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boklos
Unread post  Post subject: Could you help with pressure optimization for REM apnea ?  |  Posted: Sat Mar 09, 2019 6:41 pm

Joined: Thu Jan 31, 2019 9:50 pm
Posts: 5

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i have been studying some more and trying to analyze my data from all the nights of restless sleep.
Here are the findings i got, with attached screenshots to correct me. Also to advice what titration i should do.

Findings:
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1- i have a REM predominant apnea, that matches the flow limit intervals of 90mns- 2 hrs. IT matches my sleep study(first page) saying my REM apnea is 42/hr while my NREm+REM is 17/hr.
2- my apnea is worse supine, so i try to sleep on my side.
3- I was thinking i was waking up with RERAs each time i dream, but probably, the OSA is too high for my pressure to handle, so the airflow limit is not 100%, but maybe less than 50% and that is why i get RERAs and have a fragmented sleep of 2-3 hours that become shorter and more intense after 5 am.
4- i tried following the advice of setting a narrow range with constant pressure, it did not resolve RERM apnea. ( see graphs 1 - 8).
5- i tried letting the machine handle it and i am still unsuccessful to find the right settings ( see graphs 9-11). Based on these, i would like to ask you :
Should i increase EPAP or PS ? it seems that my 95% EPAP is from 5.7 to 6.7 but i do not know is that because the machine is trying to increase IPAP and because the PS is constant it is raising the EPAP instead ? you can see in my graphs (5 - 9) in increased the PS, while mainting EPAP constant, and it did not resolve REM apnea or RERAs.

Questions:
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1- Based on my data, do i increase EPAP ( like to 6), leave PS at 4 ( or less) and leave IPAP to max 15 ?
2- Do i increase both EPAP and PS ? and leave the machine on auto for max IPAP ?
3- I have read the higher PS could cause RERAs( not just CAs) that is why it is advised to lower EPR in APAP to 1, but in the titration proptocol for bilevel, it was said to start with PS of

Notes:
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1- I started using neck collar ( in the last graph) do not see /feel a difference.
2- i can not tolerate high pressure, i get aerophagia ( higher than 12-13 IPAP).
3- I went to yet another sleep doctor and he will do a DISE ( drug induced sleep endoscopy) to see what is really happening when i sleep. i have found an interesting doctor note on interpreting the results of DISE in choosing the type of therapy and would like your opinion, i will share my DISE results later when i get them:

Dr. Michael Schedler : "First assess history of patient. If he/she complaints about SPBA (supine position based apnea) i.e. cannot ly on back and breath normally, feeling a choking sensation, when lying supine, sometimes impossibility to find sleep in supine position.

Then, please perform somnoscopy in Propofol induced sleep with and without NCPAP and look if you note an aSGO (adult supraglottic obstruction, abstract: schedler, supraglottic obstruction) regarding base of tongue and/or epiglottis. In case of aSGO avoid APAP, since the ventilationpressure will steadily increase with rising upper airway resistance. Settle then for a lower range Bilevel therapy, which can be titrated in Propofol sleep, sneaking a thin endoscope under the mask, while setting the pressure level so that no obstruction (e.g. bending down epiglottis by airflow) is induced. Or refer to airway surgeon, who can address the problem surgically. I have personally performed about 520 laser epiglottis partial resections (EPR), close to 300 HPPs (Hyoidpharyngoplasty) and 3 Supraglottoplasties; simultaneous Laser EPR/HPP procedure".


4- The doctor told me to try an oral device if i am not getting the sleep quality from the machine, but i read here that many people had adverse effects from oral device because it messes up with your bite, so i want to give the Bilevel another chance, that is why i am posting here to get your opinion how can i get rid of the REM apneas.

Thank you.

Graphs:
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Graph 1: (EPAP 4, PS 1, IPAP 5), sleep quality : poor

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Graph 2: (EPAP 4, PS 3, IPAP 7), sleep quality : poor - medium

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Graph 3 : (EPAP 4, PS 4, IPAP 8) : sleep quality : poor - medium

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Graph 5: ( EPAP 4, PS 5, IPAP max 9), sleep quality : poor - medium
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GRAPH 6: (EPAP 4, PS 6, IPAP 10) sleep quality : poor - medium

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GRAPH 7: (EPAP 4, PS 7, IPAP 11): , sleep quality : poor - medium

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GRAPH 8: (EPAP 6, PS 6, IPAP 12) , sleep quality : poor - medium

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GRAPH 9: (EPAP 4.6, PS 7.2, IPAP 15 ) , sleep quality : medium . Note using high or v high trigger would eliminate all these CAs :

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GRAPH 10(EPAP 5, PS 4, IPAP 15) , sleep quailty : medium

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GRAPH 11 (EPAP 4, PS 4, IPAP 15) , sleep quality : poor to medium

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