[Treatment] Relationship between EPR and Flow Limitations

[SarcasticDave94]

Generically, leaks can be from the CPAP humidifier seals, the hose connection at CPAP, then the hose itself, mask connection, then the mask cushion, needing to count both sides which is sealing to your nose or face and then the cushion to frame seal.

Your chart indicates to me you have several leak sources, I see 3 possible separate types here. The low level constant look containing the example pattern at 20:50-00-10 or so is probably a mask to nose seal with your nasal mask (as listed). Second type example is around 20:35 start but maybe even back to session start and going over to 20:50, raised wide and flat, this appears to me as mouth leaks. Again the session start to about 20:35 might fall into leak pattern 3, which I'm most likely seeing this third pattern later, off and on from 02:15 to session end, this jagged sharp quick spikes thing looks like the mask itself, like with movement as the cause.

[earnerd]

Thanks for that post!! I checked the humidifier seal and hose (and connection points) for leaks this morning and I couldn't hear anything. So I think I need to address the face-to-mask seal and close my mouth.

There seems to be a correlation between the presence of these leaks and the onset of my CAs. Perhaps the CAs aren't CAs after all? I guess I will not know until I address these leaks.

Thanks, again.

[earnerd]

EPR has definitely helped my flow limitations, but I see that when EPR is set to 3, my central apneas are higher (see figure). Are there any changes I can consider making? 

   

It's worth noting that my central apnea count has steadily increased since the beginning of the year.

   

Thanks in advance for any suggestions.

[Sleeprider]

The Autoset does not have any tools to remedy CA events, which in your case are relatively high. The Aircurve 10 series can provide the pressure support (EPR) needed to reduce flow limitation, and options to reduce CA events. With median CA over 10/hour, I would be seriously considering ASV. With fewer events, we often suggest using a high or very -high trigger sensitivity with the VPAP-S or Vauto machines. You really need to start looking at ASV as a potential option.

[40plus]

Shouldnt your mask type setting be "pillows" and not "nasal" for the Brevida mask? Those settings can affect the leak rate calculations.

[earnerd]

Thanks for the response, Sleeprider. To clarify, the bar chart shows the central apnea count per night, not per hour; I will still be sharing these data with my sleep doc to see if we can do better.

@40plus, you might be referring to some charts that I originally shared. During this time I was playing with pillows and nasal masks to address leaks. I am back to using my n30 mask from Resmed.

[SarcasticDave94]

Even so, the CA count will likely be the source of suboptimal treatment as is. Dave wouldn't accept it.

To fix, complain about this until they get tired of hearing you and they'll just man up and issue the ASV.

Sorry my memory isn't working well at the moment. Did you post your sleep study redacted of personal info? If not you should, please.

[earnerd]

Thanks for your comments, Dave. I've attached my in-lab study. What is your take on the number of EEG arousal noted?

[attachment=65789]
[attachment=65790]

Cheers.

[donsburg]

I have huge respect for the way you've collected and analysed the data - love it!

I'm wondering if anyone can explain why it is that EPR is supposed to help with flow limitations? If FLs are sort of on a spectrum from Apnea -> Hypopnea -> FL then I don't see why the remedy wouldn't be simply increasing the pressure a little bit?

[OpalRose]

donsburg,

Go back to the beginning of this thread and read (post #2).  Sleeprider gave a very good description on the relationship between FL and EPR.