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+--- Thread: New user struggling with treatment (/Thread-New-user-struggling-with-treatment)
RE: New user struggling with treatment - joeblough - 04-21-2024
i've found over the last couple of days that sleeprider's advice about EPR and CA is true for me. i reduced my EPR from 3 to 1 and my CAs are a lot fewer. on the other hand, i have no idea if they were really that significant. they seemed to come in response to an arousal rather than be the cause of an arousal based on the timing of events. based on my pulseox, these events happen even without the CPAP so i might just be prone to them.
watching a few of the lanky lefty's videos, his claim is that if you feel worse with the CPAP then it's simply waking you up, possibly more than the apneas were. this would point to eliminating leaks and trialing different masks, but of course you have already been there.
RE: New user struggling with treatment - Deborah K. - 04-21-2024
I think it is more important to control the flow limits, as they affect therapy than to try to eliminate the CAs. They are not harmful. If you did not have high CAs in your sleep study they are treatment-emergent and will lessen or go away on their own as time passes.
RE: New user struggling with treatment - Expat31 - 04-22-2024
@bsroberts
I have been rethinking hour situation with EPR and flow limitations.
Can you repost your chart of the 19th of April, this time with the calendar excluded so we we can see fully all your statistics like your most recent one?
I will explain why.
As these details were not initially available, maybe we were a little hasty in suggesting flow limitations were high and EPR 3 needed. I just don't know
Only your flow limitation graph was visible, and with the scaling, difficuly to see clearly the detail.
All I could see was some bursts in high flow limitations, with most of the time the values sitting on the zero line.
I just can't tell for sure.
Can you change the y axis to max 0.25 instead of 1.0?
It is true that in some cases EPR can encourage C02 "washout" tricking the brain to stop breathing.
But we are dealing with two evils here; keeping flow limitations low with less sleep arousals and better sleep comfort, or increasing centrals and thus degrading quality of sleep.
It's a double ended sword. A real balancing act.
As always, the devil is in the detail.
Let's revisit your flow limitations as indicated above.
Thanks
RE: New user struggling with treatment - bsroberts - 04-22-2024
Thanks for all of the replies.
My initial sleep study was at-home and I dont know if I experienced CAs and my in-lab study was with PAP but I'm trying to get a copy of that study. I have a follow-up visit with my physician in a few weeks. Ugh, I might have another study is in my future.
I slept OK with the new settings but, indeed, I woke up a lot that night and by yesterday afternoon I was really crashing. I don't know if it was the APAP pressure changes or something else? I felt about the same last night.
I've attached my graph from the nights of 4-19 and 4-20 with the FL scaled .25x
Thanks again!
RE: New user struggling with treatment - Expat31 - 04-22-2024
Do you have any idea what happened at about 10 minutes after you switched on your machine on the night of 20th April when you had a pretty violent flow limitation burst ?
The rest of the night regarding FLs was pretty good.
The previous night started in a similar way, but these bursts were repeated three of four times after. You were on a fixed pressure of 6, EPR 1.
Intruiging.. something to do with REM?
Maybe try a night with your current pressure settings 8/12 with EPR off, to see where it goes.
Otherwise, I really don't know.
Hopefully your sleep report may shed some light on this, or your doctor.
RE: New user struggling with treatment - bsroberts - 04-22-2024
I'll try 8/12 and EPR off and see how it goes for a few nights.
It is interesting, looking back at older data I see a similar spike in FL shortly after going to sleep some nights. I do sometimes wakeup startled shortly after going to bed...
I'm curious, I'll try to see if there's a correlation between my sleep data and these FL spikes, that wouldnt surprise me.
Thanks again!
RE: New user struggling with treatment - staceyburke - 04-22-2024
You do NOT want your EPR off. The last night 6 with EPR0 had very high flow limits. You need your EPR set to 3. You can move up the min 1 to 9 but that is all I would do.
RE: New user struggling with treatment - bsroberts - 04-22-2024
Ok, got it Ill keep EPR 3 and move up my minimum.
Thanks
RE: New user struggling with treatment - Expat31 - 04-23-2024
Hi,
I have some observations on the last two posts
On the 20th April, stacyburke suggested the following settings:-
Min 8
Max 12
EPR full time
EPR 3
It seems that these settings were based on the graph of the 19th of April. (There were two earlier ones from back in February so not really relevant currently. )
Unfortunately vital detailed settings of the 19th of April were obscured due to the inclusion of the calendar.
Now we have full details of flow limitations. A summary of the most recent nights data is below:-
Date. Settings. FLs 95%. FLs 99.5% EPR
19th April 6 (fixed) 0.06. 0.23. 1
20th April. 8/12 0.00 0.21 3
My opinion from the very limited data of only 2 nights is that flow limitation is not particularly relevant at this early stage, as both nights 95%, are well below 0.1.
Of course, ideally they should be less, but in my opinion the central apneas are the primary issue to focus on now to improve sleep quality.
However, on inspection of the graph of the 20th, there was no significant impact on pressure from flow limitations.
My strategy therefore was to try to see what happens by eliminating EPR and if centrals reduce by eliminating possible C02 washout.
We will quickly see if it works or not, and if flow limitations increase.
It must be very confusing for you for the rather aggressive member's intervention following my last post…
Anyway, let's seewhere all this goes, we can work through all scenarios.
RE: New user struggling with treatment - bsroberts - 04-23-2024
I realize there's no clear answer for tackling treatment so I appreciate both of your advice.
I forgot to reenable EPR last night, on top of starting out with an increase to my minimum pressure (mistakes were made). Eventually I moved the minimum back to 8 but didnt notice EPR was off and ended up with lots of aerophagia and waking feeling out of breath. I attached my data but it's pretty messy.
I'm glad I gave it a try but I feel like I may need some EPR at 8-12. I'll plan to stick with 8-12 at EPR 3 for a few nights to get a baseline and report back. Maybe I should next try titrating EPR down to 2 and then 1 and see how things go?