How to lower CA index

[SleepAd2]

Hi everyone,

I've been undergoing intermittent therapy for about a month (started for 2 weeks, paused for a week, and then resumed for a week). I've tried different masks and settings, but all my results share one common issue: a high CA value.

Currently, I am using the F&P Vitera Full-face mask. Could there be something wrong with my settings? What can I do to achieve better results? I feel only minimal improvement now compared to day one.

Thanks

[SleepAd2]

Please help me

[Crimson Nape]

Your late onset of CAs makes me think that you were awakened by the pressure changes. I would increase your minimum pressure to 9 cm and leave the maximum at 10 cm. Try that out and see if you feel better.
- Red

[SleepAd2]

Hi Crimson,

Thank you for your suggestion. I made a slight adjustment to the pressure, changing it from 7 to 9 cm, and I've noticed better results over the past two nights. I'll attach today's data for your review, hoping it provides further insights to support the adjustment you recommended.

[SarcasticDave94]

Your results are better than they were. I think your mask is leaking more than would be ideal. If you're still using the Fisher and Paykel Vitera, you don't want to wear it tight. I've used one and large cushion size was best for me.

Some things to look for, make sure the cushion section over the nasal bridge isn't leaking due to folding of the seal. The whole mask needs to ride lower on your face than you might think. You'll want to have it as low as possible while keeping it sealed at the bottom.

I was doing this adjustment method, all straps loose. Hold mask in place with CPAP on. Fasten the overhead strap after you get it poisitioned up and down correctly. Next is the lower straps. Moderately tight. Then top set just enough to hold it in lightly.

Alternate tighten slightly between top and bottom sets but don't go much tighter, more adjusting to balance the tension. Too tight on the bottom will pull up the top and same in reverse.

[Sleeprider]

SleepAd2, It would be interesting to see how you respond to an increase in EPR from 1 cm to 2 cm. You have flow limitations which sometimes can result in enough airway resistance to be interpreted as CA, because an event may be obstructive, but is an incomplete obstruction and the high flow limitation can be seen as an open airway. This has worked for quite a few other members. It may be useful to see a zoomed image of some CA events to see what the respiratory flow looks like at a 2 to 4 minute resolution.

[SleepAd2]

Hi Sleeprider, thanks for your response.

I'll try changing those settings tonight to see how it goes.

Here's today's data with two zoomed in captures.

[Sleeprider]

In both zoomed cases of CA, there is respiratory effort related arousal with recovery breathing, followed by the CA event. If we can avoid the flow limitation, we might also avoid the RERA with hyperventilation and the subsequent apnea. After seeing this, I'm going to suggest EPR 3.