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A year later & still not happy with the numbers
#11
with the swap of a machine, even though you have pressures for reference from the last one, things can be different. It is just a case of looking at the data and seeing what is happening. You have a higher AHI than you did causing an unsettled sleep and its more than likely the pressures that are out of whack. I think I'm ok in saying that if you sufford with a complex apnea then your CA are only 5, which from an untrained eye says that part of the treatment is working, sort of, its the other apneas that aren't being caught as well. Maybe I'm looking at it wrong but I dont profess to knowing how ASV works just trying to think of it logically. Hoping you can get some data up tomorrow and go from there.
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#12
Here is what I've found: 
Mode:
Max pressure: 20.0
EPAP min 6.0
EPAP max 15.0
IPAP max
BPM 10
Ti
Flex type
BiFlex (1-3)
PS min 2.0
PS max 14.0

Anything left blank is because I couldn't find it. I'm trying to import the file from my SD card but it doesn't seem to be working. I'll keep trying.
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#13
(02-21-2017, 06:41 PM)joyced490 Wrote: Here is what I've found: 
Mode:
Max pressure: 20.0
EPAP min 6.0
EPAP max 15.0
IPAP max
BPM 10
Ti
Flex type
BiFlex (1-3)
PS min 2.0
PS max 14.0

Anything left blank is because I couldn't find it. I'm trying to import the file from my SD card but it doesn't seem to be working. I'll keep trying.

That is good enough.  Now we combine that information with this

[Image: attachment.php?aid=3215]

What we now see is a low minimum Auto EPAP pressure of 6.0 with a pressure support range of 2-14.  Your even breakdown is CAI 0.78, OAI 7.62 and HI 10.26. Your problem is what is known as complex sleep apnea, and there is a logical and proven approach to resolve it with your machine.  What we want to do is to first reduce the obstructive apnea and hypopnea.  So to address the obstructive apnea, you need to increase EPAP pressure by 1 cm until we see an acceptable result.  This will also reduce hypopnea, but once OA is acceptable, we can raise minimum pressure support to address that.  The titration protocol we are following is straight out of this source Page 14 http://incenter.medical.philips.com/docl...%3d9792335 .

If you're ready to go with this, the first step is to raise your minimum EPAP pressure to 7.0 and observe results. No other changes at this time.  We have no information from titration studies to show what pressure is needed to resolve OA, but we know at this point it's higher than 6, and your machine is not able to keep EPAP pressure high enough to resolve the problem in auto mode. If you can go into provider mode and go to INFO, it would help if you could tell me your current 90% EPAP pressure.
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#14
Ok. So I finally figured out how to import from my SD card. Hopefully this is at least some of what you need to see. I can't believe the amt of info that's on that card! Ty for your help.


Attached Files Thumbnail(s)
   
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#15
(02-21-2017, 07:13 PM)Sleeprider Wrote: What we now see is a low minimum Auto EPAP pressure of 6.0 with a pressure support range of 2-14.  Your even breakdown is CAI 0.78, OAI 7.62 and HI 10.26.  Your problem is what is known as complex sleep apnea, and there is a logical and proven approach to resolve it with your machine.  What we want to do is to first reduce the obstructive apnea and hypopnea.  So to address the obstructive apnea, you need to increase EPAP pressure by 1 cm until we see an acceptable result.  This will also reduce hypopnea, but once OA is acceptable, we can raise minimum pressure support to address that.  The titration protocol we are following is straight out of this source Page 14 http://incenter.medical.philips.com/docl...%3d9792335 .

If you're ready to go with this, the first step is to raise your minimum EPAP pressure to 7.0 and observe results. No other changes at this time.  We have no information from titration studies to show what pressure is needed to resolve OA, but we know at this point it's higher than 6, and your machine is not able to keep EPAP pressure high enough to resolve the problem in auto mode. If you can go into provider mode and go to INFO, it would help if you could tell me your current 90% EPAP pressure.

I am very ready to try anything. I see by looking at what others post that my numbers are terrible. I'm beginning to have doubts about my dr. :/  I had to send a request for a setup manual. As soon as I figure it out I'll try your suggestions. Ty! 
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#16
That is a huge help.  You just saved us two weeks of frustration. 

[Image: attachment.php?aid=3217]

Your EPAP is set too low. As you can see, the EPAP starts out at 6.0 and takes a long time to reach a therapy pressure where OA can be addressed, and then it just runs out of room.  I think you need to move the EPAP min to 8, but I'm missing some other information.  I need you to revise that graph and turn off the pie chart so I can see the statistics that are hidden.  In Sleepyhead, just go to File/Preferences/Appearance, and uncheck the pie chart option on the right side. Also, you can get a higher resolution image if you host the image on Imgur and post the link or image here. Instructions are in the second link in my signature. That will keep us from losing the history of these images as your attachment capacity is very limited on the forum.
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#17
[Image: vOJETvxl.png]

I'm not sure if I did it right. Hope so. Just checking.
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#18
(02-22-2017, 11:38 AM)joyced490 Wrote: [Image: vOJETvxl.png]

I'm not sure if I did it right. Hope so. Just checki
Sleeprider is the other info you needed on here? I have the correct manual now & am ready to change settings to what is suggested. ty for bearing with me.
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#19
That actually worked. We may need to go a touch higher for minimum EPAP to get those other OA. You may want to let this setting go for a couple days before making further changes, but I think increasing EPAP min in 0.5 increments is going to take care of the rest. The next move will be to 8.5.

How does this feel? Your machine i working quite hard to resolve CA and is at 20 cm IPAP pretty often. If we start to see unresolved CA we may need to go to a higher IPAP. On the other hand, if you feel the machine is being to aggressive, we can reduce the maximum PS. For most people a PS max of 10 is plenty to get the job done. Other than the residual OA this looks pretty good, so I am not pushing you to make changes.

Please try to keep the summary data on the left pane in Sleepyhead since that give us statistics on AHI and machine settings and pressures.
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#20
Just 2 quick checks/ideas
1 - do you sleep on your back, or your side? Some folks with obstructive events who sleep on their backs find those events may be reduced considerably by sleeping on the side. A bolstering pillow or wedge may help with this.
2 - do you tuck your chin down towards your chest when sleeping? Some folks have found that makes the apnea worse. A cervical collar or neck pillow may help prevent this.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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