Treating Hypopnea

[clownbell]

I've been on CPAP for 90 days. I have a ResMed Airsense 10 Autoset. OSCAR reports virtually all events are hypopneas, with only very rare OSA events of 1-2 per night. Here is what I "think' I know:

• EPR does not fight hypopnea, leading me to conclude that I should probably wean myself off EPR.

• I also read in the wiki that the pressure differential between inhale and exhale pressure helps relieve hypopnea -- but I don't understand what that means (do I need a large differential or a small differential?) or what I should do.

The question: is there a layman's version (for someone without heavy science background) describing how to treat hypopnea with the CPAP machine?

Thank you.

Craig

[Julie]

Hypopneas are just small, wannabe apneas, and generally show up in larger numbers, but shouldn't wake you at all.

They are treated the same as apneas though, with cpap or auto machines.

What pressures is your machine set at now?

If you post Oscar results - in this thread please - we can see what's going on and help advise if something needs tweaking.

EPR is used when exhale pressure feels too strong, too insistent for some, but if you don't have that problem, you can turn it off... it's not about apneas or hypopneas per se though.

[Miss Emerita]

There has been a lot of debate in the medical community about exactly how to define hypopneas. Here is what I think is the latest:

https://aasm.org/aasm-clarifies-hypopne ... -criteria/

How high is your hypopnea index as a rule?

Yes, a differential between inhalation and exhalation pressures helps with obstructive hypopneas (and flow limitations). It gives you a little assist as you inhale. That’s exactly what EPR delivers. You want a larger differential; if your EPR isn’t already at 3, try it there.

Could you post a typical chart? That’d be helpful.

[zonker]

The question: is there a layman's version (for someone without heavy science background) describing how to treat hypopnea with the CPAP machine?

Thank you.

Craig

do you see the announcement section above the topics section? i ask this because i'm given to understand not everyone can.

if you can, refer to "Pugsy's Pointers" or the "CPAP Basics" thread.

in either case, you can always post a chart here then ask your questions. believe me, this crowd loves to answer questions.

and when i say post a chart here, i mean RIGHT HERE, in this thread. and if you can, please continue to stay in one thread for the foreseeable future, so we can see how you are doing based on the previous advice you'll get.

btw, i don't fully understand the whole oscar chart thing myself. plenty of people here do, though, and i've relied upon them for advice.

good luck!

[clownbell]

I am attaching Oscar charts for three typical nights.

Thanks for sharing your knowledge.

Craig

Oscar Charts 041521.png (117.62 KiB) Viewed 1204 times

Oscar charts 041421.png (113.96 KiB) Viewed 1204 times

Oscar charts 041121.png (83.24 KiB) Viewed 1204 times

[Julie]

Any idea why your max pressure's set so low? Your charts look pretty good otherwise.

[Pugsy]

Hyponeas are air flow reductions that don't make criteria to earn the Obstructive apnea flag.
They can still cause problems, disturb sleep and in general we don't want to be seeing a lot of them.

Hyponea...air flow reduction from 40 to 79% ....above 79% then the flag is an OA flag.
OAs...air flow reduction of 80 to 100%.

Hyponeas are treated just like OAs when we want to reduce them....more baseline pressure.
There's a reason that hyponeas are included in the AHI numbers...they aren't benign little nothings to be ignored.
....
Now for your reports...while most of your events are hyponeas you aren't having a huge number of them so I don't know that they are a problem or not and actually need further reduction in their numbers.
How are you sleeping and feeling? Do those leaks wake you up or not?

[clownbell]

@ Julie - Thanks for your reply. Max pressure was set at 9.8 per Kaiser. They looked at my pressures for the first three weeks of therapy (beginning on 1/14/21) and determined that the 95% max number was 9.80 and so they changed it from the initial 5-20 to be 5-9.8.

FWIW, I went to OSCAR and recorded the 95% max numbers for the first three weeks and confirmed that the average was indeed 9.8.

I'm beginning to wonder whether 9.8 is high enough. As I understand it, if max pressure were higher but not needed, the machine would not go there. Does OSCAR have the ability to calculate the 95% number over a more recent period -- say, the last month??

[Pugsy]

95% numbers are NOT an average.
95% number are just a number meaning you were at OR BELOW that number for 95% of the night. 5 % of the night you were higher but we don't know how high when you are hitting the max.
Most of us set the max higher and just let the machine sort it out. It won't go higher unless it has a good reason to go up.

Go to the statistics page and scroll all the way down to the bottom...look in left lower corner....you can change the report to monthly and get monthly 95% numbers as well as other numbers averaged.

[clownbell]

Sorry, Pugsy, if my wording has misled. I do understand that the 95% number means AT OR BELOW.

Let me try wording it this way. Kaiser took the 95% number for each of the first 21 nights, averaged those 21 values, and calculated an average 95% number of 9.8 for the 21 days.

Thanks for the OSCAR tip on looking at the lower left corner of the Statistics page.

Always something new to learn.

Thanks

Craig

[palerider]

@ Julie - Thanks for your reply. Max pressure was set at 9.8 per Kaiser. They looked at my pressures for the first three weeks of therapy (beginning on 1/14/21) and determined that the 95% max number was 9.80 and so they changed it from the initial 5-20 to be 5-9.8.

That shows a fundamental lack of understanding about proper treatment of obstructive sleep apnea, and hypopneas.

The proper thing would be to set the MINIMUM pressure to jst below what the 'average' was, instead of doing what they did which leaves SDB untreated until the machine gets up to pressure, then causes more breathing problems as the machine continually tries to get back down to that minimum 5 pressure.

A more functional pressure setting would be 9-20

[clownbell]

Thanks, Palerider. I'm a relative newbie -- what does SDB mean? Sorry to ask such a basic question.

[zonker]

Thanks, Palerider. I'm a relative newbie -- what does SDB mean? Sorry to ask such a basic question.

Sleep
Disordered
Breathing

never apologize for asking a question here. sometimes we who have been around for awhile forget that new people don't know the nomenclature.

[clownbell]

Thanks - I learn something every day.

[zonker]

Thanks - I learn something every day.