[Treatment] Clownbell PAP Journey

[staceyburke]

No one gave you any suggestions so I will give you mine, Hoping you’re still awake. 

Min 7
EPR 3
Max 9.8 where you have it now. 

That will give you exhale of 4. We need to see how that works for ca & H.

[clownbell]

Thank you Stacey. I too was thinking 7 which is 1 higher than the current minimum of 6. I will try it and see what happens.

[Dormeo]

I think it's fine to try the changes you're considering, but I'm not seeing "lots" of hypopneas. Take a look at the Overview page in Oscar and see what the range is for your hypopnea index.

[clownbell]

Thanks, Dormeo. Fair point. I was looking at the number of events, not so much at the index. 

Consider:
4/11    12 events
4/8      18 events
3/28    15 events
3/26    31 events
3.21    31 events 

I understand that you did not have the March info to look at. And I don't mean to pick a fight. Just want you to know what I was thinking about. Also I note a fairly large number of Central/ClearAirway events on some nights.

[Dormeo]

Sure, no problem. You might keep an eye on the index, which is important, and the way the events are spaced throughout the night, which can also be important. For example, if you had only 8Hs but that was during a one-hour nap, that'd be noteworthy, and if you had 18 Hs during the night but they were almost all within the same half-hour period, that would suggest you had a positional issue, not a settings issue.

[clownbell]

Stacey - I should clarify about the 9.8 IPAP.

At inception, Kaiser set the machine to 5-20. Kaiser reviewed the data from my first 3 weeks of CPAP usage beginning 1/14/21. They took the 95% readings for each of 21 days, added them up, and determined that the average 95% number was 9.8.  So they set IPAP at 9.8 and left EPAP at 5.

I do understand that if the machine were set to higher IPAP, the machine would only go as high as needed.

Thank you.

Craig

[Sleeprider]

Based on what I'm seeing, you need to be at a minimum 9.0, maximum 14.0 and EPR 3. This will take out a lot of pressure variation and should resolve most hypopnea and flow limitation. I'd take you to a minimum 10.0 pressure with EPR 3, but don't know what your comfort level is. My bilevel starts at a pressure of 13/9 so a suggestion of 10/7 doesn't seem very extreme, but it's up to you.

[clownbell]

I am bumping this thread with another related question. 

It is my understanding that the pressure differential between inhale and exhale helps relieve hypopnea, but am unclear on which direction is better for this particular purpose -- a large differential, or a small differential?

Is the underlying understanding wrong?

Thanks to all for your guidance.

[Crimson Nape]

No, the pressure difference, EPR in your case, is to treat flow limitation. Treating hypopnea requires an increase in your EPAP pressure.

[SarcasticDave94]

Hypopnea are the baby brother to Apnea.