MoreSleepLessNap's Therapy Thread

[MoreSleepLessNaps]

Hello,

I'm new to this forum and OSCAR. My dad was diagnosed with moderate obstructive sleep apnea a few years ago. He has ResMed AirSense 10 and started with a nasal pillow cushion with chin strap. I noticed he was still having air come out of his mouth, so we switched to a full face mask, AirTouch 20. It had lots of leaking, so we are now using the full face mask AirFit 20 with a CPAP pillow. We still have some leaks still, but most of the time it's under the 24 liter threshold. 

I wish I knew about this forum and OSCAR sooner. My dad's AHI has still been high. His doctor's goal was getting an AHI under 9. My dad's current pressure is 11, but his AHI was still above 9. From reading posts in this forum, I decided to see if turning EPR on would make a difference. I set EPR at 2. His AHI decreased to 4.04 from 13.26 the first night with EPR on. The second night it decreased further to 3.42! However, that night his large leak was 14.94% according to OSCAR. The next night with EPR on, his AHI was 6.68. I was then told by someone that EPR was just for comfort. My dad has no difficulty breathing out with the mask on, so I turned the EPR back off. His AHI then increased to 11.96. His AHI hasn't been under 11 since EPR has been off.

Should I keep EPR on? If so, can someone please explain to me how it lowered his AHI? Also, should I be worried about Cheyne Stokes Respiration? I read that it can be related to central sleep apnea, which my dad was not diagnosed with after the first sleep study years ago. I also read that it can be related to heart failure. My dad has recently been diagnosed with heart failure. Cheyne Stokes Respiration also seems to be less when EPR is on. 

One last thing, I don't know if it makes a difference with the data or not, but my dad often has his CPAP on and running when he's just reading in bed and not sleeping yet. He does this because he has the tendency of falling asleep without putting his CPAP on first.

Thank you in advance!

   
   
   

[Crimson Nape]

Hi MoreSleepLessNaps!  -  

Resmed advertises EPR as a comfort feature, but it actually makes it a very limited bi-level machine.   Based on your graphs, particularly the Flow Limit, he should respond very well to an EPR of 3.  Since the EPR's value is the reduction in exhale pressure in cm H₂O, you need to increase the pressure setting to compensate for this.   Based on the all the hypopneas, I would increase his pressure to 15.   This would make his exhale pressure 12.  This should help in reducing hypopneas.   Also, sleep position is also critical.  Sleeping on your side is the preferred position, while sleeping on your back is the worst.  Chin tucking can cause obstructed airways (OAs) and hypopneas too.  Having the back-of-the-head strap too low on the neck can promote tucking.  Being positioned too low causes the mask to tighten when you tilt your head upward and releases the tension when tilting forward.  While asleep, the pressure against the face would subconsciously cause the patient to tilt forward to relieve the pressure, thus causing airway obstructions.

I would normally say set the AS10 to Auto, but the Resmed uses the Flow Limitation value as a guide to increase pressure.  As much limitation as he is currently experiencing, the CPAP would run up to the maximum set pressure and would not offer any benefit.

Play with these ideas and see if you can get some improvement.

Good luck!

- Red