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I've been using APAP for 1-2 months. I was diagnosed with mild OSA from a home sleep test (AHI 8, primarily hypopneas but a few obstructive events), which I think helps to explain some symptoms I've dealt with the past 1-2 years. I'm sleeping pretty well with the APAP and feeling better overall, but still fairly tired and don't feel back to myself yet. I've posted a few recent nights of sleep. I was initially playing with the settings too much and have now left them stable the past 1-2 weeks. The highest I've had my minimum pressure was 8 (only one night) and the flow limitation numbers were essentially the same and I had painful aerophagia the following morning.
What I am wondering from the community is, should I just give it more time since I am still new to therapy? Could the flow limitations be an issue and should I optimize those more? Thanks so much for any input.
Flow limits are apnea just like O and H events the difference is duration (O or H has to be at least 10 seconds) and the amount of blockage. Resmed machines raise pressure when it finds flow limits to stop them from becoming larger O or H events. Flow limits can stop you from getting into deep sleep or could wake you up. With the rise in pressure some people swallow more air. To limit flow limits we use EPR. Right now you are NOT using any EPR except during ramp;
I would suggest the following changes to your settings.\
Min 7
EPR Full time
EPR 3
see if these settings work for you and post again.
It would also be helpful if you would turn off ramp. You have been on your machine long enough that you probably don't need it now. You get no real therapy during ramp, and every time you get up for a bathroom break, ramp turns on again, stealing away needed therapy time.
Thank you for all of your input! Is there any concern about EPR causing an increase in CA's or is that something you just don't really know until you try it? I see that I have some already, sometimes close to 1 CA/hr, so that was a concern of mine. Thanks again.
Here are some recent nights of sleep. I have been slowly working toward the changes you suggested as I did not want to make drastic changes right away. I am using EPR 2 and have been slowly increasing my minimum pressure to treat OAs. My flow limit data looks better, but still getting a few OAs at times throughout the night. I am assuming increasing EPR to 3 would likely make my OAs worse. The OAs often seem to occur as the pressure drops back down to the minimum pressure, other times it looks more random. The timing of these events also often correlates with sleep disturbances on my sleep tracker.
Increasing the minimum pressure seems to be the answer. I'm just concerned about increasing the pressure, because some mornings I wake up bloated and crampy from presumed aerophagia and it takes up to 2 hours or so to resolve. I also wonder if I'll start to get more leaks and disturbed sleep from increasing the pressure. Should I just keep slowly increasing minimum pressure? I really appreciate any input.
All 3 of these charts show good treatment. Your goal to guide therapy setting at this point is not zero events, however should be good charts like this with comfort and getting a well rested state.
Leaks and flow limits look good too.
You may get a bit better results by trying out standard response vs the soft you're using now.
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Thank you for your replies. Stacyburke, I understand increasing EPR might further improve my flow limitations, but couldn't it increase the frequency of OAs by reducing the effective pressure? I also ask because some of the OAs occur without any registered flow limitation. I also wonder if reducing the minimum pressure to 7 would potentially increase OAs. Granted, I am still new to all of this, but would you mind elaborating on your recommendation?
09-01-2024, 05:07 PM (This post was last modified: 09-01-2024, 05:40 PM by Tommy C.)
RE: Question about flow limitations and settings
StacyBurke,
I see you have a ResMed 10 ASV AirCurve machine as I do. Is there any way to duplicate your settings on our machines? I do not trust the flow limitation readings (flat-topping at 1.0) and might look into nasal mucus breathing problems if I can't make any progress. There are no EPR or Min controls in the clinical menu that I can see.
