Why did dropping my EPR affect my brain fog, lack of energy, etc.?

[palerider]

By keeping EPR at 3, you're lowering the min. pressure of 7 to 6 at best, if not less and I'd either lower the EPR or raise min. pressure more... that's how it works.

Please don't talk about these things when you don't understand how they work, you just confuse people.

to the OP, this is *WRONG*. a min 7 and EPR 3 is giving you an exhale pressure of *FOUR*

[chunkyfrog]

We can say our doctors are too lazy,
but they could say that they are too busy.
Gotta work hard to pay off medical school.
Then the income gets addicting--and they overbook to pile on the green.

[palerider]

I raised minimum pressure to 7 and put EPR back at 3 which, I think, is in line with the main suggestions.

er, no.

I had a poor night of sleep with more obstructive apneas than clear airway events. ...
I am particularly puzzled by the increase in obstructive apneas.

You set your pressure to 7, and then reduced it by 3 (EPR) in between breaths, which is where your throat closes up. So your pressure was FOUR, that's too low... that's where your problem was before.

If you want EPR 3, then set the minimum to pressure to 10.

Maybe they are connected to eating a food

No.

Palerider, can you explain what you mean by looking at the pressure curve? What is the pressure curve and what would we be looking for/at? I assume that it is what is shown on the "pressure" section of OSCAR. I don't know how to interpret a pressure curve. The guide to OSCAR tells me what a pressure curve is but not what it can tell us.

Look at the pressure graph, see where the pressure spikes up? you want your minimum pressure to be at least a little more than the places it spikes up, PLUS any EPR you use.

[palerider]

My breathing got out of synch with EPR.

No, it didn't. EPR is *PURELY* driven by your breathing.

My episodes decreased quite a bit, when I turned EPR off. I think Pugsy helped me with this last year.

Yes, they may very well have, but not because of any 'sync' issue.

[palerider]

It's too late at the moment to read that wall of text

Sorry for all of the narrative!

Not a problem, I was just headed to bed and didn't have time to read it then.

[chunkyfrog]

If you expect your doctor to deal with your data, you need a different doctor.
Your best bet is to save those Benjamins and get a concierge doctor.

[albigensian]

Palerider, can you explain what you mean by looking at the pressure curve? What is the pressure curve and what would we be looking for/at? I assume that it is what is shown on the "pressure" section of OSCAR. I don't know how to interpret a pressure curve. The guide to OSCAR tells me what a pressure curve is but not what it can tell us.[/quote]
Look at the pressure graph, see where the pressure spikes up? you want your minimum pressure to be at least a little more than the places it spikes up, PLUS any EPR you use.
[/quote]

Palererider, just to clarify. I look at the highest spikes. That's pretty clear. Over in the left-hand corner of the daily report, I see data that tells me what the highest spikes are:

Pressure Min 9.00 Median 10.12 95% 11.04 Max 11.38
EPAP Min 6.00 Median 7.12 95% 8.04 Max 8.38

So, you are suggesting that my minimum pressure should be a bit more than 11.8? When you say, "PLUS any EPR you use," do you mean "add the EPR number to the maximum pressure"? In this case, that would suggest a minimum pressure of about 14.6. But my maximum pressure is set at 12 because I have never gone above that number; it was started at 20 (dumb DME), then I dropped it to 16, and then my MD dropped it to 12.

I must be misunderstanding what you said, as this doesn't seem to make much sense: I can't set my min pr over my max pressure, and I would have to raise my max pressure if I put my min pr at 14.6. Can you clarify what you meant?

And, while I am asking for more information, would you please explain why this is what I should be doing or send to me a link or a Wiki that will help me to understand it? Thanks.

for palerider on the min pr issue recent OSCAR.png (146.27 KiB) Viewed 1519 times

[Julie]

While I can't address your main question to PR, I will tell you that your DME was smart - 20 is the usual setting for the max pressure, and anything over 4 would be the minimum - the one that does the job and goes up and down all night (relatively). Setting the max too low can prevent the min. from going higher when it wants to.

[palerider]

Palerider, can you explain what you mean by looking at the pressure curve? What is the pressure curve and what would we be looking for/at?

I explained it, did you read what I wrote already?

Yes, the pressure trace in Oscar.

Make it bigger, so that you can see the changes better, you don't need the tidal volume and Mask Pressure.

[albigensian]

Thanks, Palerider. I figured out what you must have mean by referring to the pressure curve was on the Oscar chart. I know this sounds dumb, but I didn't realize that you (quite literally) meant, "look at the way that the graph moves on section of the chart labelled 'pressure.'" Duh! But my line of work is full of strangely precise wording and that sometimes makes it hard for me to be sure that I understand what someone is saying.

I have inched up my minimum pressure, as I was advised. I'm at 9 now, with 12 max and 3 EPR. I'm doing a lot better. Brain fog is down, energy level is up. Still working on finetuning, though. I have more events than I did with the weird 5 min/1 EPR/12 Max setting that dropped my events so dramatically but that I was urged to abandon because it wasn't likely to be feeding me enough oxygen. But my CA's are largely vanquished and the new targets are the remaining OAs and leaks (nasal pillows leaking/hissing and the air that is forced into my mouth and then hisses out slowly through the permeable tape on my closed mouth). I am considering a FFM to see if it can help me lessen leaking.

Thanks to you and the other experts who shared their knowledge with me. I wanted to post this to document the outcome of the advice that was offered -- and to remind others that seeking information and experimenting with advice can produce good outcomes. It takes patience, though, and some degree of diligence.

Here is last night's data: Min 9/Max12/EPR 3; mouth taped, cervical collar on, sleeping on my back on one of those large slanted support pillows, with a small roll under my neck to maintain the curve of the cervical spine. If anyone has any comments/insights/suggestions, I'd be glad to hear them.

10_14_21 9 12 3EPR.png (142.33 KiB) Viewed 1338 times