Tyrone747's therapy

[palerider]

The pressure *increase* during inhalation can help alleviate flow limitations, sometimes more than just static higher pressure.

[Jay Aitchsee]

The pressure *increase* during inhalation can help alleviate flow limitations, sometimes more than just static higher pressure.

I was thinking that. Probably not technically correct, but something like greater acceleration or momentum when starting from a lower level with EPR.

[tyrone747]

The pressure *increase* during inhalation can help alleviate flow limitations, sometimes more than just static higher pressure.

This is interesting and I think I am feeling it. With EPR on the air on inhalation seems to have more inertia sort of. I'm wondering if this effect is also causing my CA's in a similar way that higher pressures can. I wonder if I should just wait them out on EPR and see if I adapt.

[palerider]

The pressure *increase* during inhalation can help alleviate flow limitations, sometimes more than just static higher pressure.

I was thinking that. Probably not technically correct, but something like greater acceleration or momentum when starting from a lower level with EPR.

Well, *classically* with bilevel, they say you stop apneas with epap and then stop hypopneas with ps. So it follows that FLs would be reduced with more ps, also.

[Jay Aitchsee]

The pressure *increase* during inhalation can help alleviate flow limitations, sometimes more than just static higher pressure.

I was thinking that. Probably not technically correct, but something like greater acceleration or momentum when starting from a lower level with EPR.

Well, *classically* with bilevel, they say you stop apneas with epap and then stop hypopneas with ps. So it follows that FLs would be reduced with more ps, also.

Well, there you go. My data is inconclusive and insufficient. However, what little I have does indicate a possible increase in FL with EPR off. Or, stated the other way, a possible decrease in FL with EPR on. But, I must stress I don't have enough data to say one way or another for sure. My standard setting is EPR 3.

[tyrone747]

Probably too soon to tell but any chance you feel like you slept any differently?
Feel any different today?

If you weren't looking at the software reports to judge things but instead only going on subjective feelings....any change?
I know it is a bit soon but had to ask.

Did you ever take the time to look at those centrals up close to see if you were really asleep or not?

I actually don't notice much difference in how I feel with EPR on or off. Possibly a bit better with it off. My CA's seem to be a mix of the classical SWJ and other one's that don't seem to have a pronounced breathing spike before them.

[Pugsy]

At 25 minute time segment zoomed....a little too long for me to decide if SWJ or asleep.
I like around 10 minute segment showing with the events in question as far to the right side as possible so that I can see the breathing prior to the event better.

[tyrone747]

Well, *classically* with bilevel, they say you stop apneas with epap and then stop hypopneas with ps. So it follows that FLs would be reduced with more ps, also.

That's wonderful info to have.
Looking back through my data I have never had an OA at an EPAP of 6 or above. Therefore I think I should use 6 for EPAP and change my PS based on my hypopneas.
My data says EPR off produces significantly more hyponeas while an EPR of 2 or 3 are similar.
EPR 3 has slightly less FL's than EPR 2.
EPR 3 has more CA's than EPR 2 and, to my untrained eye, EPR 3 looks like more unstable breathing.
I have little data for EPR 1.

I think I will try fixed CPAP for a while since it's easier to compare data without pressure varying all night. My appropriate settings to test will be 9 EPR3, 8 EPR 2, and 7 EPR 1. This will give an EPAP of 6 for all three.
I will start at 8 EPR 2 because I think that will give the best compromise between CA's and hypopneas.

[Jay Aitchsee]

Tyrone, here's an oldie that may be of some interest to you:
(I think it was when wearing a FFM)

viewtopic/t100497/Soft-Neck-Brace-Reduc ... ml#p936554

Lately, I've been getting some mask leaks after I fall asleep, I assume due to my jaw dropping as I relax. I decided to try something new, a soft neck brace I made from some 1'' foam I had. I made a piece that was about 3 1/2 inches tall that wrapped a little more than half-way around my neck and held it in place with one of those stick to itself ace bandages wrapped around the outside of the foam.

The surprising result is depicted below. My Flow Limitations, which I most recently became aware of with the purchase of a new S9, have almost disappeared! This has been a consistent result since I using started using the brace, about 6 days ago. I notice my pressure average, in auto, has dropped and all obstructive apneas and hypopneas have virtually disappeared as well.

I think what is happening here is that the brace is not only keeping my jaw from dropping, but it is also helping to keep my airway open by keeping my head from tipping forward.

I'm not sure the long term implications of this, but it seems, at the very least, I will be able to lower my pressure settings. I wish I could say I felt significantly better, I don't, but then I was feeling pretty good already, with a sub 1.0 AHI. Needless to say, I ordered a real soft cervical collar and should get it tomorrow.

I post this in the hopes it may help someone with their therapy.

[tyrone747]

Funny you should mention that Jay since I tried a cervical collar last night and kind of liked it. It was firm foam not soft foam so I will order a soft one as you suggest and see if it's more comfortable while still doing the job. I didn't notice any difference in FL's probably because I was using EPR2 which keeps my FL's low anyways. Tonight I will try EPR1 because the CA's are still a bit high for my liking. I might go back to a FFM just for this testing phase too since I had two minor mouth leaks last night that I remember arousing me. I don't want that interfering with my sleep quality as I try to find what settings work best for me.

[tyrone747]

With EPR 1 I had a further reduction in CA's and still have excellent FL's. I was actually surprised to see them so low with little EPR. It may be down to the cervical collar like Jay suggested. Another thing I wore last night under the Dreamwear FFM was a nasal dilator. This could also be playing a part in the reduced FL's since I do have a fairly deviated septum. But if my CA's are indeed exasperated by EPR then I should probably not be using it at all. Tonight I try CPAP 6 and EPR off.



Here is a more zoomed in example of some CA's that Pugsy requested:

[Jay Aitchsee]

Here is a more zoomed in example of some CA's that Pugsy requested:

To me, that looks like an arousal around 01:16:30 followed by a CA followed by awake breathing at 01:17:20 followed by the second CA. I don't think either of these would count in a lab setting.

[tyrone747]

Every OA I've ever had has had irregular breathing before it as well. Does that mean they are all fake too? I wonder if I even have sleep apnea.

[Jay Aitchsee]

Every OA I've ever had has had irregular breathing before it as well. Does that mean they are all fake too? I wonder if I even have sleep apnea.

Remember, you don't see the apneas that were prevented by the therapy.

[tyrone747]

That's a very good point Jay.

Last nights results with EPR off shows another dramatic reduction of CA's. But I traded them for RERA's and also had higher FL's. I didn't use me nasal dilator last night because my nose was a bit sore from it. Tonight if it is healed enough I will try it again. If not I will try increasing pressure with EPR off and see if I can clear up the RERA's without increasing CA's.