New to APAP & Need Advice

[APAP4ME]

I turned off EPR 4 days ago and things have been going pretty good but I notice that I have more flow limits. What does this mean and do I need to correct it? I have attached last nights OSCAR report for comments/suggestions.

[APAP4ME]

Well, it's been several days since my last post and want to give an update. I was OK for a couple of nights with EPR turned off but was particularly uncomfortable a couple of nights ago and turned it back on. I'm still struggling with the CA's. Last night was particularly bad as I had 110 CA events. I slept for 9 hours and woke up feeling good but was surprised by the high AHI. I also use an O2Ring and that reported good oxygenation last night. I attached my OSCAR report.

Any suggestions where to go from here will be greatly appreciated.

[Dormeo]

EPR helps with FLs because it supports your inhalation with a little pressure boost, helping you overcome limitations within your pharynx. Many people are not bothered by FLs; others are. Your worst FLs were right at the beginning of the night when you probably weren't asleep. Maybe your nose was a little stuffy? At any rate, I would put that issue on the back burner.

Try reducing the EPR to 1 tonight to see whether that's comfortable. With luck that will help you avoid those long clusters of CAs.

Next time you post a chart, would you include a zoomed-in view of that 10/9 chart, maybe 20 minutes capturing a bunch of the CAs?

The good news is that you're feeling good during the day and maintaining your O2 levels at night. I think it makes sense for you to keep trying to get the CA clusters busted, but your bottom line is still positive.

[APAP4ME]

I didn't change the settings last night but had a better night than 10/9. I have attached a 20 minute view of some of the 10/9 CA's as requested as well as a report from last night.

[Dormeo]

Glad you had a better night. The zoom-in shows the instability of your breathing during this period; you have a CA-flagged pause, then you have deeper-than-normal breathing as you recover, which washes out CO2 and induces another CA, and on and on. I'm fairly hopeful that as your body adjusts, you'll get into these cycles less and less often. Keep us posted, would you?

[APAP4ME]

Glad you had a better night.  The zoom-in shows the instability of your breathing during this period; you have a CA-flagged pause, then you have deeper-than-normal breathing as you recover, which washes out CO2 and induces another CA, and on and on.  I'm fairly hopeful that as your body adjusts, you'll get into these cycles less and less often.  Keep us posted, would you?

Do you see anything in my OSCAR reports which would indicate the need to adjust my pressure setting higher or lower than max=min=6cm h20?  My doctor suggested maybe trying max=min=5cm h20 but not sure if doing that would make matters worse?

[Sleeprider]

Your events are predominately central, and a pressure of 5 may help to reduce the CA events.  The risk with lower pressure is an increase in obstructive events.  I don't see any reason not to try your doctor's suggestion and compare the OA events.  In your last chart you were using EPR set at 2 and your CA events came back strong. Your best session was this one. In spite of higher flow limitation, the reduction in EPR had a very positive effect on your CA.

[clownbell]

@OP - It appears you started PAP therapy in early September, meaning you have been on therapy almost 45 days. The CAs sometimes take a while (not a day or a week) to work themselves out. Congrats on perseverance. 

Pressure changes can be viewed as experiments. If you try an experiment (such as 5-5) and give it a week or so, and things don't work out, you can always change back. You won't damage yourself.

PAP therapy sometimes involves trade-offs. Kinda like life in general. Remember the song "You Can't Always Get What You Want?" You mentioned flow limits higher than desired. Classic example. If you increase EPR to hopefully drive down FLs, but that results in increased CAs, then you have a choice to make. On a relative basis, FLs are the least bad among all the event types. So maybe the choice is to put up with sub-optimal FLs in order to keep CAs down. Food for thought.

[APAP4ME]

Hello All,

It's been 10 months since my last post and I'm on day 417 of usage.  I'm attaching the summary report from OSCAR to see if anyone has any comments or suggestions on the effectiveness of my therapy.  Should I be tweaking settings or leave well enough alone?

Thanks in advance for any help.

[Dormeo]

Could you post a typical recent daily chart?