Therapy Questions, EPR, CA, Low O2

[Sleeprider]

Okay, we can help with that. You have a lot of flow limitations and RERA. In addition, you have an abnormally low tidal volume and minute vent, even assuming you have small stature. The way to address that is with EPR so that you get what is effectively 3-cm of pressure support. With the Airsense 10, it is pressure relief, so we need think in terms of exhale pressure (EPAP) and inhale pressure (IPAP).

Go to the clinical settings and set EPR ON, FULL TIME at setting 3. This is in the comfort settings. This will reduce your EPAP so that with your current pressure settings you will start at 7/4 (IPAP/EPAP) and it can and will rise to 10.6/7.6. The difference in pressure between IPAP and EPAP will make breathing easier and relieve much of the flow limitations and RERA. To compensate for the reduced pressure during exhale, you need to increase your CPAP pressure range. As you can see, your maximum pressure is already reached as your Median pressure, 95% and Max. So it may not be high enough. I recommend a minimum pressure of 8.0 and maximum pressure of 12.0, and we can re-evaluate after you have tried it a while. I think you will find the change in pressure and addition of EPR much more comfortable, and it will certainly help you get the support you need to relieve the upper airway restriction that is your prominent feature. If you are using the X-small or small nasal pillows, please increase one size up. I think you will have a better seal and better airflow.

[kingskid]

Hi Sleeprider.  Thanks for the advice.  I’ve been floundering a lot trying to understand terms and settings.  Yes, I am small, 4’11” if I stretch, and normal weight.  I tried EPR at 2 with my current settings and my AHI increased, but will change to your recommended min and max and put EPR at 3 and see what happens.  Will do that tonight and report back with results of a few nights.

[Sleeprider]

Good luck. We are hoping to see the flow limitation improve. I'm not surprised your AHI increased with EPR at current settings. We do need to compensate for that lower exhale pressure.

[kingskid]

Sleeprider, I forgot to ask about Ramp.  It is off right now.  Should I turn it on, if so, for how long?  Oh yes, forgot to mention that I put a medium pillow in, so I can hardly wait to go to bed to try everything out! 

[Sleeprider]

If you are not bothered by the pressure, my preference is to not use ramp. I don't use it, and your starting pressure are not very high. I'm certain you will find the different inhale and exhale pressures more comfortable, and it should clean up the events. Most members that have tried a larger nasal pillow, never go back. You will get more air and probably a better seal.

[kingskid]

Okay, I'll go with that!

[yankees123]

Just wondering if you would do better not in the for her mode but the regular autoset mode?
Just a thought.

[kingskid]

(I kind of wondered about that, but since the for her mode has a special algorithm for women, I thought that was the correct setting, but I really haven’t a clue.  Perhaps Sleeprider would know.

[Gideon]

One of the things I look for once the numbers are in line is how you feel and what symptoms you are experiencing. I'll say let's get the numbers good, see how you feel, try the for Her, tweak it, then choose.

[kingskid]

One of the things I look for once the numbers are in line is how you feel and what symptoms you are experiencing.  I'll say let's get the numbers good, see how you feel, try the for Her, tweak it, then choose.

Okay,  bonjour, that sounds good.