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+--- Thread: I don't know how to fix this! (/Thread-I-don-t-know-how-to-fix-this)
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I don't know how to fix this! - Cpapti72 - 08-03-2024
So, my sleep doctor has been no help, he just tells me that this is a complicated case. I keep having arousals for an unknown reason, I'm not sure if the breathing looks off in these charts but it shows the micro arousals. I was asleep between 9:30 to 11:30, I have included the data for this time.
I have tried EPR with success on bringing down total flow limit, however my centrals boost to 5 an hour so I had it very low last night. I have tried raising the pressure to 12 from 10 but then my centrals go to 10 an hour.
Do you guys see anything on the breath wave that would indicate breathing restriction? I'm going to lose my mind, I have ben trying to fix this for months.
My AHI was 2-4 on both sleep studies but my RDI was 17 NREM 27 REM. So I don't know what to do anymore, I wear my CPAP every night for as long as I can and I don't mind it, but as you can see the sleep is still unrestful.
RE: I don't know how to fix this! - PeaceLoveAndPizza - 08-03-2024
I suggest going back to basics. Start by self-titraing with the following:
Mode APAP
Min pressure 7
Max pressure 15
EPR 1 full-time
No ramp
We can see how you respond to those settings and can adjust from there. You may need a bit more or less pressure, same for EPR.
Once we have narrowed down your range requirements, you can make a decision as to whether you want to use a fixed pressure or a small adjustable pressure range.
RE: I don't know how to fix this! - Cpapti72 - 08-03-2024
I will try this tonight, I think you might be on to something. I have to say when I was down at a pressure of 8, my breathwave was much more smooth, so maybe the higher pressures are the cause of the arousals?
I was having trouble with feeling like I was still having choking episodes that low, but maybe I wasn't?
Thanks so much Pizza!
RE: I don't know how to fix this! - PeaceLoveAndPizza - 08-03-2024
Too high pressure may cause what you are experiencing.
If you try a min pressure of 7 and it feels too low, increase it by 1 cmH2O until it feels right. What we want to find is what a good min/max/EPR pressures are for you and to see how the machine needs to adjust your pressure with those settings. We will have to fine-tune a bit, but those settings seem a good baseline for you based on what you have tried.
RE: I don't know how to fix this! - CPAPfriend - 08-03-2024
I think for once that your doctor might be right. Firstly, I would need more information to assign more confidence to what I'm about to say, but just understand that it is speculation.
Your flowrate does indeed look quite bad and clearly demonstrates sleep-disordered breathing. Based off of what you have shared, I suspect you may have high loop gain, or a sensitivity to changes in CO2, in other words. This is supported by your strong reaction to EPR and pressure increases, both of which will disturb said sensitivity, particularly EPR. Your case could be a case of "complex apnea", where without treatment you are primarily obstructive (I don't know because I don't have the data from your sleep study) but with treatment you have central and / or obstruction. Your flowrate does illustrate periodic breathing (catchall term for pattern of breathing), which further supports this narrative, though reviewing the flowrate in detail would provide more colour / confidence. Another plausible explanation is those centrals are just post-arousal from obstruction. More detail is needed.
The breaths in the very short-term snapshot which you shared do show some flow limitation (obstruction).
RE: I don't know how to fix this! - Cpapti72 - 08-03-2024
So I went back to look at older data using a pressure of 8 and an EPR of 2 and this was one. So I think you might be on to something. Maybe low and slow is the way to go. Maybe I was just assuming more pressure equals better treatment, I really hope this is the way lol.
RE: I don't know how to fix this! - Cpapti72 - 08-03-2024
Hey thanks for taking the time to reply! I actually watched some of your vids early on in my cpap journey and they really helped learn about cpap and not be as scared about it so thanks! A lot of people just give up but having videos like yours on the net helps with persistence!
RE: I don't know how to fix this! - Phaleronic - 08-03-2024
Hi Cpapti72, your constant pressure chart @ 8cm with EPR on 2 looks better than the 10cm charts, and as the people have responded we'd like to see the sleep study to determine if you do have CSA. We also would like to see a full night of data rather than the snapshots-the data is important
RE: I don't know how to fix this! - Cpapti72 - 08-10-2024
I just thought I'd update everyone who contributed. So I did what pizza said and I used apap, I opened my pressures from 7 to 11 the first night. This resulted in a huge flow limitation upon falling asleep that woke me and choked me.
So the next night I used 8.2 to 11 because it said my pressures stayed under 10 for a couple of nights and hung around 8.5-9.0. The only thing that was happening the whole night was very low level flow limits that would shortly drive the pressure up. No apneas, and with an EPR of 2 with the settings of 8.2 to 11 my central apneas stopped.
So now... I have found my pressure range, I actually prefer apap as I can see I need variable pressure to deal with the flow limitation. I'm going to try my nasal mask one more time as the full face mask seems to be causing microarousal, I'm assuming from an itchy face or nose haha.
Regardless you helped me find my pressure range and I was pushing it waaaay to high up for my issues. No wonder I was having so many problems.
I hope the nasal mask works because I find it more comfortable, the reason I stopped using it was because a pressure of 12 was causing my mouth to blast open lol. However since that is essentially 3 more cm of water than I need most of the time, I think I will be fine now.
Thank you so much Pizza and everyone who contributed, now maybe I can get some actual restful sleep.
RE: I don't know how to fix this! - SarcasticDave94 - 08-10-2024
It sounds like the CA may not be an issue, but one day isn't a trend. Even so, you'll want the sleep study detailed data report. Lots here on Apnea Board consider getting the report a basic treatment requirement. Doctor may not like giving it, but in the US it's legally allowed for you the patient to get it.