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+--- Thread: Poor sleep quality because of CA events? (/Thread-Poor-sleep-quality-because-of-CA-events)
RE: Poor sleep quality because of CA events? - paulag1955 - 12-18-2023
Okay, that is not what I expected to see. When I went from autoset to fixed pressure, my CA events were cut in half, not doubled.
RE: Poor sleep quality because of CA events? - Crimson Nape - 12-18-2023
Look at it from this standpoint, using variable pressure can cause a CO2 washout as the pressure increases. Using static pressure maintains a constant gas mixture.
- Red
RE: Poor sleep quality because of CA events? - PeaceLoveAndPizza - 12-18-2023
The bad night was not unexpected. Let’s work on getting you comfortable.
Since almost all events are CA’s, try turning off EPR. If needed for comfort you can set it to 1 or 2. Note your flow limitation will increase with no EPR, but as it is fixed pressure we don’t really care about them for now.
I also noticed your CA’s tend to cluster, so consider trying out a soft cervical collar and flatter pillow if not already using one. It will help with the chin-tucking and also keeping the airway open.
RE: Poor sleep quality because of CA events? - paulag1955 - 12-18-2023
It was unexpected for me based on my experience.
RE: Poor sleep quality because of CA events? - PeaceLoveAndPizza - 12-18-2023
Paula, I should have been more precise. It was not unexpected to me. I had the same reaction as you when I went to fixed, but I suspect our good friend Hypoxic has a different path to follow.
Hypoxic, I’ve been going over the posted information with the primary complaint of poor sleep seemingly related to the arousals in the charts. The CA’s are presenting as well, but that is just another piece of the puzzle.
The latest fixed pressure had an EPR of 3, which did not work well as there were quite a few CA’s and some leaks. I believe we need to find a way to smooth out the flow rate and that it may need more pressure. EPR should be used carefully as needed for comfort given your reaction to it. If you are open to more testing, try reducing EPR to 1 at a fixed pressure of 10.
Hang in there. It takes time to find everyone’s sweet spot.
RE: Poor sleep quality because of CA events? - paulag1955 - 12-18-2023
I should have known. Everything related to my therapy is counterintuitive to me. My OA events go UP when I increase pressure.
RE: Poor sleep quality because of CA events? - staceyburke - 12-19-2023
I would suggest
Min 8
EPR full time set to 3
RE: Poor sleep quality because of CA events? - PeaceLoveAndPizza - 12-19-2023
I think Stacey is right as the next thing is to go back to baseline settings with pressure 8-15, EPR 3 full-time, no ramp. Go with a flatter pillow to help with the flow limitations. Depending on how that goes we may need to start considering a bilevel to get more EPR.
This is the same challenge I and others have had to figure out. An EPR of 3 is just not enough and the only way to get things to work decently is to use lower pressures than we need. This may give a good AHI, but the sleep quality is poor as there is not enough pressure to handle the arousals. If we do up the pressure then we create other problems. A bilevel is the best machine solution as it not only supports EPR > 3, but also has trigger settings that help with CA’s. The combination of the two makes a big difference.
RE: Poor sleep quality because of CA events? - Hypoxic - 12-20-2023
Thank you all so much for sharing your thoughts!
In the past, I used min8/max13/ERP3 for 4 months. I see I had a median AHI 1.85 and a median CA 1.46 (1st screenshot).
After the disastrous Sunday night, I switched back to min4.4/max13/ERP 3 and felt much better.
I also changed my pillow to a flatter one as PeaceLoveAndPizza suggested.
I uploaded the screenshots of the last two nights. Simply talking to you, improves my sleep
RE: Poor sleep quality because of CA events? - Hypoxic - 12-20-2023
(12-19-2023, 09:54 AM)PeaceLoveAndPizza Wrote: I think Stacey is right as the next thing is to go back to baseline settings with pressure 8-15, EPR 3 full-time, no ramp. Go with a flatter pillow to help with the flow limitations. Depending on how that goes we may need to start considering a bilevel to get more EPR.
This is the same challenge I and others have had to figure out. An EPR of 3 is just not enough and the only way to get things to work decently is to use lower pressures than we need. This may give a good AHI, but the sleep quality is poor as there is not enough pressure to handle the arousals. If we do up the pressure then we create other problems. A bilevel is the best machine solution as it not only supports EPR > 3, but also has trigger settings that help with CA’s. The combination of the two makes a big difference.
Unfortunately, trigger sensitivity is locked on EU machines. Checked it.
Anyway, trying a bilevel is something I was considering too.
As soon as I get round my provider to give me one, I'll need your help for the settings.