(01-07-2019, 01:27 PM)Sleeprider Wrote: Along the same lines of though as Bonjour, you are currently at 13 cm fixed pressure with EPR at 2. Most of your events are hyopnea, and I don't think the CA cluster is of particular concern at this point.  I would consider a pressure reduction to 12.4 cm as suggested by Fred, and increasing EPR to 3 and see if that resolves the hypopnea, or converts to a higher CA.  I think this is potentially more comfortable and targets the cause of hypopnea which is a reduced breathing volume. This will also help your flow limitation which are present, but not shown on this chart.

Let's look at the positive side of these results. For the first time, your machine is properly showing expiration is longer than inspiration. I think flow limitation is probably less and that should help with your previous high RERA, however the S9 will not track that.  Please try to include the Flow limit chart if it is available since pressure and mask pressure are fixed, those charts are less important.

(01-08-2019, 09:25 AM)bonjour Wrote: Looking at the previous chart, The Obstructive Apnea was negligible implying that we may be able to lower pressure, Lowering pressure has a good chance of decreasing the small amount of Central Apnea that was there and increasing PS/EPR is always a good way to treat hypopnea the largest component of the previous apnea.  As Sleeprider is aware, increasing EPR can, not always, increase Central Apnea.  My plan, not stated, was to consider raising EPR on night 2. Not wrong, just different.

The other fact is that managing Central Apnea, in all of its forms, is consistently inconsistent.  That is, while the CA seemingly will look to be in control it will flare up and show more significant numbers randomly.  

Last night may or may not be a flareup.  Each of our apneas, while they have a lot of similar aspects, are different, and respond a bit differently simply because our bodies are different.  This is why we need to tweak/titrate settings for everyone. 

As SR said we will "see if that resolves the hypopnea, or converts to a higher CA"

I see 2 realistic actions, the first ride the settings as they are for another night. The second is to decrease EPR to 2.  I would likely suggest something else if I could actually see the charts.

Fred

(01-08-2019, 08:44 AM)herbm Wrote: Sleeprider probably knows more about this stuff than I do but with no concern about CA and some H, I would NOT have reduced my settings.

Instead I would have gone up.

You had a higher AHI (with reduction) but this does NOT prove me correct -- could be anomalous, but if you've tracking under 5 for more than a one or two nights it's more likely to mean something.

My thought would be to bump it up, 13 or a bit more, from the previous setting instead of reducing.

Do you really need EPR?  I turned my off almost immediately and never needed it.