Increase pressure but Hypopnea's and OS's go up

[fdw]

Should I increase EPR to help out with the Hypopnea's

[Pugsy]

The amount of change in hyponea numbers from last night to the night before is statistically insignificant.
Doesn't warrant anything but a passing glance.

If you keep wanting to make changes based on one night (last night's) report instead of long term trends you will be chasing your tail changing things every day and never get anywhere.

We don't sleep the same way each night...impossible to predict if tonight we are going to repeat last night's sleep or the night before....unless you have a better crystal ball than I do.
The numbers can and will change from night to night. It's just a fact of life.
I know you are wanting to try to find the "perfect" number but guess what? There is no "perfect" pressure number or EPR number or whatever that works perfectly 100% of the time.

Unless you want to use 15 or 16 cm in fixed cpap mode all night long...there's going to be a chance that something gets flagged.
Heck, I don't know that 20 cm would totally eradicate everything. These machines are so sensitive that it's easy for some stuff that is awake breathing to get flagged and we can't do anything about it.

It takes a lot of time and patience when you are tweaking pressures at this level.
I know the knee jerk reaction to slight changes in AHI is to "fix something" but these reports aren't really designed to be put under the microscope like this. We should go by trends and patterns and what works "most of the time" and not what happened only last night.

Increasing EPR...that amounts to decreasing the overall average pressure...not the way to go if trying to prevent OAs or hyponeas. Reducing EPR would be the way to go if those OAs and hyponeas were present in large enough numbers to be a problem and one night with 1 per hour more average for hyponeas is far from being a number that is a problem.

[fdw]

The amount of change in hyponea numbers from last night to the night before is statistically insignificant.
Doesn't warrant anything but a passing glance.

If you keep wanting to make changes based on one night (last night's) report instead of long term trends you will be chasing your tail changing things every day and never get anywhere.

We don't sleep the same way each night...impossible to predict if tonight we are going to repeat last night's sleep or the night before....unless you have a better crystal ball than I do.
The numbers can and will change from night to night. It's just a fact of life.
I know you are wanting to try to find the "perfect" number but guess what? There is no "perfect" pressure number or EPR number or whatever that works perfectly 100% of the time.

Unless you want to use 15 or 16 cm in fixed cpap mode all night long...there's going to be a chance that something gets flagged.
Heck, I don't know that 20 cm would totally eradicate everything. These machines are so sensitive that it's easy for some stuff that is awake breathing to get flagged and we can't do anything about it.

It takes a lot of time and patience when you are tweaking pressures at this level.
I know the knee jerk reaction to slight changes in AHI is to "fix something" but these reports aren't really designed to be put under the microscope like this. We should go by trends and patterns and what works "most of the time" and not what happened only last night.

Increasing EPR...that amounts to decreasing the overall average pressure...not the way to go if trying to prevent OAs or hyponeas. Reducing EPR would be the way to go if those OAs and hyponeas were present in large enough numbers to be a problem and one night with 1 per hour more average for hyponeas is far from being a number that is a problem.

I suppose what I should have done when I got my S9 was setup AutoSet to 13.0 minimum and 15.0 maximum and EPR 2, since my old S8 was set at CPAP 13.0 , EPR 2 and then walked away. But I wasn't feeling very good with the S8 and it was time to buy a new machine anyway. My hopes was to get a AutoSet machine with good data that could help me figure out where I needed to be with the ad of good software, and people like you. I know Ive been asking a lot of questions and making a lot of changes, and really appreciate your (everyones) patients.

I've read comments that say your graphs look great.....that's with minimum pressures at 9.6 , 10.6, 11.8, and now at 12.2. So I don't have a lot of confidence in where Im at, and grasping for assistance figuring this whole thing out.

Trust me I ready to simply set it and forget it, when I can get out of bed feeling refreshed I'll be done.

[Wulfman...]

Looking at your report......and the approximate pressure where there are virtually NO events, I would think that a straight pressure of 12 cm. would give you some good results and sleep.


Den

.

[fdw]

Looking at your report......and the approximate pressure where there are virtually NO events, I would think that a straight pressure of 12 cm. would give you some good results and sleep.


Den

.

Your talking about straight CPAP and no EPR

[Pugsy]

Are you looking at your reports first thing in the AM and letting the reports dictate how you think you feel the rest of the day?
If so, try looking in the evening.

There's more to feeling well rested than the AHI numbers or a set of pressures used or the small changes that we expect to see in the reports each night.

Quit putting the AHI under the microscope and start trying to associate how you feel without factoring in the numbers. Those numbers lie to us all the time. I know it's harder to be subjective without numbers to guide us but when the numbers don't vary any more than yours are varying...the answer isn't in the numbers all by themselves.

You were used to a fixed pressure....now you've tried auto adjusting pressures....I suggest you try a fixed pressure and see what happens. Pick something that feels comfortable...if you like EPR...factor in EPR in to whatever you choose.

You say you think you feel better in apap mode...but give cpap mode with this machine a chance...it's a different machine with a different algorithm and it might worked better for you.

Remember...wake ups for any reason will mess with how we feel the next day and not all wake ups can be blamed on OSA or pressure changes or a tiny event sneaking past the defenses.
So your quality of sleep also needs to me evaluated and AHI 0.0 doesn't mean squat if you don't sleep good getting it.

[Wulfman...]

Looking at your report......and the approximate pressure where there are virtually NO events, I would think that a straight pressure of 12 cm. would give you some good results and sleep.


Den

.

Your talking about straight CPAP and no EPR

Yes, I'm talking about single pressure.
But, you could try it with or without EPR settings. SOME people have apneas at the point where their exhale cycle ends and the beginning of their inhale cycle.......and some people don't.
Even with the "Flex" technology of the Respironics machines (which isn't a complete pressure drop).......when I finally shut my C-Flex off about a year and a half ago, I cut my AHI by about half. (and it was pretty low to begin with)


Den

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