Help Getting AHI Lower

[ajack]

min 11 is a good start and epr does make it easier to breathe out. To keep it simple, you set the epr you like and then move the min pressure to treat the OA and H. the same as before. If there are too many OA and H, you raise the min pressure.

I would also raise the max pressure as well, because the 95% is 14.8 and the max is 15 and your max pressure on the machine is also 15. This to me means the machine wants to go higher, I'd have 17 max and see where it lands. You want the machine max pressure at least 2cm above the 95% or generally above the max pressure on sleepyhead. To give the machine room to move. easier would be to just put it at 20 and let the machine sort it out.

[olywa]

Sleeprider:

Thanks very much for your input.  I was thinking about going with pressure at 9 tonight and slowly go up to 11.   I could try 11 or is it better not to jump all at once.  Just for fun (if you can call it that) I tried the pressure at 11 earlier today and it was pretty hard to breathe.  But, since you suggest EPR at 3 I am thinking it will be more tolerable.

Thanks again,  Peggy

[olywa]

Thanks Ajack.  I have been wondering about max pressure.  It is the one thing that has been consistent over the past month with the statistics looking like I could possibly go higher if I let it.

[Sleeprider]

Do a practice session with a minimum pressure of 10 and EPR at 3. See how you feel Most people feel like it is very easy to breath with EPR on. I think your pressure will climb as needed during the night, and that EPR will make a big difference on your hypopnea event rate. Remember that using EPR means your exhale pressure drops according to the setting, so with pressure at 10 and EPR at 3, your pressures are 10/7 which is lower than the exhale pressure you currently start at. At 11/3 its about the same. Don't fear the pressure, because the contrast between inhale and exhale should feel very natural and comfortable. Try it, you'll like it.

[olywa]

Good Morning:

The results from making those changes last night were not what I expected. After changing pressure from 8.4-15 to 10-17 with 3 EPR, my hypopneas changed to OAs and I had some Cheyne-Stokes breathing. Any feedback would be great.

Thank you!

https://i.imgur.com/bjkbeCw.png

[Gideon]

Not bad. I'd ignore the cluster at the end of the night and I count 12 events in about 6-6.5 hours which is an AHI of 2 to just over 2. On the CSR I'd suggest posting an expanded view of the CSR segment so we can see the flow rate in greater detail. I suspect it is nothing to be concerned about.

Your numbers are well under AHI of 5 which means that you are technically "successfully treated" so make any changes small ones and give them several days to a week to settle out. When you are in this range your "comfort" and daytime feeling become much more important so how do you feel? You said previously that you "toss and turn quite a bit".

Fred

[olywa]

Thanks Fred.  I have attached a couple of screenshots to hopefully give a better picture of CSR.  Since I first started on the machine my numbers have consistently gone down until recently.  I am now stuck generally in the 3-5 range.  I have to say that I am feeling better overall.  I do toss and turn, but not as much as I did before using the machine. I woke up too early this morning but don't feel overly tired.  Thanks for any feedback on the CSR, as well as anything else.

https://i.imgur.com/n5iwk7Q.png


https://i.imgur.com/bjkbeCw.png

[Sleeprider]

Olywa, most of your events were at the very end of the night. EPR actually resolved the hypopnea without causing any increase in CA, and that is very good news. Most of the obstructive apnea occured at the very end of the night, with only 5 events through most of the night. In addition to the significant improvement in hypopnea, you also cut RERA significantly.

With EPR your median pressure was 10.82/7.82 and the 95% pressure was 13.8/10.8. This compares to previous results of 11.12/11.12 and 95% of 14.82. So pressure was enough lower, that you had some OA. I'm very confident that adding to minimum pressure will resolve the OA, so try minimum pressure 11 leaving EPR and maximum pressure as-is. The periodic breathing, labeled incorrectly as CSR is not a problem. Adding EPR was a big move, and resulted in improvements other than OA. These results are not unusual nor unexpected. Adding back some minimum pressure should smooth out the problems here.

[Walla Walla]

Ignore the CSR report. That's not CSR. I agree with Fred toss out the events at the end. Your numbers look good.

[olywa]

Thank you all very much. I am going to go to 11. I can't tell you all how invaluable this site is. There is no way I would get feedback from the doctor's office like this. I don't think they even get data detailed enough to help in this way. Thank you!!