New chart for review

[JBarizona]

Respiratory therapist friend of mine thinks I need to be on BiPAP, that I need more expiratory support she says.. I'm not sure what she means

[palerider]

Respiratory therapist friend of mine thinks I need to be on BiPAP, that I need more expiratory support she says.. I'm not sure what she means

You very well may need *less*.

"respiratory support = the difference between inhale and exhale pressures."

[JBarizona]

Can you tell me what makes you think that? I saw you suggested lowering my epr from 3 to 2.. how come?

[Jas_williams]

Can you tell me what makes you think that? I saw you suggested lowering my epr from 3 to 2.. how come?

It was suggested to reduce the EPR to see if it reduced the number of CA’s

[palerider]

Can you tell me what makes you think that? I saw you suggested lowering my epr from 3 to 2.. how come?

It was suggested to reduce the EPR to see if it reduced the number of CA’s

What he said.

[Pugsy]

There is a very small percentage of people who find that Pressure Support actually tends to cause centrals.
EPR (or any form of exhale relief really) is creating pressure support that is a bit limited when compared to what bilevel pressure machines can do.
Some people just get a lot of centrals when they use pressure support. It's a very small number of people though because after all exhale relief is considered a comfort setting and even when people do have a lot of centrals the usual first try in machines is a bilevel.

I haven't worried too much about your centrals at this time because they could very easily be post arousal centrals and not real (meaning asleep event) because of the obstructive stuff that is going on at times during the night.
My thought was to better prevent the obstructive stuff and see if the centrals reduce as a by product of the reduction of the obstructive stuff and worry about them later since we can't do anything about them anyway with your machine.
A few centrals are normal and no big deal anyway.

[JBarizona]

Last nights chart...Kept pressures at 12/20 and EPR at 3...Ive heard sometimes its best to let new settings "bake in" for a few days before making changes...also, from an analysis standpoint, best to change one variable at a time in order to gauge success as opposed to changing both pressure and EPR settings.....as usual, I reached top pressure early in the session like I typically do..No matter where top pressure is set, it always reaches it at some point...CA doubled from previous night...OA and Hypop down slightly..noticable increase in RERA since changing pressures to 12/20...what's the deal with that exactly??....updated view to include flow limitation...seems if I pin more than 4 graphs, it gets too small to see...leak rate not included, however, leaks have not been much of a problem as you can see from stats on the left side...graciously awaiting your feedback and thanks to all.

[nicholasjh1]

What's the logic behind raising the bottom pressure? If the bottom pressure is 12 and even a top pressure 15 isn't stopping the apneas why will the bottom pressure of 12 help me?

I'm sure someone already said this, but yes because instead of waiting for the machine to sense incipient Apnea's and then raise the pressure it just prevents them instead. way more effective (as long as it doesn't increase centrals, so just look out for that. )

[JBarizona]

Yes raising the pressure has also increased my centrals... Last night I had twice as many centrals as I did obstructive and hypopneas combined....I know there's talk of sometimes you get false readings of centrals but when I look at the flow rate and I see that I'm not breathing for 30 seconds that doesn't seem like I'm just turning over in my bed....

[JBarizona]

Last nights chart..AHI down below 5 for the first time in weeks...pressure settings 13/20..EPR 3...as per usual, reached top pressure of 20 early in the night yet no apneas present...also more incidence of RERA since pressure changes last few days...anyone speculate why pressure would reach 20 while not having any apneas? Also, I was asleep longer than I have been in weeks, had a lower AHI than Ive had in weeks, and yet today, I feel more tired than usual...ugh. Any insight is much appreciated

[Snoregone Conclusion]

Pressure will be raised for flow limitations as well: a flow limitation is a hint that it could progress to a more severe flow limitation that could ultimately result in a full apnea if left alone.

In short: the machine is taking care of your needs pretty well.

[JBarizona]

except that I feel like crap. LOL so does rera cause flow limitation or does flow limitation cause Rera? I still haven't figured out why I'm having all this Rera..

[Pugsy]

as per usual, reached top pressure of 20 early in the night yet no apneas

anyone speculate why pressure would reach 20 while not having any apneas?

The machine sensed the airway closing because of the warning signs of an impending collapse that you can't see on the report.
Warning signs that it responds to (besides the obvious OAs/hyponeas) are snores and flow limitations.
In your case...look at the FL graph at the time of the increase in pressure....that's what drove your pressures up.
Once the pressure got up to where it needed to be the FLs reduced and didn't complete the collapse up to the point of earning a flag for OA or hyponea.

Think of the FLs as wanna be OAs/hyponeas. They are so important that all auto adjusting algorithms will respond to flow limitations with more pressure because that is pretty much the earliest sign the airway is trying to collapse.
These machines work best when in prevention mode and not fix it mode.

The machine is simply doing its job when it responds to the FLs even though you don't see anything else flagged at that time.

As for the RERAs....not sure what to make of those. My guess is the FLs probably disturbed your sleep or breathing a little and that's how come it got flagged.

Flow limitations aren't something to be ignored just because they might not grow up to earn the OA/hyponea flag. They can still disturb sleep and cause breathing issues during the night.

Same thing if snores were present...snores usually are considered another early warning sign of an impending airway collapse.

The whole idea of these machines is to prevent those early warning signs from growing up and becoming full grown flagged OAs/hyponeas. Prevention is the key here.
Even when an OA/hyponea does slip past the defenses the machine does nothing at all while the event is happening.
Once the airway is open again that is when the machine evaluates again whatever it is sensing going on and tries to come up with the best way to PREVENT that sort of thing from happening again.

[Pugsy]

You probably still feel like crap because your sleep quality/architecture is still sub optimal.

[Pugsy]

RERAs are a response to something...they don't cause anything.
Flagged RERAs are a symptom of crappy sleep...they don't cause the crappy sleep.
Flagged RERAs just mean that your breathing looks like someone's breathing that is having respiratory related arousals....
crappy sleep from some sort of respiratory issue.