[Health] Interpreting sleep study results, EERS enhanced expiratory rebreathing space

[JoeyWallaby]

Hi, Joey
this is complex ! I would rather go for things I think would more simple. It won't cost me nothing, this opinion hereinbelow; it might help.

-Your charts suggest a great deal of long duration unflagged RERA's, too many which could be improved by properly adjusting your EPAPmin and PS.

_too many arousals/awakenings….hard to ask, but do you have any issue with RLS/PLMS issues? hope not....

Good luck

No RLS/PLMS.

EERS is only to manage centrals. The xPAP is used to manage the obstructive events. And I missed your comment on increasing EPR needing a compensation in EPAP to compensate.  You are correct and that is the "secret"  to using a ResMed CPAP, Elite, or AutoSet as a limited BiLevel .

So yes, both need to be manipulated to achieve optimum results. Increasing PS and EPAP both have the capability of reducing your pCO2 in your blood and causing additional centrals.  Then the EERS needs to be adjusted to bring the centrals back down.

The centrals went up because the EPR increased thus decreasing the pCO2 in your blood which caused your Real Centrals.

Thank you, that's helpful.

Results on the VPAP Auto look very good, and it's surprising not to see more emergence of centrals with the higher pressure support.  I have personally found that on the Vauto, my CA results are consistently better with a trigger sensitivity set to high rather than medium.  These are my results and  yours may vary.  If you are more comfortable with bilevel, stick with it, and add EERS if the CA re-emerges.  The flow rates look pretty good where leaks are controlled, and there is less flow limitation.  Your best tidal volume and respiration stability continues to be with the use of EERS, and it would be good to see you try that system with the VPAP.

It's surprising to me as well. It would be interesting to try that.


I slept two nights with another 6" of EERS but the first night I didn't have the SD card in. This is from last night, I woke up feeling good. I woke up after the last event. I turned the min pressure up to 12 because 11 and 10 didn't feel like enough (effect of more co2 increasing respiratory drive?). I could probably turn it up to 13 or even 14.

[Sleeprider]

CA and flow limit looks excellent ant your tidal volume at 620 is pretty phenomenal. There is almost no change in pressure through the night, and that is going to contribute to very low disruption. If this is comfortable, stick with it.

[slowriter]

CA and flow limit looks excellent ant your tidal volume at 620 is pretty phenomenal.  There is almost no change in pressure through the night, and that is going to contribute to very low disruption.  If this is comfortable, stick with it.

What do you make of the fact that his I:E ratio is inverted?

[Sleeprider]

I noticed it, and don't know what to think of it. I would argue that none of the flow rate close-ups confirm that statistic. Also, all of the OA events are breath-holds, not preceded by an expiration. So most of those events seem to be arousal or movement.

[mper6794]

CA and flow limit looks excellent ant your tidal volume at 620 is pretty phenomenal.  There is almost no change in pressure through the night, and that is going to contribute to very low disruption.  If this is comfortable, stick with it.

What do you make of the fact that his I:E ratio is inverted?

It looks a good question, slowriter. That had called my attention too. 

One of these days, I did a brief analysis of this E:I reations while moving from APAP to BPAP. It is here, on my thread, and other posts.
http://www.apneaboard.com/forums/Thread-...wer?page=4

all the best

[WillSleep]

... I have personally found that on the Vauto, my CA results are consistently better with a trigger sensitivity set to high rather than medium.  

I am curious.  

For those xPAP that can do it, I often see mention of setting trigger sensitivity to High to help reduce CAs but have not seen much discussion of adjustments to Cycle. 

If we set Cycle to Low would that shorten Expiration a little, and would shorting Expiration reduce CO2 washout?  So would setting Cycle to Low be a way to reduce CO2 washout and then in turn help reduce CAs?   

What have you guys learned about Cycle with regard to CAs?

Note:  I asked the question Cycle here on this thread because if the Inverse I:E ratio does become a concern adjusting Cycle might be one of the tools to help influence the I:E ratio.  

WillSleep

[JoeyWallaby]

CA and flow limit looks excellent ant your tidal volume at 620 is pretty phenomenal.  There is almost no change in pressure through the night, and that is going to contribute to very low disruption.  If this is comfortable, stick with it.

Thank you 

CA and flow limit looks excellent ant your tidal volume at 620 is pretty phenomenal.  There is almost no change in pressure through the night, and that is going to contribute to very low disruption.  If this is comfortable, stick with it.

What do you make of the fact that his I:E ratio is inverted?

I noticed it, and don't know what to think of it. I would argue that none of the flow rate close-ups confirm that statistic.  Also, all of the OA events are breath-holds, not preceded by an expiration.  So most of those events seem to be arousal or movement.

 Don't know either

I feel okay today, charts look bad (because of leaks I think). Didn't secure CPAP mask good.
Full data (password apneaboard) https://www.mediafire.com/file/6s0y6ovug...S.zip/file

Last night charts

[JoeyWallaby]

Should I try BiPAP again? EERS has significantly improved both tidal volume and amount of central apneas but the BiPAP waveforms look significantly better to me. What do people think?

Auto CPAP EPR 3 with extra EERS (data from two nights)


Auto BiPAP pressure support 4 no EERS (data from two nights)

[JoeyWallaby]

More waveforms, they're interesting

Auto CPAP EPR 1 no EERS (data from one night) data from here #13


Auto CPAP EPR 3 no EERS (data from one night) data from here #7

[JoeyWallaby]

Auto CPAP EPR 1 Standard EERS (data from one night) data from here #58


Auto CPAP EPR 3 Standard EERS (data from one night) data from here #69