How To Adjust Pressure For Clear Airway Apneas

[upsman]

I'm no expert, but I want to follow this thread as I have many hypopneas too, and would like to know if there's anything to do for them. 

Just an observation. It looks like you aren't using EPR any longer. What made you try that? Also, your pressure is pegged at 11 cm for almost the entire night. What made you cap it at 11 cm? Your FL seems to have gotten worse too.

I'm not exactly sure how all these things interact with each other, but I feel like they do. This is why I'm interested in any resolution. 
Hang tight and I'm sure one of the experts will be along soon to help.

[pholynyk]

I found that my hypoapneas went down considerably when I set my Exhale Pressure Relief to 3 Full Time. Conversely, when the RT left it Off after a manometer test, they shot up. EPR also helps to reduce the Flow Limitations, which are quite high in your chart. We like to see less than 0.10 at the 95% point, but yours are 0.35.
I think you are hitting your maximum because of the flow limitations, so the only change I would suggest is setting your EPR to 3 Full Time for a few days, and then we'll see if anything else needs to change.

[Ice Man]

I didn’t realize my EPR was off.  I’ll turn it on to 3 tonight.  Thanks a bunch.

[clownbell]

Ice Man -

I am just a user like you, a tad younger at 76.5, and definitely not an expert. That said, I'm not so sure that hypopnea are worse than obstructive events, as you mention (in an earlier post) that you were told. I base that on their definitions:
Obstructive Apnea = airway completely blocked for 10 seconds with flow rate <10% of 5-minute moving average.
Hypopnea = airway partially blocked for 10 seconds with flow rate <50% of the baseline 5-minute moving average.

When I look at the definitions, hypopnea don't sound as bad as obstructive events. Hoping an expert will clarify for us both.

[Grandpapa-G]

Throughout this discussion you seem to be equating your quality of sleep with your apnea index. You have never told us how you feel the next day. I have found that my quality of sleep, based on how rested I feel correlates best with my flow limit numbers or my hypopnea index. As you do not have any obstructive events it is possible your hypopneas are central in nature and varying the pressure will not be helpful. Keeping the EPR set to 3 is important as others have suggested as this does reduce the flow limit. I would suggest you try a fixed pressure (cpap mode) in the range of 7-10 cm to find where you are most comfortable. This may be a slow process with several nights at each pressure setting to try to find an optimum pressure (or range of pressures)

[Ice Man]

Someone told me about Hypopneas, which I had assumed were less trouble than apneas because there is not a complete cessation of breathing.   I may be wrong.  Thanks.

In response to Pholynyk.  I checked the EPR on my machine and it is set to On with a level of 3.  However, the OSCAR view of the properties of each day shows it as Off.  I went back through the days using OSCAR and found where it was On a few weeks ago before I started experimenting with CPAP mode.  I don’t know if OSCAR is wrong or my machine.  Any ideas?

Also, if we assume my EPR is On, what pressure should I change to to cut down on the amount of time I am hitting the maximum?  Thanks again.

[pholynyk]

In the chart for the 5th of May - post #20 - shows that the Pressure and EPAP are the same, so EPR was Off on that day, at least.

The next time you use OSCAR, please check the EPR setting both for OSCAR and on the machine. If they differ, please let me know.

[Jeff8356]

Ice Man,

It may help if you can post an entire screenshot (including the bottom part of the left pane) this would include the "machine settings' which give valuable information.  Try using F12, or View > Take screenshot
If needed, use two screenshots to get the info posted.  It may help others help you.

[Ice Man]

            The screenshots (2) show my events for last night (Monday).  The time scale is off by one hr. 4:30 is actually 5:30 am.  I continue to have a lot of problems with CAs and Hypopneas occurring mostly in the last 2-2.5 hr. of my sleep time.  I’m in bed at 11:00 and get up at 6:30.  My sleep is usually excellent (deep) from 11:00 - ~4:00, then I enter my poor sleep period, where I get many CAs and Hypopneas, rarely OAs.  Frequently, if I get up around 4:00 to go to the bathroom, my AHI will 0.0, but after that I can’t get back to sleep.  Time passes very slowly. 
 
I know that the machine can mistake changes in breathing for events (sleep wake junk), but some of these CAs and Hypopneas must be real because I experience adrenaline surges, which totally wake me up and cause me to go the bathroom.  I don’t know whether the CAs or the Hypopneas are causing my problem.  The more I have, the next day the worse I feel: sleepy and tired.  Last night my AHI was 1.78, which isn’t that high, but usually the events are concentrated in a one hr. interval.  If I see my AHI starting to go up rapidly (+0.5 in a half hr.), I have started turning off the machine and sleeping the rest of the night without the mask to minimize the CAs and Hypopneas.  I know this isn’t a good long-term solution.  Anyone have any suggestions?