Which machine type should I go with? Depressing!

red1 wrote:Since I only get a max of 3 with EPR, raising the pressure also increases both the Ipap & Epap. I think its my Epap pressure that is causing the increase in centrals. The reason I think this, is because I reduced the EPR from 3 to 1 while keeping the same pressure & it caused an increase in centrals.

I am not surprised that reducing EPR will increase Centrals using the S9 Elite.
Example...just for example sake....If someone's setting is 10 cm with EPR of 3...and they have large number of centrals which may be pressure induced...their overall average will be 8.5 cm half the time with 10 cm and half the time with 7 cm (over simplified but you get the idea)...So an average of 8.5 still triggers centrals.

Reducing EPR with the same 10 cm setting will increase the overall average more then 8.5 which we already know will trigger centrals. So we would expect for centrals to occur in greater numbers.

Pugsy wrote:

red1 wrote:Since I only get a max of 3 with EPR, raising the pressure also increases both the Ipap & Epap. I think its my Epap pressure that is causing the increase in centrals. The reason I think this, is because I reduced the EPR from 3 to 1 while keeping the same pressure & it caused an increase in centrals.

I am not surprised that reducing EPR will increase Centrals using the S9 Elite.
Example...just for example sake....If someone's setting is 10 cm with EPR of 3...and they have large number of centrals which may be pressure induced...their overall average will be 8.5 cm half the time with 10 cm and half the time with 7 cm (over simplified but you get the idea)...So an average of 8.5 still triggers centrals.

Reducing EPR with the same 10 cm setting will increase the overall average more then 8.5 which we already know will trigger centrals. So we would expect for centrals to occur in greater numbers.

Yes, but the increase in pressure in on the Epap side, as that pressure would increase, "at least I asume it would" on the Epap side when I remove or lower the EPR setting. A general increase of 1 would also increase the centrals, because both the Epap & IPAP would increase, becasue I am already at a EPR of 3. I thought that a decrease in the EPR would only affect the pressure on the Epap side & not the Ipap. Telling me that the centrals & higher Hi's are brought about from the Epap side of breathing. Therefore I could have a larger IPAP setting & a lower EPAP setting, & since the cpap & auto only allow 3 with EPR, that would bring me to the Bipap, which would allow a lower setting on the Epap side. (I hope this is right)

red1 wrote: Yes, but the increase in pressure in on the Epap side, as that pressure would increase, "at least I asume it would" on the Epap side when I remove or lower the EPR setting. A general increase of 1 would also increase the centrals, because both the Epap & IPAP would increase, becasue I am already at a EPR of 3. I thought that a decrease in the EPR would only affect the pressure on the Epap side & not the Ipap. Telling me that the centrals & higher Hi's are brought about from the Epap side of breathing. Therefore I could have a larger IPAP setting & a lower EPAP setting, & since the cpap & auto only allow 3 with EPR, that would bring me to the Bipap, which would allow a lower setting on the Epap side. (I hope this is right)

Red1, I have no idea and you really got me confused. I just wanted to say though...that's a hell of a paragraph!
J

jamiswolf wrote:

red1 wrote: Yes, but the increase in pressure in on the Epap side, as that pressure would increase, "at least I asume it would" on the Epap side when I remove or lower the EPR setting. A general increase of 1 would also increase the centrals, because both the Epap & IPAP would increase, becasue I am already at a EPR of 3. I thought that a decrease in the EPR would only affect the pressure on the Epap side & not the Ipap. Telling me that the centrals & higher Hi's are brought about from the Epap side of breathing. Therefore I could have a larger IPAP setting & a lower EPAP setting, & since the cpap & auto only allow 3 with EPR, that would bring me to the Bipap, which would allow a lower setting on the Epap side. (I hope this is right)

Red1, I have no idea and you really got me confused. I just wanted to say though...that's a hell of a paragraph!
J

Reading it over, I can understand the confusion. (See, I am getting loopy from all this disturbed sleep)

When increasing pressure, I needed to know which side of breathing caused the increase in centrals & AHI's. IPAP-EPAP or both.

What I was trying to say is: When the pressure on my cpap gets increased, even by 1, without changing EPR, there is an increase in Centrals, & Hypopneas. Increasing the pressure by 1 effects both the Epap & the Ipap by 1. So, the centrals & hypopneas are increasing from either the Ipap side or the epap side. Hopefully not both sides. I have the EPR set at 2 full time. I wait a week, then I drop the pressure back down by a pressure of 1 and in a few days, and my AHI returned back to about 13.4.

I then Decreased my EPR from 2 to 1. ("expiratory pressure relief") The numbers go up again. By decreasing the EPR from 2 to 1, caused a pressure increase of 1 on the EPAP side but not on the IPAP side. The centrals & Hypopneas went up again. A week later I raise the EPR from 1 to 2 (original settings) Slowly things came back down to an average of 13.4. This tells me that a pressure increase in Epap increases my numbers.

I then Increase the pressure by 1 and I set the EPR from 2 to 3. The increase in pressure by 1 would increase both IPAP & EPAP, however, setting the EPR from 2 to 3 would drop the EPAP down by 1 again, back to where it was before I raised the pressure by 1. Now, I simply have an increase in pressure by 1 on the IPAP side, not the EPAP.

There was little change with this. From all this, I would guess that my increases in centrals & Hypopneas were caused by an increase in the Epap side of breathing & not the IPAP. This is assuming that changing the EPR from 2 to 1 or 2 to 3 changes the EPAP side of breathing by a pressure change of 1 either up or down. From 2 to 1 is a pressure of 1 up & from 2 to 3 is a pressure of 1 back.

I need to be able to seperate IPAP & EPAP by more then 3, in order to allow enough of a raise in IPAP pressure to reduce the 13..4 AHI average, which includes both centrals & obstructive events.

I know median pressure is EPAP plus or minus EPR & IPAP divided by 2. This has nothing to do with the actual IPAP or EPAP plus or minus EPR pressures individually.

Does this make any more sense. ( I actually forgot why I even tried to explain this, first time around)

Rick

Red1,
I wasn't criticizing you, honestly. Just commenting on a very complex paragraph that I didn't understand...hopefully with a bit of humor.

I am not a ResMed guy but I've read enough to understand the difference between EPR and flex. But as you are trying to sort all this (very complex) stuff out, it seems to me that you should eliminate variables.

I would shut off all "comfort measure" variables. And observe things without that distraction. The more variables you have...the harder it is to determine what is causing what.

But since it's already determined that you're going to get a bilevel machine, and you've narrowed it down to a Resmed, well then go for it.

I actually do not know which pressure on a bilevel is more causative of central apneas. It's the epap that is used to guage success in preventing obstructive events. Ipap is considered curative of the hypops. (as I understand it)

You should do some research on complex sleep apnea. Very few people have pressure induced centrals. 10% to 15% is the common statistic thrown about.

But for some reason bilevel therapy sometimes helps. I hope that's the situation with you. So hopefully we'll both understand soon!
Jamis

Jamis,

I know you were not criticizing. Thats why I had the at the beginning of my post. I really value the comments by both you & Pugsy in regards to my bipap issue.

Thank you for all your help Jamis.

Both you & Pugsy have been of great help to me through all of this.

Rick