First off, thank you for being such a trooper and being so wiling to give things a go. Your patience is very much appreciated.
And most importantly, how do you feel after last nights sleep?
Now, let us review things first. Your results are consistent regardless of pressure as you will see.
- Fixed 8 no EPR - Most events are hypopnoea’s and some tagged as RERA. Lots of flow limitations.
- APAP 8-12 EPR 2 - Pressure hits ceiling at 12 cmH2O due to FL’s. Fewer hypopnoea at higher pressure, but it is uncomfortable to you possibly from pressure swings.
- Fixed 9 no EPR - mostly hypopnoea events, few CA’s.
- Fixed 10 EPR 3 - Most CA’s, few H.
- Fixed 11 EPR 1 - Mostly H and few CA’s.
Given that the APAP mode was uncomfortable, we should put that aside as an option at the moment. You have very few leaks, so not worried about that at the moment either.
Our sample size is a wee bit small, but we can see a trend. First, you need higher pressure to control the hypopnoea’s. Second, EPR causes CA’s for you, so we need moderate that for comfort. Third, you have a lot of flow limits even at EPR 3.
I think you need higher pressure with or without some EPR for comfort. I also believe you may be a good candidate for a bilevel due to the high flow limitations. There are more FL’s than an EPR of 3 can handle, so you need more pressure support. I think we can help you make a case for getting a Vauto if you so desire and want insurance to pay for it. You can always buy one out of pocket from an online
Supplier, Facebook Marketplace, or other source. I have used
Supplier #1 quite a bit and they are very helpful.
I would like you to try a fixed pressure of 12 with no EPR. If it is uncomfortable add an EPR of 1 or 2. Depending on how that looks and feels, we may have to increase it further, but I am concerned about your comfort so we may need to keep using a bit of EPR.
Also think about sleep hygiene. A low pillow helps keep you from kinking the airway, but more so does a soft cervical collar. I do not know if you FL’s are from position or other internal source, so just want to be sure you are keeping the airway as open as possible.
Good luck and hang in there. We are getting close!
