Newbie need some help

mrenteria · Post by **mrenteria** » Mon Apr 12, 2021 1:26 pm

First, thanks for viewing my post
A little background. I was first diagnosed in 08 with AHI 35+ and was able to stay for the first year and gradually stopped the therapy because mask would leak allot and I would wake up with very dry mouth even when using the humidifier. Last year I went to get a physical and one of the test that measured carbon dioxide was very high but the PA dismissed as a mistake. I started doing a little research and appeared it may have something to do with apnea. I went and purchased a Viaton SP02 reader and it confirmed too many drops in 02 levels and as low 80 through out the night.
I went back on therapy for about a month now but I don't see much improvement my AHI is still in 30's with central apneas being the dominate and I get allot of leaks. I used nasal, pillows, and full face masks along with mouth strips but I still get leaks

I cant say its not working because I can see when I don't have the mask on my 02 reading immediately drops.
My main question is how do I lower my AHI; should I increase/decrease pressure use EPR ?

Pugsy · Post by **Pugsy** » Mon Apr 12, 2021 5:04 pm

Go to regular auto mode instead of the for Her auto mode.
I can't see if EPR is on or off because you have omitted the pressure graph but the statistics look like EPR is off...
If it is on...Turn EPR OFF...if you can handle it. If you can't fall asleep without EPR then set EPR to ramp only and set a time frame for ramp that should allow you to go to sleep.

Use the current settings otherwise for now...minimum 10 and max 17 is good enough for now but in the regular auto mode and not the for Her auto mode.

Do you take any sort of pain medication at all that might suppress respiration?

mrenteria · Post by **mrenteria** » Mon Apr 12, 2021 5:27 pm

Hello Pugsy thank you for the recommendation.
I do not have EPR on
I am able to fall asleep without the ramp on the cpap does not hinder me in falling asleep
I do not take any pain medications although I have been looking at taking tryptophan to try to get a restful sleep
I will change to regular Autoset I just thought the for her would increase pressure quicker if needed

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Pugsy · Post by **Pugsy** » Mon Apr 12, 2021 5:33 pm

The for Her mode doesn't work so great for some people when pressures around 12 or more is needed hence the idea to at least try the regular auto mode...it will actually respond more quickly at the pressures you appear to need.

To be honest...I don't know if we can do anything about the centrals unless by some remote chance reducing the OAs/hyponeas happen to reduce arousals and the bulk of your centrals are arousal related.

Centrals can't normally be dealt with using the model machine you have unless we get lucky and that are either EPR related or arousal related.

Let's see what regular auto mode gives us.
Don't turn EPR on....it might even make the centrals worse.

mrenteria · Post by **mrenteria** » Mon Apr 12, 2021 5:45 pm

Pugsy, good info. I wasn't aware the for her may not work well over 12.

Thank you much for your advice. I will give recommendations a try.

Miss Emerita · Post by **Miss Emerita** » Mon Apr 12, 2021 5:51 pm

Do you by any wild chance have a copy of your sleep study? If not, do you think you could get one? I'm especially interested to know whether you had a lot of central apnea events then.

Meanwhile, do everything Pugsy tells you to do -- you're in the best of hands!

mrenteria · Post by **mrenteria** » Mon Apr 12, 2021 6:22 pm

Unfortunately I don't it was 13 years back but it is interesting that i was given an S9 to use where their bpap back then

Pugsy · Post by **Pugsy** » Mon Apr 12, 2021 6:23 pm

mrenteria wrote: ↑
Mon Apr 12, 2021 5:45 pm
Pugsy, good info. I wasn't aware the for her may not work well over 12.

Thank you much for your advice. I will give recommendations a try.

Technically it should work well enough at the higher pressures if certain conditions are met but apparently those conditions aren't being met so the machine won't go higher for the OAs/hyponeas you are having. Not sure why but it's not going as high.
The centrals...whole different ball game and pressure tweaks won't help and about the only thing I can offer is changing modes and see if we get lucky.
If we don't get lucky....you are likely going to need a different machine to deal with the centrals.

The centrals....if not present on the original sleep study some years ago....could simply be from cpap use. Complex sleep apnea from treatment emergent centrals. Now sometimes they will fade away with time but not usually when the number of centrals seems to be as high as you are having. About 10 to 15 % of people who didn't have centrals on the diagnostic sleep study will develop centrals when beginning cpap therapy.
If you did happen to have a bunch of centrals during the diagnostic sleep study....you had complex sleep apnea from the beginning and not much we can do with little tweaks to help the situation.

I hope we get lucky....the machine that can deal with centrals is very expensive.

mrenteria · Post by **mrenteria** » Mon Apr 12, 2021 6:45 pm

Pugsy, my suspicion is the the centrals have increased because of stress. As with allot of other folks I've been unemployed for almost two years and living off savings and 401 and I have noticed that sometimes before i get to rem sleep I recognize that i stop breathing when I'm thinking about certain stressful things. I'm hoping the tryptophan will help

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