Initial Post: XhwMikey Treatment Thread

[xhwmikey]

Hmm,
I must have messed something up with the attachment process...

Trying again with the other two screenshots...

   

   

[Sleeprider]

You still have some flow limitation as seen in the flattened inspiratory wave. The first CA event is preceeded by two big sigh breaths and is probably an artifact of that. CA event at 03:11:30 looks like normal deminimus CA pause, and the OA event was an arousal and shift in position with big inhale, breath-hold OA marked, then exhale and arousal breathing. Glad to hear it's feeling better. That's what counts.

[SarcasticDave94]

OK, it is getting better. I can't suggest any edits. Maybe try to build the trend, see what happens in a day or so. You'll likely need to look for a balance where all things are as low consistently as you can get while keeping things comfortable and repeatable.

Reminder, CA of any kind will be consistently inconsistent making them hard to pin down.

[xhwmikey]

Greetings!

I've been doing a bunch of reading on this forum trying to get a handle on the relationship between EPAP, IPAP, EPR (pressure support(ish)) and Flow limits.  I think I've had my "eureka moment".

It came yesterday on a thread discussion about flow limits and pressure support - I was thinking about EPR (pressure support(ish)) in the inverse way to how it actually works on the machine.  I was thinking that somehow the machine subtracts pressure from the IPAP value IAW the EPR setting.  I was having trouble wrapping my head around how just making the EPAP lower could affect flow limits - when the correct (for my dopey thought process) combination of words occurred to get me to think about EPR and Pressure Support - as implemented in the machine - actually happens.  Conceptually, for me, the machine adds pressure to the EPAP value for the IPAP pressure.  That's how PS (and to a certain extent EPR) helps with Flow Limits - the machine literally helps the inspirationally challenged complete their breath with larger values of PS (and to an extent EPR).  Now I understand how higher EPR (which helps created more inflow and the concomitant increased blowoff of CO2) can affect CA events.  Wow!

A huge thank you to the posters here who explain this stuff!  My interpretation my not be perfectly correct, but it is much closer to the truth than what it was a few days ago.

On to some interesting observations from my ongoing journey with CPAP...

For some reason, my trusty F20 mask began leaking.  It was not that old (it was the original mask I received from my PSG), but I tried a new mask which leaked even more than the original.  Additionally, my AHI increased into the 8ish range which was going the wrong way.  I went back to my F30i mask which was better - but the pressure on the bottom of my nose was keeping me awake.

So I tried my p30i mask again - which in the past worked well, but I had panic issues and mouth leaks.  This time, I had acquired a Ruby style chin strap.  The first night, my AHI was below 1 (0.49 over 6 hours).  Last night my AHI was 1.49 over the entire night (8 hours).  Much better, but I noticed a bunch of flow limits - enter my new understanding of EPR, and I'm going to change my values a bit to allow EPR to "help" my inspiration - I'm going from 9.8 - 12.6 EPR 1 to 10.0 - 14.0 (I don't like the number 13) EPR 2.  I realize that I might see increased CA events (because of the increased blowoff of CO2 due to better inspiration volume (hopefully)), but I should see fewer H events with lower Flow Limits (I hope).

I'm intrigued about why the nasal pillow mask had such a dramatic impact on my AHI compared with my full face mask.

At least I feel like I'm beginning to understand some of the concepts (I think) - yeah, it took long enough 

I've attached the last two OSCAR screenshots for requested analysis...
   

   

[Crimson Nape]

Congratulations! You know EPR well enough to explain it with great clarity.  Your new pressure/EPR setting would start your EPAP a little lower than its current pressure. Before the pressure change, the EPAP would have been 8.8. With the new settings, it will be 8.0. Is this a planned thing?

A word about you getting CAs from your new settings.  Don't worry if they occur.  They will usually subside over time.   If you happen to get some, look in your Events tab on the left of the daily screen and expand the Clear Airway listing.  The number within the parenthesis will give you a quick review of how long each event lasted in seconds.  Hopefully, they will be at or near the 10-second minimum.

If you continue to have mask leaks, you may wish to consider trying an F&P mask.  Their engineers seem to have an inside scoop on getting a mask to seal.

- Red

[xhwmikey]

@Crimson Nape,

Doh! Good catch on the math issue!  I'll change to 11 - 14 EPR 2 so min EPAP = 9.  Thanks Red!

Thanks also for the suggestion of F&P - I'll have a look at them!

Mikey

[xhwmikey]

Greetings,

It's been a while since my last posts, and I wanted to document my progress thus far.  I'm encouraged, and hoping it continues!

Last night's results were quite the surprise.  My AHI had been oscillating from 0.2 to 2.0, but then last night happened (0.0 AHI).  I realize this is just the beginning of the journey and much can happen, but I wanted to acknowledge those who helped me get to this point.

Thank you to everyone here on this forum who helped me get to this point!  Sleeprider, SarcasticDave94, Crimson Nape, and everyone else I am forever grateful.

As far as how I feel, that is also a positive.  No more out of control night sweats.  No more brutal morning headaches.  I (mostly) wake up noticeably more refreshed then before starting CPAP therapy.

I'm now keeping an eye on Flow Limits (although with EPR @ 3 I'm not sure more could be done with my machine (ResMed AS10) ).

I'm astonished at the difference that the mask selection had on the results.  My full face masks resulted in AHI readings mostly above 4, but the switch to my P30 had an immediate effect on lowering the AHI to ~2 and lower.  I'm just hoping that things don't change significantly from here.

Thanks again!

Mikey