New to CPAP and the Apnea Board

[davedadiver]

   

Hi everyone.  I have been using my Resmed machine since mid February and I am having trouble getting my AHI number down below 3.  Last night was a typical night.  My EPR is currently set to 2 (it was set to 3 before)  I recently raised the maximum pressure from 11 to 11.8.  A am concerned with all the Clear Airway activity that occurred before I woke up this morning.  
I have been reading a lot of your posts trying and trying to titrate the pressure to maximize the therapy, but it's time for your advice.
I had a sleep study a few years ago (and have misplaced the information).

If anyone could give me their thoughts it would be greatly appreciated.

Thank you.

[wordjoy]

I am not a DR.
But my lower pressure is higher (10) and I only occasionally see the machine increase it, then it settles back down.  
I have been doing this a long time and know that I have less apnea than I used to.  Often wondered treatment trained my body. 
Your machine is almost always at a higher pressure that a minimum.
Was that number prescribed or are you figuring this out yourself?  6 seems low to me, but I am not a Dr.

[DeepBreathing]

G'day Dave. Welcome to Apnea Board.

Could I ask you to reformat and upload your chart again, please? We need to get rid of the calendar and pie chart which are covering up important information. We also need to see the following graphs (only): Event flags, Flow rate, Pressure (not mask pressure), Leak rate, Flow limitations, and (if it will fit) Snore. The instructions for organising the charts are linked in my signature.

The second thing to do is find that sleep study report. It's important to know if all those central apneas were pre-existing, or have only come along since you started treatment.

In the interim, I'd think about raising the minimum pressure to about 8.0, to overcome the obstructive apneas. At the same time, reduce EPR to 1 or (if you can tolerate it) turn EPR off altogether. This should have the effect of re-balancing your blood gases. CPAP makes your breathing more efficient (and EPR even more so), and the level of CO2 in your blood remains artificially low. The brain sees the low CO2, says "I don't need to breathe just now" and you get a central apnea. (Well that's the layman's version coz I can't spell hypocapnia )

It's possible that the late centrals are sleep-wake junk, as you transition out of sleep and go into a dozing phase with irregular breathing. So let's have a closer look - can you zoom in onto a two minute window during that heavy apnea period?

These suggestions are somewhat of a guess, but won't do any harm and may well help. Let's see the full data and we can be more definitive.

[davedadiver]

Thank you for responding to my post.  I really appreciate it and I will get that info. to you later today.  It might take me a little while to get the sleep study. 

[davedadiver]

Okay DB, I think I have the correct screen shot for you.  

Once again, any information would be greatly appreciated.

Regards,

Dave

[Sleeprider]

Dave, your therapy stats show you actually have normal (good) respiration volume, pacing and a low rate of flow limitations. With pressure of 6.0-11.8 with EPR 2, your median pressure is almost 8.0 cm and mostly stays below 9.2. Events are mostly distrbuted through the night without clusters except for the events from 7:15 to 7:45. That last cluster may have been related to arousal or could even be positional. I think you are on the right track by reducing EPR, and I recommend a further reduction to 1. You have a fairly long ramp, and wth your relatively low starting pressure, I recommend you just turn off ramp. Let's start with these minor changes and see if that makes a difference n the frequency of CA events. You're probably aware that CA is fairly common in new users, and they can be caused by a number of things including arousal and changes in position. Sensitivity to EPR can be a big factor in CA events, so that is why we want to reduce that.

[davedadiver]

Thank you Sleeprider.  I really appreciate your help and advice.  I will get rid of the ramp and set EPR to 1.

Will keep you posted.

Thank you again,


Dave

[davedadiver]

Okay, I turned off the ramp function.  I tried the EPR at 1, but I felt uncomfortable with that setting.  I kept EPR at 2 for now (I will change to 1 next week).

I have included another screen shot to show the difference.

Any other advice will be a great help.   Especially when looking at the Clear Airway Apneas.

Thanks,

Dave

   

[Sleeprider]

Go with what makes you most comfortable. We can be too quick to judge a cluster of CA at the end of the night as somethng significant when it's merely sleep disturbance or what we sometimes call "sleep-wake-junk". The latest chart is more obstructive and suggests minimum pressure is a bit too low. EPR would potentially help this, so don't worry about lowering it to 1.

[davedadiver]

Ok, the ramp has been off and I am comfortable with the change.  I still have the EPR set to 2.  I am going to lower that to 1 this evening.

I just wanted to post a new Oscar sleep report.  I am trying to eliminate the Obstructive events by raising the minimum pressure in increments of .2 cm H2O.

I still see clusters of Clear Airway events.  You have advised me to lower the EPR to address these events.

I am including last evenings data and two closeups for your advice.

Thank you,

Dave