Paula's - Therapy Thread

[paulag1955]

Okay, I tried raising my fixed pressure to 9.0 and setting EPR at two. I wouldn't say it looks promising. My average AHI with a fixed pressure at 8.2, with no EPR, is 2.04, 95% flow limits is 0.14 and 99.5% flow limits is 0.30. You can compare that to last night's chart below. Question. My mask came off last night. I'm pretty sure I didn't take if off, and I know for sure that I didn't turn the machine off, but when I woke up without it, there was no air coming out of it. Does it turn itself off at some point?

How many nights do I stick with the new settings it to get a real feel for the results?

   

[paulag1955]

Okay, this looks a lot better than the first night on fixed pressure at 9.0 and EPR set to full-time at 2. Flow limits are comparable to when I was using autoset at a max of 10.

Short session on the CPAP last night. We're having a bit of a cold snap here and the air is dry. My nostrils dried out to the point where they were painful enough to wake me so I took the mask off. I've decreased the temperature and raised the humidity for tonight.

   

[Old Steve]

Try for another night and if the results are not much different I would try 10cm pressure and set the EPR at 3.

[paulag1955]

My results are always all over the place, so I feel like I need to give it at least a week to see what happens over time, but if I don't feel like I'm having good results after that, I will try upping both the pressure and the EPR.

[paulag1955]

AHI is up from yesterday, but flow limits are still looking better.  

A question for you. I expected my central events to go down when I switched from autoset w/EPR to fixed pressure w/o EPR, but my obstructive apneas also went down. Hypopneas and RERAs went up, but not by as much as obstructive apneas went down. It makes no sense to me.

   

[Old Steve]

It is hard to say why.  Although, between 5:50 AM and 6:20 AM it looks as if you may have been having some positional apneas.  I would give it a bit more time.  I still think that 10cm pressure CPAP and 3 EPR may be better for you..  Anyway, it looks like you may be going in the right direction and you may just need some fine tuning.

[paulag1955]

Yep, I think I rolled onto my back around that time, which is unusual because I'm usually a stomach/side sleeper. Although not so much on the stomach now because it makes my mask leak. Sad.

I'm going to go two more nights at my current settings, which will make five nights. I feel like that's a fair try. Then I'll try pressure at 10, EPR 3 and see what happens.

[paulag1955]

As long as I'm pondering the mysteries of my treatment, why does CPAP help me at all? I had 20+ central apneas in my home sleep study. Where did they go and why?

[paulag1955]

I should have said 20+ central apneas per hour in that last post.

Here are the results from night four at my current settings. What would be considered to be a significant improvement in flow limits? I guess what I really want to know is how much improvement I should expect to see by enabling EPR.

   

[paulag1955]

Do you ever wonder why medical costs in the US are so high?

Back in - I think it was August - my husband had a home sleep study, resulting in him being diagnosed with mild sleep apnea. I don't remember his exact AHI, but it was between 5 and 6. But because he reported poor sleep quality, they set him up with an Airsense 10 in August. He didn't really feel like the therapy helped him at all and so he sent it back at the end of October. To back up a bit, he had been diagnosed with aFib in 2018 and is scheduled for a catheter ablation on 12/28. So the last time he spoke to his cardiologist, she told him that she really wanted him back on CPAP therapy before the ablation. So he called the sleep clinic. You'd think that since his cardiologist wants him on the therapy before 12/38, and they have a sleep study from August, that they could just...you know...send him another machine. But no. He needs to have another consultation with the nurse/PA (not sure what she was, but she was definitely not a doctor) to re-evaluate. Our insurance is Kaiser and our plan requires that we go to their clinics and see their doctors. So they are actually wasting their own time and money. Makes no sense, but there you have it. That's why medical care is so expensive in the US.

Random thought: Why doesn't ResMed make the inside of the humidifier chamber flat and smooth?

My five-day trial at fixed pressure 9, EPR 2 is over. Results below. I'm not sure which way to go next. Fixed pressure of 8.0 and no EPR clearly provided my best results, other than for 99.5% flow limits. I think I'm going to go back and try 8.0 with EPR at 2 and see what happens. I'm still struggling to understand 1. Why CPAP therapy works for me at all (my in-home sleep study results showed more central than obstructive apneas); and, 2. Why don't my obstructive go down as expected when pressure is increased. (You can't see it in the attached spreadsheet, but my obstructive events averaged 3.03 on Autoset with a pressure range of 7 to 10 with EPR enabled.)

Ignore the Total rows in the spreadsheet. The first three pressure levels are fixed pressure, no EPR.