Paula's - Therapy Thread

[paulag1955]

You mean the nights after I switched to fixed pressure, right?

As a point of reference, I had more CAs than OAs in my original sleep study and my AHI was over 40. I was also titrated to a fixed pressure of 8 in my in-lab sleep study.

Here are my first three nights after making the change.

   

   

   

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Here are screenshots of my best and worst nights after making the change and also one that's zoomed in so you can see what my flow rate looks like before/after apneas.

   

   

   

[gainerfull]

The zoomed in event looks like two position changes back to back and a breath hold each time you shifted but completely normal and I wouldn't make any changes for flow rates like that.

What is your memory, cognition and energy levels like on a day to day basis? How often do you take naps?

I bet you'd benefit from EPR considering the hypopneas but I'm concerned that the pressure difference may increase central apneas due to c02 washout. Plus, EPR subtracts from pressure so you'd likely run into more obstructive events as well. I would be curious to see your OSCAR data for a day of CPAP set at 11cmH20 w/ EPR 3 if you were ever curious to know how dialed in you can get your sleep data but overall it seems like as long as you're not experiencing symptoms.

To answer your earlier question - the most important thing is how you feel and if you feel the same either way the next thing I'd focus on is REM consolidation to make sure you're sleep architecture is solid night over night. After that, neither AHI nor flow limits really matter if you're sleeping 8hrs per night, dreaming most nights and are not exhausted during the day. In your Nov 7th chart based upon the tidal volume it looks like you had at least 4 sleep cycles so your sleep is pretty good.

[paulag1955]

This is what's so weird about my data. My hypopneas are higher with fixed pressure set at 8.2 or 8.4, but with fixed pressure at 8, they are about the same as they were when I had EPR enabled. What can even account for something like this?

   

[paulag1955]

I might try it with max pressure at 11, but honestly, I'd be more interested to see what would happen if I decreased my fixed pressure to 7.8.

[paulag1955]

Okay, so I have been trying to weigh the relative importance of AHI versus flow limitations and the best way to balance those conflicting (for me) factors. I'm attaching a synopsis of my latest data download. I calculated my RDI (dang, those hypopneas and RERAs can really add up) and looking at this new piece of data, it appears that a fixed pressure of 8.2 has been most effective for me so far. I have a limited amount of data and am now wondering how many nights at a given set of parameters constitutes a fair trial? For example, I have only 9, 6, and 4 days worth of data for fixed pressures of 8, 8.2 and 8.4 respectively and there are more variables than I want to try to analyze for when I was using autoset, so let's just say 22 days on autoset. So to go back and do this in a more organized way, how many nights should I stick with [X] settings before I move on to the next?

   

[paulag1955]

Okay, ignore that last data set that I posted. There was an error in one of my formulas. I'm attaching the real data. 

I do have, though a limited data set and am wondering how many nights is a fair trial for a given set of parameters? A week? Two weeks?

   

[Sleeprider]

I'm not sure what I'm looking at with these statistics. Are these fixed pressure with or without EPR?
How are you feeling with the therapy? With your diagnosis I expected you to need ASV, and you would tolerate pressure support if you had the ASV.

[paulag1955]

Yeah, I'm just trying to get a sense of what settings are most effective for me. I have to go by the numbers and not by how I feel because I always feel fine. With CPAP, without CPAP, fixed pressure, autoset...I always feel the same, which is fine. And for me, it's hard to just look at a list of AHI numbers and determine where it is that I'm doing better, because my AHI is within roughly the same range. Even at fixed pressure, I still have nights where my AHI is as high as 4.

The fixed pressure is without EPR. My in-lab sleep study showed my best results at a fixed pressure of 8. My flow limits must have been high in the lab, so I have to assume that the sleep doctor wasn't concerned about them. My insurance is Kaiser, and I have to see only Kaiser doctors, so my guess is that every sleep doctor I could see would also be unconcerned. In order to get a prescription for an ASV, I think I'd have to lie about how I feel. 

Here's a question for you. If my machine is set at a fixed pressure of 8 and I enable EPR, how does that work? Does it lower the pressure when I exhale, then return to 8? I'm having a hard time wrapping my head around how enabling EPR is different than autoset.

I appreciate you getting back to me.

[Old Steve]

I get my best results with my machine in the CPAP mode with the EPR turned on.   I would suggest you try 9cm pressure using CPAP and a 1 or 2 EPR for a night or two and see what it does.

[paulag1955]

Thanks, I am going to try this starting tonight.