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DavidHorn +0 points · 7 months ago Original Poster

Help with interpretation? Suggestions?

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Sierra +0 points · 7 months ago Sleep Patron

You are pretty consistently staying under the treatment guideline of 5 for AHI. It seems your most dominant component of the AHI is central apnea. Generally that can be reduced by lowering the pressure. Since your obstructive apnea and hypopnea are low, my thoughts would be to do two things:

  1. Lower the minimum pressure to 7, and lower the maximum pressure to 8 cm.
  2. Set the EPR to 3 but for ramp only. This will be more comfortable for going to sleep. After you are asleep the EPR is not helping you. It reduces the effective pressure of the CPAP, so it then increases pressure to compensate. When it increases pressure it may be causing the central apneas.
  3. Set the machine to auto ramp with a start pressure of 7 cm. Your graph looks like you are not using the ramp or you have it set to a short timed ramp. I find the auto ramp works very well. It essentially holds the pressure at 7 until it detects you are asleep. With the EPR on ramp only it will give you 7 cm on inhale and reduce that to 4 cm on exhale.

I would try that and post again. The hope is that the reduced pressure will reduce the central apnea without increasing the obstructive and hypopnea. The best setting in the end may be to go to a fixed CPAP pressure. However I would not do that until you see how it works with a min of 7 and max of 8.

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DavidHorn +0 points · 7 months ago Original Poster

I think if I drop it down to 8 cm, I will have obstructive apnea, this is why i set it up at 8.8 - 9.0. You think 8.0 will be okay? Yes, I dont know why central apnea is so high. I thought the EPR is for the whole night, when you inhale, it helps lower the setting by 1cm? Is this not correct? I find this easier to breathe. I don't need Ramp as starting at 8cm feels comfortable for me already.

I can try starting at 7cm to 8cm max with 1EPR still and see what happens. Any suggestions, let me know by tonight :).

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Sierra +0 points · 7 months ago Sleep Patron

I think a maximum pressure of 8 cm may be possible, IF you set the EPR to ramp only. When you have your EPR on full time the effective pressure during the night is really the green line on the graph. The effective pressure is not as high as you think it is. The problem with EPR is that it reduces pressure on exhale, but if you have an apnea event the machine will just increase the pressure to compensate. So you have gone full circle. EPR reduces it 1 cm and then the auto function increases it 1 cm or more to stop the apnea, and you are back where you started. If you use the EPR full time you can be getting the worst of both worlds. The EPR reduces the effective pressure, causing more events, and then the Auto function increases pressure which may likely be causing central apnea events. Bad, and more bad!

The idea of using the Auto Ramp is so you can control the EPR so it is only on when you are awake, before you go to sleep. It is not really a ramp but a hold in pressure. If you set the Ramp Start pressure at 7 cm (your can set the Ramp Start the same as your minimum, pressure) and set EPR at 3 cm and for Ramp Only, you will get 7 cm on inhale and 4 cm on exhale which should be very comfortable. When you go to sleep you will have 7 cm on inhale and exhale, but you will be asleep and should not notice it. the way you have your machine set now, you are exhaling against 7 cm or more already.

I noticed that In all your settings in your history, the lowest AHI you averaged was in April 2019 with EPR in ramp only. The pressure settings at that time were probably too high though, and you should be able to get away with less. But I think you would benefit from the Ramp Only EPR.

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DavidHorn +0 points · 7 months ago Original Poster

Sierra,

Thank you for your reply. Here's data from yesterday. 7min and 8 max, EPR Ramp only at 3cm. Any input? CA seems still high, though a couple of them were just above 10seconds, the obstructive apnea, 2 are just above 10seconds, one was 31seconds. The pressure stayed close to 7.99 - 8.00 throughout the night? What do you think about lowering it 6cm min to 7cm?

Let me know your thoughts.

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Sierra +0 points · 7 months ago Sleep Patron

I think on your ramp you are still in a standard timed ramp. I would suggest switching it to a AutoRamp mode. Then there will be no ramp time to set. It will only stay at the start pressure as long as you are awake -- up to a maximum of 30 minutes.

The central apnea seems to be still there. So, yes I would try a 6 minimum and 7 maximum to see if that helps reduce the CA events. The AutoRamp Start Pressure would have to be reduced to 6 cm, as it cannot be set higher than the minimum pressure. The EPR can stay at 3, but it will not reduce the exhale to less than 4.

I think it is worth a try to see if the CA events could be reduced.

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DavidHorn +0 points · 7 months ago Original Poster

Let's give that a try. Results tomorrow!

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DavidHorn +0 points · 7 months ago Original Poster

Updated data from this morning. CAs seems to be present, but they were only within 10-14 seconds. I did put on Ramp Time Auto, not sure why it's showing 45mins here, but auto on the machine. Any real concern? Any input?

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Sierra +0 points · 7 months ago Sleep Patron

I am having a hard time seeing these reports. It is best to post with the orange button in the bottom left corner when images are included.

You may be getting close to the optimum pressure. OA and CA are more in balance. Probably best to watch it for a while to see if there is any pattern to it.

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