Switched to ASV

[KatieW]

I tried reducing EPR to 2 last night, but after awhile, woke up breathless. I recovered after sitting up for a few minutes, then turned EPR back up to 3. Sigh.

[palerider]

Can you try lowering your EPR by 3, AND lowering your pressure?

It might make breathing tolerable, and still reduce the extra ventilation.

[KatieW]

Can you try lowering your EPR by 3, AND lowering your pressure?

It might make breathing tolerable, and still reduce the extra ventilation.

Good suggestion. My minimum is 10, maximum 14, EPR 3.

So do you mean change to: minimum 7, maximum still 14, and EPR off?

[palerider]

Can you try lowering your EPR by 3, AND lowering your pressure?

It might make breathing tolerable, and still reduce the extra ventilation.

Good suggestion. My minimum is 10, maximum 14, EPR 3.

So do you mean change to: minimum 7, maximum still 14, and EPR off?

Yes, ... I don't know what it'll do... but it *might* work.

Your *effective* minimum is 7 now, since your resting pressure (EPAP) is pressure - EPR on an auto machine like that. I don't know if this will work for you, but it's an easy thing to try, and it *might* help.

[KatieW]

Machine Settings: Min 7, Max 14, no EPR, no Ramp. Inhale felt like there wasn't enough air, so I upped Min. to 8, during the night. Exhale felt comfortable without EPR.

If EPR was causing Centrals, do these results show an improvement from Nov 26? Or, does it take a few nights to see any change? It was a restless night's sleep, and did not feel well-rested.

[palerider]

38 to 25, it's better, but not good enough.... If you can try another night, it would be good, it might be better, or it might just an anomaly.

[KatieW]

Yes, I will try another night with these settings. Thanks, Palerider.

[KatieW]

2nd night with no EPR. 1st segment of sleep was great! Rest of night was light sleep, restless, perhaps due to some pain issues, and gas.

[Pugsy]

Have you ever tried regular auto mode with this machine?
I wonder what caused you to wake up in the first place after the first good session..

[KatieW]

Have you ever tried regular auto mode with this machine?
I wonder what caused you to wake up in the first place after the first good session..

No, but am willing to try.

Nothing on the report to indicate why I woke up, except maybe noise from mask leaks? Maybe the cats made a noise? They are not in my bedroom, but have the run of the rest of the house.

[Pugsy]

Trying the other mode probably won't do much but it might be worth a try just to see.
Just something to try that is unlikely to hurt the situation and might remotely make some sort of difference.....good or bad.

I have seen this sort of thing happen before...where people have maybe half a night like your first session and the second half everything goes to hell and looks like your other sessions. I have talked to a couple of sleep techs and one doctor about it and no one really knows what the real trigger is. They just say "sometimes we just don't know why this sort of stuff happens".
We know it is the unstable breathing where the carbon dioxide levels don't get high enough to trigger breathing but we don't know why they don't get high enough for just parts of the night and not be a problem other parts of the night.

And we need to know "why" to really fix it. It sucks but we don't always get the answer to "why".
Hopefully this is where a good pulmonologist can earn his big bucks.

[KatieW]

I have been trying to analyze why the first session was so good. Turning off EPR seems to be a factor, since it hasn't been that good for months.

Could it also be positional, temperature of the room, my sleepiness, nighttime meds, etc? Very curious. I got the overnight oximeter, will try that out tonight, for any clues.

[Pugsy]

It could be any number of things and that's what makes it so hard to figure out.
It could be external and it could also be internal and related to what your body does or doesn't do in terms of the blood gases exchange process that ends up triggering the centrals.
Heck....it could be a combination of things.

[Geer1]

Turning off EPR seems to be a factor, since it hasn't been that good for months.

I am just curious when the CSR started? You say it hasn’t been this good in months but your first few posts from end of August/early September don’t seem to indicate this problem either originally with the Autoset at 3 EPR or with Bilevel and PS at 5. Was this ever present prior to the food poisoning incident? Did the issue start while on Bilevel? Did it coincide with certain points of your treatment (going off oxygen or anything like that)?

If it were me I would be trying to pin down when this started and seeing if anything seems to have triggered it then try to talk to a knowledgeable doctor on why it might have happened and what to do about it. Sounds like you have started down that path so hopefully you get some answers and can get this under control.

[palerider]

I have been trying to analyze why the first session was so good. Turning off EPR seems to be a factor, since it hasn't been that good for months.

Could it also be positional, temperature of the room, my sleepiness, nighttime meds, etc? Very curious. I got the overnight oximeter, will try that out tonight, for any clues.

You mentioned pain. Did your pain meds run out in the latter part of the night, causing restlessness?