case, they will lessen over time on their own.

[flyinnerd]

Still working on getting used to it but think I am almost there. Last night however I apparently had CSR lasting 26.5 mins. I am attaching two close in views and 1 of the whole night. Is this something I should be concerned about or may it be a one off?

[Jay51]

The majority (probably vast majority) of times CSR is reported like yours, it is false.  It is mistaking variable breathing for CSR.  Do you have any significant heart issues or heart failure by chance?  This increases the odds of the CSR being legitimate.  

If you wouldn't mind, please do a 3 minute up close zoom of the CA clusters and post them here.  The places where the purple bars are the darkest in color; and where they cluster together the most.  Around 2:15 is one I see.  Maybe one of two more 3 minute close ups would help.  

Just click on the cursor just right of when the CA dark purple bars start (or clusters of CA's) and drag to the right for 3 minutes of time on the OSCAR chart.

[flyinnerd]

Here's a 3 min look of the CA clusters from the night of the CSR, I note there was a period of a large leak afterwards, so not sure if that had anything to do with it. 

Also attaching 2 recent nights. 

Got the AHI down to 3.12 in one of them, but then it went back to 7.2 on the next night. 

Not sure if i should be tuning any settings yet to help things out?

[Jay51]

Thank you for posting those charts.  The 3 minute zoom of the CA's doesn't quite look like characteristic CSR (looks like several tennis balls connected by a string.  Very symmetrical.  Crescendo and decrescendo to each cycle.  

The best thing to do IMO would be to try to max out your therapy on your current machine to see if you can reduce these CA substantially.  If not, there are more advanced machines that can treat CA effectively.  

I have seen a few charts where leaks precede CA's and were most likely the cause of them.  Your leaks occurred after the CA's though.

You have a lot of hypopneas in those charts.  Some clustered.  Have you tried lowering your pillow height, or changing sleep position (i.e. from back sleeping to side sleeping) or even used a soft cervical collar?  These moves could reduce the hypopneas.  Increasing pressure could help also, but increasing pressure could raise your CA's even more.  So first try lowering pillow height, change of sleep position if you feel like it, and soft cervical collar.

[flyinnerd]

Hi all, 

It's been a few months worth of treatment and would like some more guidance.

I have averaged an AHI of 4.33 in the last 2 months with min 10.6, max 13, EPR of 2. 

Previously, I had an AHI closer to 3.9 with min 10.6, max 12.8, EPR of 3. 

Attached are some charts from the past week. 

My questions - 

Should I further increase my max pressure? My last 30 days 95% pressure was 12.92. 

I set my EPR to 2 in an effort to prevent CA's, but not sure if that is causing an increase in the AHI? 

In a separate post in this thread I will show examples of my breathing - is this something to be concerned about? I guess the pattern looks weird to me. 

I believe some of these may be positional, and am thinking of using a cervical collar. However wanted to post this to see if there were other suggestions to improve therapy.

---

Here are the breathing patterns. THANKS in advance.

[Jay51]

Wow.  Those are some pretty rough looking charts IMO (especially the close ups).

Increasing you max pressure would be a good move.  You can try raising EPR to 3 to try to reduce your high flow limitations.  This may give you more CA's though. 

If you lower EPR, then the flow limitations will surely rise further. 

Very tough situation.  You have high flow limitations and high CA's.  We can try to optimize your machine as best as possible, but the current machine you have may not be able to treat you successfully.