(11-10-2024, 12:12 PM)G. Szabo Wrote: The 20-minute ramp is long and might lead to events. It would be best if you reduced it or eliminated it.
In my case my history would disagree with that recommendation. Eliminating the ramp would be one of the worst things for me to do. If anything adding 5 to 10 minutes would be a possibility for those occasions where I struggle a bit to get to sleep for the second session after that middle of night bathroom trip.
I am hyper-sensitive to the EPAP. In the past I have NEVER been able to become compliant with using the machine. The closest I ever came was when a sleep lab let me bring home an asv to trial it. Regretfully during that week that damn study was released that disqualified me from using ASV. so I was provided the bipap that I still have and am currently using. The same machine that spent years on end in a corner of my closet because I could not adapt to it, the only time it was pulled out was in Dec 2020 when I had covid (thanks to some **** **** **** people that worked with my wife that just had to have their big family Thanksgiving get together.) After my week in the hospital when I got back home after cleaning it up the machine went back into the closet, because I still was not able to adapt to it, even at the lowest vAuto setting.
At the beginning of this year I began to notice my breathing was causing me to have worse sleep. So I dug out the machine and began to give it another try while setting up an appointment with a new sleep dr.
I kept quite the journal this time. I started it with a little recap of what had happened previously, and noted that while it was a struggle to get to sleep with the epap at 4, during sleep when it increased pressure not long afterwards I would wake up and stop using it. Plus the CA's were way too high.
One of the first things I did was I printed out the clinician manual and really studied it. A few lightbulbs went off about how many different settings the AirCurve 10 VAuto has. I realized the previous sleep labs/drs had not done me any favors by sticking to only the vAuto settings.
So I began by changing to S mode, which manually sets the pressure and it does not change. My first setting was epap 3 Ipap 7. I actually began to become compliant with the usage at those settings! Fewer OA's, mostly CA's. I know the general response to these low pressures is "but that is too low, it's not therapeutic". Well, the machine setting in a closet isn't therapeutic either. At least this way I was starting to use it and more importantly it created the bridge to where my body began to adapt to it.
I tested out a lot of the settings in that S mode, easy breathe off, rise time, tiMin, tiMax, cycle, trigger, and as I began to get these settings adjusted to where I was doing better at using the machine, I began to increase the pressures, and found using the ramp was needed.
Eventually I got back to where I could switch back to vAuto. But I am still hyper sensitive to epap, and without the ramp it would be game over, I lose, because one other major obstacle I had to work through was the horrendous transitional clusters (mega CA's) as I went from conscience to unconscious breathing. Now about the only time they show up is when ramp ends and I have not made that transition.
One thing I noted from reviewing the oscar graphs, is frequently when I do make the transition the pressure remains low for a while.
So it has been quite the fight to get to where I am at. My apneas are low, but my breathing is still erratic and irregular while I am sleeping.
I am attaching 3 screenshots from last night. The first 2 are the transitions on the 2 sessions. For session 1 I fall asleep very fast. For session 2 it takes longer, but I made it before the 20 minute ramp ended. Notice how the pressure remained low after both transitions. The 3rd is one of the episodes that didn't raise to being flagged as an apnea, but was not smooth breathing.
I am going to research about that hormone, would you mind sharing a link that you have on it?
Thanks.