ASV question

[bernieb]

I'm doing well with my Resmed ASV machine with many nights of 0 AHI's and other nights mostly under 1.0...I guess I can't ask for anything better than that. The only problem I am having is some ear which I believe is from higher pressures. Saw sleep Dr. today for Medicare requirement (61+ days) and she suggested reducing the minmium EPAP from 6 to 5 to see if that helps my ear discomfort. My old brain does not understand that adjustment. It seems to me that the maximim EPAP or the PS should be reduced. I'm probably wrong in my thinking but thought I would ask.

[Pugsy]

Reducing minimum EPAP gives you an all night reduction in EPAP.

Reducing just the maximum of anything only gives you a reduction IF (big if) you ever even hit the max.

Do you want a for sure reduction or a maybe reduction?

[bernieb]

The question that I don't know the answer to is what is causing my ear pain? I never experienced ear pain with my old APAP machine with pressures up to 11 or 12, so i think the ear pain is caused by my ASV machine going up to the mid 20's at times. If that is correct then wouldn't I want to lower the maximum IPAP a little and NOT lower the minumum EPAP?

[Pugsy]

Max IPAP is ONLY used when dealing with central apneas. That's a very brief burst of pressure to jump start your breathing.
It is NOT something that is consistently used in most cases...meaning when you go to 20 or so..it's for a second or two and the rest of the time it's down quite low.

Post one of your recent detailed reports...let's see just how often and how high it is going.

Your doctor suggested what I would have suggested and done for myself if I were in your shoes.

You may want to have your ears evaluated by an ENT guy. Pressures don't normally make it to the inner ear unless there is a problem with the Eustachian tubes anyway.

[bernieb]

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I have been able to alleviate most of the pain by using Flonase spray every day but there is still some discomfort there. It has gotten better as time goes by but was much more painful when I neglected to use the Flonase. I will definitely go see an ENT if a reduction in pressure does not help. Here is my chart from last night.

[Pugsy]

You need PS for the centrals.
I don't think that there is a max IPAP setting per se....instead max IPAP is just a function of EPAP plus PS.
So if you were to try to limit IPAP you would have to do it by limiting PS max and it appears the machine thinks you pretty much need that max of 15 or close to it quite often. That's how it breathes for you when you have a central apnea and don't breathe on your own.
If you limit PS max you could end up with your central apnea not being well treated.

If Flonase helps...try an oral decongestant also. Something going on in the inner ear and some oral decongestants will help.

[bernieb]

Thank you Pugsy. I understand that. It seems like lowering the EPAP will have no effect but I guess I'll try it. I have taken some pseudoephedrine but it did not seem to help. My problem is not as bad as it was several weeks ago. Perhaps I will get used to it in due time. Thanks again.

[bernieb]

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Last night was first night at new EPAP setting of 5. Looks like all of my pressures were down a little and I slept pretty well. Time will tell if this is beneficial to my ear pain.

[bernieb]

Three nights at lower pressure has almost cleared up my ear. Pain is gone but it still feels like some fluid or inflammation is there. I feel like that will clear up in a few more days.

[ajack]

You need PS for the centrals.
I don't think that there is a max IPAP setting per se....instead max IPAP is just a function of EPAP plus PS.
So if you were to try to limit IPAP you would have to do it by limiting PS max and it appears the machine thinks you pretty much need that max of 15 or close to it quite often. That's how it breathes for you when you have a central apnea and don't breathe on your own.
If you limit PS max you could end up with your central apnea not being well treated.

If Flonase helps...try an oral decongestant also. Something going on in the inner ear and some oral decongestants will help.

Good advice there pugsy.