New to apap

[ChadBSr]

10/29 CSA flags increasing, feeling like pressure is too high and the machine is breathing for me

---

10/30 Still on APAP and EPR but reduced pressure

[ChadBSr]

11/1  I switched to CPAP and VCOM with no EPR at the lowest pressure I felt comfortable with.  Increasing 0.2 each night.

---

Series of pressure increases.

---

11/14

[SarcasticDave94]

What were your sleep study (PSG) diagnostic results? Post some info from this sleep study, especially things like the doctor recommendation notes and the table with events type and count.

If you don't have it, call up the doctor that issued the CPAP. You want to request your detailed sleep study report.

In the US, you have the legal right via HIPAA law to request and receive it." No you can't have the report" will not be acceptable. If they attempt to refuse, say HIPAA says yes. If they refuse further, find your regional medical board and report them.

You need to know about those Central Apnea.

[ChadBSr]

Home sleep study

[ChadBSr]

Last page

[SarcasticDave94]

OK yep this is the stuff.

Image 2, pAHIc 3% at 12, these were Central Apnea recorded. You had some, but compared to the overall at 91, they were a minority of events. But yes they were there then, and CPAP multiplies them for you.

You currently have almost no variation with CPAP mode at 8 cmH20. If Ramp is active, you'll want that off too. For me, unless I was on ASV with the backup breath rate function, variable pressures made CA worse.

Suggested things to think on, consider requesting to swap CPAP for ResMed AirCurve VAuto. This has a setting called Trigger, where High or Very High setting has helped members avoid some CA with this. Beyond this, then you'll want to get ASV Titration to get the ASV instead due to CA.

Do you live in a high elevation? This can itself cause more CA. From there, it'll probably be idiopathic, unknown medical cause.

[ChadBSr]

I live in low altitude.  Yes I found that any variation from APAP or EPR increases centrals. Also if I get to around 10cm I have so many my AHI is worse than no cpap.  Adding Vcom and switching to cpap reduced centrals.  I now vary from nearly zero to around 2.5 ahi. Getting a different type of machine would be difficult. I had a sleep study from a company online and because my insurance has a high deductible I paid out of pocket. So I have no insurance and no doctor.

[ChadBSr]

@SeePak  I took another look at what you said.  I do often have an inverted I:E.  This makes sense during recovery breathes, but even during regular breathing when inhalation is shorter than exhalation it is less than 1:2, more like 1.5 times.  This happens regardless of apap vs cpap, epr on or off, vcom or not.  I don't really know what to make of that yet except maybe I'm just not tolerating pap at all.  I've ordered the supplies to make and experiment with an EERS.

[SeePak]

Yeah I don't believe there's any Rhyme or Reason for that ratio 
is just something that I noticed that most people are either even or a longer exhale but there are those of us with the longer inhale
 with me I believe it has to do with being plugged up nasally a lot taken a longer inhale to get my air.
Don't believe any cause for concern at all there.
Also check close up of flow chart line can stay close to 0 and go back and forth above and below zero which can skew inhale and exhale times as per members here.

[ChadBSr]

1:3 to 1:5 inhale to exhale is the "correct" ratio.  The concern is gas trapping and central apneas being caused.