Therapy Questions, EPR, CA, Low O2

[kingskid]

My latest charts are buried in post #29 in this thread and were uploaded yesterday.   Could someone please look at them and provide an analysis?   I’m really interested in a read because i’m getting my second sleep test two nights from now.

[Gideon]

The charts still show good numbers and persistent Flow Limitations and RERAs. As SR indicated earlier, a BiLevel is the best machine to reduce those.
What do you want to come out of your sleep study?

[kingskid]

The charts still show good numbers and persistent Flow Limitations and RERAs.  As SR indicated earlier, a BiLevel is the best machine to reduce those.  
What do you want to come out of your sleep study?

I want knowledge, my O2 deficit addressed and resolved, and a BiLevel approved if that is what I need.  I really like my Resmed AirSense 10 for Her, though....but if I need a BiLevel I should do some research here and see which machine I should ask for.  Probably a Resmed BiLevel?

[kingskid]

I have attached Aug 9 (Fixed 7cmH2O) and Aug 12 (Min 8 Max 12cmH2O, EPR 3) charts to take in to my second sleep study tomorrow night.  These two charts are typical of the two settings noted so they are good representations of the titrated pressure from 2014 and what was optimized for me on the forum here around June 2019.  Can anyone explain how the 8/12/EPR 3 setting is giving me better therapy than the Fixed 7?  I can read the settings, but am unable to interpret them.  I feel the same when I wake up at both the titrated and optimized settings; however, the optimized setting makes me feel like my chest is full of air, like I am being pumped up like a balloon or something..aerophagia?  Your thoughts, please.  I will take these two charts in to my sleep study tomorrow night.  Thanks much.

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[kingskid]

I have attached Aug 9 (Fixed 7cmH2O) and Aug 12 (Min 8 Max 12cmH2O, EPR 3) charts to take in to my second sleep study tomorrow night.  These two charts are typical of the two settings noted so they are good representations of the titrated pressure from 2014 and what was optimized for me on the forum here around June 2019.  Can anyone explain how the 8/12/EPR 3 setting is giving me better therapy than the Fixed 7?  I can read the settings, but am unable to interpret them.  I feel the same when I wake up at both the titrated and optimized settings; however, the optimized setting makes me feel like my chest is full of air, like I am being pumped up like a balloon or something..aerophagia?  Your thoughts, please.  I will take these two charts in to my sleep study tomorrow night.  Thanks much.

 Could one of the experts please address my concerns in post 37 here?  I tried to make it a new post so it wouldn’t get buried, but it got placed here for continuity.  I need to know if the Fixed 7cmH20 or the optimized 8/12/EPR 3 looks like the best therapy.  Thanks.

[Sleeprider]

The post was moved because it is a continuation of the previous discussion, and it is easier to see it in context with that.

Your results for 8/9 and 8/12 have some similarities and differences. On 8/9 your pressure was fixed at 7.0 with no EPR, and on 8/12 your pressure was set to a range of 8 to 12 with EPR 3. Respiratory statistics (rate, flow limitation, tidal volume) were nearly the same both nights. Both nights show a low rate of hypopnea and RERA with 8/12 having more CA events, suggesting a sensitivity to EPR. Neither chart recorded OA events, which are apparently turned off. With auto-CPAP the flow limitations cause the pressure to remain near the maximum (12) most of the night.

Flow limitations suggest upper airway restriction, however it is not responsive to the change in pressure from 7/7 to 12/9. These results seem similar to previous analyses we have posted on your therapy, where flow limitation and RERA have been present, and may be more responsive to bilevel therapy than to CPAP, with or without EPR. Event rates are low, and we can't predict what will be seen in your sleep study, however, I would not expect a large number of obstructive events. Most sleep studies do not document flow limitation, however it may score RDI.

[kingskid]

Thanks Sleeprider.  I suspect that since my events/AHI is always below 5, my prescription machine may stay what it is.  Will find out soon.  Don’t know if a BiLevel will even be addressed but will talK to my doctor about it once he gets the new sleep results.  I think my first sleep test four years ago did show RDI, but I don’t know what it is or its significance.  If it pertains to flow limitations, that’s good!  When I get my sleep test, should I post it here or in a new post?

[Sleeprider]

It would not hurt to express an interest in bilevel. While your event rate is relatively low, if you feel unrested, it is likely because of the inspiratory flow limitation and notably low tidal volume. If these issues are a concern, discuss them with your doctor and ask if he has considered whether bilevel pressure support might be helpful.

[kingskid]

It would not hurt to express an interest in bilevel.  While your event rate is relatively low, if you feel unrested, it is likely because of the inspiratory flow limitation and notably low tidal volume.  If these issues are a concern, discuss them with your doctor and ask if he has considered whether bilevel pressure support might be helpful.

I’ll do that, thanks.  Will a BiLevel make me feel like my chest is being pumped up?  I looked it up and what I feel at 8 min 12 max isn’t Aerophagia but just the air being pumped in.  Maybe that is how a BiLevel is supposed to feel.  Is that how it is for you with the Air Curve 10 Vauto, and did you go to that machine from the Resmed AirSense 10?

[Sleeprider]

Your Autoset is only capable of 3-cm difference between inhale and exhale (IPAP/EPAP). That is the EPR setting. The IPAP (inhale) pressure range is 8 to 12, which results in pressures of 8/5 to 12/9. So EPR reduces pressure. I have never felt like bilevel pressure "pumps up my chest" however, it does part of the work of inspiration, and that is why it helps with flow limitation.

With an auto bilevel you could increase the pressure difference to 8/4 to 11/7 or something like that. The pressures would actually be lower, but with more pressure support to make breathing easier.