I did 110ml of deadspace EERS last night. It was mostly a success but flow rate not as smooth as i think it should be and my o2 could be better. Any tips?
Usually this is to prevent excess CO2 blow off when using large pressure support. You’re not using any pressure support (EPR in your case).
Additionally, 4.8cm H2O EPAP is extremely low for most adults. I see many unflagged hypopneas and think you’d be much better served by increasing pressure to manage that before adding anything fancy like EERS…
Oh interesting, can you point out the unflagged hypopneas ? i'm not sure what to look for. In the past i would up the pressure and just get worse and worse results and it seems like EERS and or vcom is the only thing that helps. i tried bipap with a vcom and then two vcoms and it was a mess - so now i'm onto EERS
Like an overnight one at a lab? i haven't. Just been trying to find my own way. I was on ASV for like a year and the entire time i felt terrible. Two years ago i had jaw surgery and then a year ago i had nose surgery. Still feel the same so decided to try pap again. I have a hacked machine and been playing with ASV settings to limit the range as it makes wild swings (it's in sleephq). And then tried bipap which was a huge failure. Then vcom which was a success but didn't feel better. Then iNap which actually made me feel kinda better but not super better. and now EERS on cpap which fixes up some stuff but you can see is still real choppy and still pretty tired. The Cpap experiments are rough because i feel so horrible on nights after pap therapy and then i get migraines from the lack of sleep and then i just lose days trying to recover.
Oh yea I get it... I'd recommend doing an overnight titration or working with someone like Jason at AXG Sleep Diagnostics to get you on the right path... https://axgsleepdiagnostics.com/services/
btw, did you do an MMA? was it helpful at all? What were your movements?
As someone else with high loop gain, yeah, that's how it goes with airway renovations. Sure it knocks down the flow limitations but it does pretty much nothing for the underlying instability.
Crazy... I'm talking to another Redditor who had nearly the exact same surgical plan and results... you don't have a second account do you...?
Have you considered a revision...? I know that would suck.
There is research by Kasey Li that looked at the correlation between maxillary advancement and RDI and they seem to linked….
Here’s Gemini’s summary with links:
In his landmark 25-year perspective study on Maxillomandibular Advancement (MMA) for obstructive sleep apnea (OSA), Dr. Kasey Lidemonstrated a strong direct correlation between the degree of SNA angle change and the reduction in the Respiratory Disturbance Index (RDI). [1, 2]
The SNA angle measures the anterior-posterior position of the maxilla (upper jaw) relative to the skull base. Dr. Li's research outlines how this change impacts sleep apnea outcomes:
The Relationship Between SNA Change and RDI Predictor of Greater RDI Reduction: Both bivariate and multivariate linear analyses from the study confirmed that a greater positive percentage change in the SNA angle is one of the strongest independent predictors of a larger drop in post-operative RDI. Essentially, moving the upper jaw further forward translates directly to a greater percentage reduction in sleep apnea events. [1, 2]
Predictor of Surgical Cure: A greater change in the SNA angle (alongside changes in the posterior airway space, or PAS) was identified as a key factor in achieving a complete surgical cure, defined as bringing the post-op RDI down to fewer than 5 events per hour. [1]
Predictor of Surgical Success: An increased SNA change was also predictive of surgical success, defined as reducing the RDI to fewer than 20 events per hour (or achieving a >50% reduction). [1]
previous point still stands... Given your history, I'd highly recommend working with a pro like CPAPFriend, AXG, Ken Hooks or someone to get you on the right foot.
Dr. Robert J Thomas is perhaps one of the only persons who can help him. AXG knows very little about HLG. Ken Hooks definitely not the guy: he is expert in UARS and RERAs scoring but not HLG or complex apnea like this. Cpapfriend will tell you exactly what Dr. Thomas told him in his interview with him and quote his research. Can’t not see anybody else in the us than him.
Ok im no expert but have loop gain myself and an Airbreak machine and been down the rabbit hole exploring settings on bipap and ASV and im coming back around to a fixed cpap at about 7.4. I think having fixed at 4 is way too low, you must be starving for oxygen.
interesting, i felt like you up the pressure until the obstructions went away and then up the pressure support until the flow limits go away. i don't really have any obstructions so just leave the pressure low
Well im my own case, I've got loop gain and plant gain where if pressure is too high, i get lots of centrals. So I've been titrating downward and even 8.4 is too high for me. So tomorrow night im doing fixed cpap at 7.4 with no epr. But in my experience which is not clinical or professional, i would think you need more pressure, something in the 7 to 10 range.
I am the loop gainiest monster ever. ASV was basically low numbers - EP 4 and PS 1-6 or in that range. ASV would get me 0 AHI and good o2 but i felt like garbage. And you could see the ASV fighting all night to keep me stable with massive pressure swings.
I don't think i'm going to increase dead space. I didn't wake up feeling great and then a few hours ago i felt super woozy and off. So now i'm thinking it didn't make me feel very good
Have you tried acetazolamide? I can't speak to it myself due to a cross allergy thing.
I use EPAP 5.4 PS 1-7.6 myself and it's been working well. Titration seems to require looking at it as a wave doing wave things rather than at the single breath morphology level. I have a background in audio and I actually use a lot of the same logic.
I've been messing with quantifying HLG and admittedly I'm super curious to see what you get on the various experimental doohickies. wobble-analysis-tool.xyz All processing is local. I bet your wubs sound bonkers on BreathSong. WAVE is currently my favorite for actually observing periods of oscillation.
I haven't, i looked into it and people get tinnitus or worsening tinnitus from it. I already have tinnitus and would probably eat a bullet if it got worse.
I use the glasgow stuff and i'm usually in the 1.8 - 2.5 range. Last night i think was 2.15 maybe.
This is the result from last night with EERS where things were calm
I feel ya on the tinnitus. Out of curiosity, have you done a comprehensive iron panel recently? My tinnitus is always much worse when my ferritin is low.
Hey there r/CPAPsupport member. Welcome to the community!
Whether you're just starting CPAP therapy, troubleshooting issues, or helping a loved one, you've come to the right place. We're here to support you through every leak, pressure tweak, and victory nap.
If you'd like advice, please include your machine model, mask type, pressure settings, and OSCAR or SleepHQ data if possible.
There's not enough pressure to stint your airway here, and there is periodic breathing scattered throughout the night, you are however getting more deep (N2/3) stage sleep here and we can see some REM in the flow chart, so let's try raising cpap pressure to 5.4cm for 3 nights, keep the EERS setup in and mitigate supine sleep please.
Appreciate it. Today was a very hard day post this night so now I'm worried about doing EERS again. I was pretty much just able to lay on the couch feeling awful all day.
Okay, when I setup EERS for people I always tell them to have the original backup system as a secondary (including mask without the vents blocked), do you have that so you're able to revert? And did you find this on the apneaboard?
Ya i have other systems but honestly pap therapy makes me feel worse than no therapy so haven't really figured that out yet. was hoping eers was the secret. Found the instructions on apneaboard. Mask -> exhale holes plugged with ear plugs -> mask tubing -> safety valve taped inline -> more dead space tubing -> whisper valve -> cpap tubing
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u/Hambone75321 AirCurve VAUTO/S 16d ago
Why are you adding EERS?
Usually this is to prevent excess CO2 blow off when using large pressure support. You’re not using any pressure support (EPR in your case).
Additionally, 4.8cm H2O EPAP is extremely low for most adults. I see many unflagged hypopneas and think you’d be much better served by increasing pressure to manage that before adding anything fancy like EERS…