New to CPAP and the Apnea Board

[jaswilliams]

Try the lower EPR it may help it may not but it costs nothing to try

[davedadiver]

Ok everyone.

I've turned off the ramp, the EPR is set to 1, I've raised the minimum pressure (and I will bump it up another .2 cm H20 tonight) and I've switched to the AirFit P10 (which I really like because it is so quite and I really feel like the air is being delivered into my nose perfectly).

My AHI is lower, which is great.   I am trying to get my AHI below 2.   My plan is to raise the minimum pressure to 8, keep the maximum at 11.

Is it time for me to turn the EPR off to help further reduce the number of Clear Airway events?

Your thoughts are always appreciated.

Dave

[davedadiver]

Hi all,  I cannot seem to lower my clear airway events.  Last night I had 43 Clear Airway events and 5 Obstructive events.  I'll have a pretty good night (12 Clear Airway events and 1 Obstructive event), but then the chart below is pretty much the usual for me.

Ramp is off, EPR is set to 1.  I tried EPR at 0, but I felt uncomfortable with that setting.

If you could help me any further, that would be great.

Dave

[Gideon]

You have a concern over Central Apnea/Clear Airway.

These may, not will, minimize overtime, typically 2-3 months as your body adjusts to CPAP.
Management choices fo CA are limited and include.

1. Time, see if they go away over 2-3 months. This is most likely what your doctor will initially choose.
2. Reduce/turn off EPR. The higher EPR increases the efficiency of your breathing improving oxygen saturations (good) and increases the flushing out of CO2 (sometimes Bad)
3. Minimize pressure changes and keep pressures lower (doesn't always work)
4. ASV, the only machine that will actually, and specifically treat Central Apnea, and your Obstructive events which are currently well managed.

If you want your doctor involved start now by letting him know of your concerns about your Centrals ans ask him, repeatedly, what you should do about them.

Also be aware that Central numbers are all over the place, we call that consistently inconsistent.

[davedadiver]

Ok, so I did an experiment.  I got my hands on an Aircurve 10 ASV.  I read as many of the posts everyone had made on the forum and I tried to set up the machine to something I thought was appropriate to my case.  I set the ASV Auto, EPAP min 6, EPAP max 10, PS min 2, PS max 7.  The experience was very different than the Airsense 10 Autoset,  it is definitely varsity level training.  I found that the pressure at times was much higher than I had experienced and that would wake me up throughout my 4 hour sleep.  I feel that if the highest pressure was a little lower, I might have been able to sleep for 7 or 8 hours.  The other thing I noticed is that my respiration rate did not coincide with the machine's respiration rate.  It was if it was trying to inspire (breathe) for me a little earlier than my body's natural tendency.


The good news is the AHI was the lowest I have ever seen, albeit the amount of sleep I had was about half of what I normally clock.

After 4 hours I went to the bathroom and switched back to my Airsense 10 Autoset, and that felt weird.  So I am trying to switch over to the ASV, I think it is going to take me some time to get used to it.

I am asking the experts their opinions to adjust the settings.  If you look at my Oscar chart, it shows no Clear Airways, it is not even on the list of Apneas in the box to the left.  Does this mean the machine is so efficient that it is assumed you will not have a Central Apnea with this machine?

I am posting two charts,  one from two nights ago on the Autoset and last night from the ASV (I had 63 clear airway events with the Autoset).

               

[sheepless]

"It was if it was trying to inspire (breathe) for me a little earlier than my body's natural tendency."

someone will be along to help with settings.

nmeanwhile, fyi, it probably was trying to trigger a breath. asv addresses ca, or the failure to initiate a breath, by increasing ps to get you to breathe. it can feel awkward at first & can lead to runaway pressure.

the trick is to blow back (exhale) forcefully to reset to a lower pressure. after a week you should adapt & not notice the machine nudging you to breathe.

asv flags unclassified apnea, ua, rather than oa & ca. you are correct that the assumption is that when an asv is optimized for you, most ua is oa.

[davedadiver]

Thanks for your response.  To clarify, the recorded unclassified apneas are truly obstructive apneas when using an ASV machine?

I look forward to adjusting the machine settings.

Regards,

Dave

[jaswilliams]

If it was me I would raise the max PS to 12 the ASV won’t go there unless it needs too and sleep with the machine for a week it takes a couple of nights to get used to the way the ASV works. If you are awake and the machine seems to be forcing a breath on you blow back at it and it will back off for a few minutes

[sheepless]

asv doesn't identify oa & ca so it's an assumption, at least on my part, that most ua is oa. the only way to 'know' is to look closely at the ua in the flow rate. interpreting these takes some experience & although some here are pretty good at it, it's not always definitive. lucky for us, asv is really good about getting ahi down below 5 & often 2 or 1 so we don't really have to worry about what type of apnea the remaining few are.

[Sleeprider]

I agree with Jaswilliams on max PS. you can see your chart has a lot of flatness along the top of the pressure which means it ran out of room to manage the CA events. The tidal volume, respiration rate and minute vent charts are useful to look at with ASV to see if it is stable. We don't want to see a lot of fluctuation in tidal volume moving with pressure support. The therapy looks much improved with ASV.