Xeros - Therapy Assistance

[Xeros]

Hi, quick question. I used to use an APAP machine but my sleep never felt much better (Low AHI and high RDI on sleep study). Never had insurance so had to do it all on my own. I didnt know about this site until recently. I tried APAP and CPAP mode and someone pointed out in my old data a lot of flow limits and arousals (Apparently resmed doesnt pick up RERA's). I had maxed out EPR so I tired higher pressures. All it caused was air swallowing, leaks and also more periods of not breathing or very small inhalations followed by paused breathing. I since got a bipap from someone for a good price. I am currently on a EPAP of 4.6 and a IPAP of 8.6 (low pressures ik) but I dont really have OA's so I figured starting low is better. The highest I ever got on CPAP was 12 with an EPR of 2. I immediately felt better on BiPAP the first night but I had the trigger setting at very high per recommendation to prevent CA's, which I now think was bad advice. I still had weird breathing so I changed my settings to 10 over 5 and the trigger to normal that night and slept just as well, but had a ton of central apneas, many in clusters. Because of this I turned the trigger back to very high. However with trigger on very high I found myself more and more exhausted physically and once I turned it down to high I felt much better the very next day, but still not as good when on medium. I plan on turning it back to medium tonight. I have found since that putting a ball behind my shirt has helped my sleep quite a lot as well. Also a CBCT showed my airway was very good, but my nose...not so much. I am trying to tackle my allergies better. However my breathing still seems flow limited, and while I feel 60 precent better than the death I felt like before, I still feel like im missing something, maybe its just more time but I dont think that's all.  I pause breathing a lot and have really long inspirations that seem to pause half way. I had similar issues when my CPAP pressures were high. Any idea on what this is? I'd really appreciate it.

[Sleeprider]

Your results with PS 4 using fixed VPAP-S pressure, looks excellent here, and CA does not appear to be a problem. Time in therapy is good and leaks are controlled. Flow limit is zero across the board, so you can probably afford to reduce PS slightly. Your pressure support is adjustable in increments of 0.2 cm, and if you feel a slightly lower PS might be a better solution, you seem to know how to reduce to 3.6 or 3.8. Your decisions on trigger sensitivity seem to be sound.

[Xeros]

Thanks sleep rider. I didn't know if pausing breathing a lot was normal or not. Therapy is going well but still toss and turn a lot. I will look at other factors for this and give the current settings more time.

[Xeros]

Hey one quick question sleep rider. Is it true when on S on any machines that the machines dont record flow limits? Or for example when on CPAP mode on an APAP?

[sleep2023]

I would like to know that too. I have Aircurve 10 and when in S mode there is no flow limitations recorded there. Why is that?

[Crimson Nape]

It is true that the S-mode does not record Flow Limitations. An easy workaround is to use the VAuto mode, setting the maximum IPAP pressure to equal the sum of the EPAP+PS.

- Red

[Sleeprider]

I think some of the recent machines may record flow limits in S mode, but the historic normal has been CPAP and VPAP do not record flow limits in fixed pressure modes. My mistake on the earlier post...good catch.

[Xeros]

Well I actually learned that from you,  which kind of saved my hide. I had pretty large flow limits even with EPR 3 and pressure maxed back when I was placed on a APAP. I turned it to auto mode and actually saw some flow limits but they seem minimal. If I go over 4 PS my CA and air swallowing will increase. At the moment I can tolerate the amount or air I'm swallowing and my CA are small and likely just TSA. Maybe I'll try an work up eventually at a slow pace or use extra ventilation tubing if I need. I highly doubt I need an ASV but I do seem really sensitive to flow limits. Anyways, I'm rambling. I feel much better after years of not getting anywhere thanks to this board and especially your advice. Still have a ways to go but I think I just need to be patient and give it time.

[Xeros]

Tried a cervical collar for the first time last night, actually slept through some dreams and while im still waking up rn, already feel a lot better (tended to tuck my chin a lot). I got the collar to help ease some remaining flow limits that happened in big spikes, thought a collar would help, but didnt, they look the same. However my AHI shot up from around 1.5 a few nights in a row to over 5 AHI. Im not really alarmed by this but curious, did the collar remove the need for as much PS thus resulting in more centrals? Some of my centrals are SWJ, but most seem legitimate. I still woke up a lot last night but didnt have the urge to pee for once either. All weird to me. Any thoughts?

[Rice95]

I wear a collar. Sometimes I worry the collar is too tight or not tight enough. I would think that if it’s too tight it would have the ability to cut off the airway somewhat. I’m really careful now. If you can’t slide your chin into the collar it’s perfect. You need a few fingers width . This may or may not be the reason. I think if it was cutting off the airway you’d have a lot of positional flare ups and you don’t, so that argument probably doesn’t hold water but worth mentioning I think. 
Could also just be an odd coincidence. EPR settings also can affect CA’s. I’m not an expert but some of the veterans here may chime in. If your EPR is set to 3 , try 2 and see if it improves the events. These are ideas shared with me when I first started my therapy. I normally don’t have any CA events though. Hope it helps.