Still need help with cpap therapy

[notam2]

Serge's initial sleep study included a small number of central and mixed apneas.  The CAs might in fact be drug-induced.  While EPR is likely causing some treatment-induced CAs, Serge's initial sleep study had something like 180 arousals vs 20-ish apneas.  In my opinion his main problem is arousals/flow limitations.

Serge only had 2 OAs last night.  Doing a range of 8-14 isn't going to help.  The machine is going to detect flow limitations and try to treat them with more pressure.  The thing is, I think any pressure over 9 likely isn't helping Serge since his airway is probably pinned as open as its going to get.  The extra pressure won't do anything but cause discomfort and/or CAs.  This is why I think Serge is better off with a fixed pressure.

Its possible that 9 with EPR 3 is as good as Serge is going to get with his current machine.  That said, I think another day at 8 EPR 3 is probably worthwhile as an experiment, and if he gets the same result then try 9 EPR 3 for a week and see how it is.

I don't think he should lower his EPR to 2.  His flow limitations would go up.  He's in a tricky spot, but his big problem are the arousals/flow limitations and not the apneas.  Hopefully the treatment emergent portion of his CAs subsides with a little time.

I was in a similar spot as Serge (but without the same amount of CAs) where increasing pressure didn't help to improve sleep quality and only caused me discomfort.  What really helped me is when I got a VAuto, reduced my pressure and increased my pressure support to 4.  My 95% flow limitations went down to zero at that point, and I was able to start getting decent sleep.

Edited to add:  I completely agree that the less ramp the better (with zero ramp preferable).  Capping the ramp at 15 minutes sounds like a good idea to me.

[weuw]

Good morning

Last night I tried pressure Auto 8-13 with EPR 2 (ramp 15 min).

It was (roughly, more EPR 1) a setting I used a few months and sometimes it worked, sometimes not... I don't know exactly why but my Doctor told me to use only fix pressure (no EPR, 8 then 10 then 12 with EPR 1...).

Yesterday I had more anxiety problems, so I used more anxiolytics than usual. I wasn't optimistic when I went to bed.

But when I woke up this morning, I was surprised to notice that my watch showed 2 hours of deep sleep. I did not have so much deep sleep since end of June.

However I feel a bit tired this morning, but maybe due to medication.

And numbers are so-so : IHA 3,47 - CA 2,89 (lower than usual) - 95% FL 0,13.

I wonder if this Auto presure with EPR 3 could be a compromise solution ?

[weuw]

Last night EPR 3 with Auto 8-14 and 15 min ramp. Deep sleep 1 hour. AHI 5.2 and 0.06 95% FL. 

I've computed this stats with my Oscar datas (these are average for 6 months):

EPR - AHI - 95%FL - PEAK FL 
3 - 4 -  0.05 - 0.21
2 - 3 - 0.08 - 0.21
1 - 1.95 - 0.12 - 0.26
0 - 2.5 - 0.17 - 0.31


As you can see this is linear... AHI is really best with EPR 1.

As a conclusion, I am going to try one week with pressure 8-12 and EPR 2. If it doesn't work I will lower EPR to 1.

Thanks again for your help.

[factor]

Please keep also a record everyday of how you feel and why.

Notes like this:

But when I woke up this morning, I was surprised to notice that my watch showed 2 hours of deep sleep. I did not have so much deep sleep since end of June.

However I feel a bit tired this morning, but maybe due to medication.

Its the feeling good we are looking for.  Like the deep sleep times and length.  As we compile data we will find the sweet spot.  It may never be perfect.  The data coupled with how you feel will help you find the best spot.

Also a few OSCAR screen shots would help.

[weuw]

I feel better for a few days and yes it's the main goal.

Screenshots of Oscar for last two nights :

   

   


Regards,
Serge

[weuw]

Hello there

No news for a few days, good news ?? 
As usual there are good and bad times. But mostly good after all.

I changed my mind about auto pressure 5 days ago, because one more time my deep sleep was too inconsistent (still 0 min deep sleep at times).
So I came back with fixed 8.8 pressure and EPR 3.
Ramp is auto.

And for the last 4 nights, my deep sleep has been more regular (average 1h23 by night).
I feel rested during the day.

BUT last night I had a lot of central apnea + CSR (yes, it's probably periodic breathing ?).

Here are screenshots :

   

   

As you can see AHI was high with 6 but I got 2 hours of deep sleep, so it seems it did not bother my sleep. 
Before night I got  1h10 deep sleep with AHI 3.

As a conclusion, I think the better is to ignore this central apneas (and CSR), hoping they will disappear when I will be used with EPR 3 ?
Or lower EPR at 2 and pressure at 7 ?

Regards,
Serge

[Sleeprider]

I think continue to optimize for comfort, and if CA events and respiratory instability continue, consider EERS http://www.apneaboard.com/wiki/index.php...ace_(EERS)

[weuw]

However today I feel rather tired, I think CA may affect my energy ?

One thing I noticed : the more CA I have, the more physically I am tired, and the more flow limits I have, the less I got deep sleep and the more I am intellectually tired !!

EERS ? I've seen that on the forum and indeed it could be a solution but not obvious to find parts here in France.