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Adjusting my pressure down, advice
#11
generally treatment starts at lowest EPAP (min EPAP) and the IPAP is the EPAP plus the lowest PS setting.
--- example min EPAP=5 PS is 2 min 4 max. start is EPAP 5 IPAP 7.
as treatment continues, IPAP and EPAP may increase, but only until the IPAP gets to max IPAP.
--- example min EPAP=5, max IPAP=12, PS=2 min 2 max. while you start at EPAP 5 IPAP 7, you can end up as high as EPAP 10 IPAP 12, but no further.

it just gets more complicated from there.

suffice it to say, as #vsheline states, raise maxIPAP to allow room to resolve OA, raise maxPS to allow the lowest EPAP to minimize treatment induced CA, increase minIPAP to reduce the amount the machine has to climb in order to help you.

hope this helps. please set your ramp above 8 or turn it off...

QAL



.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#12
Thank you sir I'm going to absorb this and make my changes. Hopefully I can seek your advise again.
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#13
(02-03-2015, 12:01 AM)quiescence at last Wrote: as #vsheline states, raise maxIPAP to allow room to resolve OA, raise maxPS to allow the lowest EPAP to minimize treatment induced CA, increase minIPAP to reduce the amount the machine has to climb in order to help you.

Yes, except I wouldn't recommend increasing Max PS because that could increase the number of centrals.
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#14
@vsheline - would you try to keep PS between 2 and 3 in that situation?
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#15
(02-03-2015, 09:52 PM)quiescence at last Wrote: @vsheline - would you try to keep PS between 2 and 3 in that situation?

Increasing Max PS may allow PS to occasionally go higher. A higher PS would be expected to be helpful toward avoiding Flow Limitation and RERA events, but in some patients may also cause more central apneas.

Decreasing the PS may worsen how many RERA events we get but in some patients may also reduce the number of central apneas we get.

Original poster often has too many centrals, but at least sometimes has more RERA events than any other type. So hard to know which whether to increase or decrease improved sleep position might be most important.

If centrals start acting up strongly again, may be helpful to lower PS but raise Min EPAP by an equal amount.
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#16
So I received prescription based on titration. The Dr ordered a new machine ResMed Aircurve10 VAuto with settings of IPAP max17 and EPAP min12. PS of 4. This means a pressure of at least 16 IPAP? What is this pressure going to do to my Centrals? I don't understand the reasoning other than I didn't exhibit Centrals during titration.
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#17
(02-08-2015, 08:59 PM)sumzzzs Wrote: So I received prescription based on titration. The Dr ordered a new machine ResMed Aircurve10 VAuto with settings of IPAP max17 and EPAP min12. PS of 4. This means a pressure of at least 16 IPAP? What is this pressure going to do to my Centrals? I don't understand the reasoning other than I didn't exhibit Centrals during titration.

Hi sumzzzs,

You already have an Auto bilevel device. I would not expect the AirCurve 10 VAuto to work any better than the machine you have.

Request by email the Set-up Manual (clinician guide) for the AirCurve 10 VAuto to see whether it even reports RERA events. I am pretty sure it does not.

I suggest not accepting the precription unless your doctor can explain how the AirCurve 10 VAuto would be better than your present machine. I suspect it would be worse, since I think it does not report RERAs, which in the data you posted were your dominant cause of arousals and fragmented sleep.


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#18
both the titration study and our observations are consistent that you should be seeking (1) a higher start pressure, and (2) a higher max pressure. will you slowly adjust your pressure up to the prescribed pressure to see what that does?

an example adjustment plan might be -
assuming your current setting is max IPAP 14 min EPAP 8, and ramp on:

2/9 -> turn ramp off, max IPAP 15.5 min EPAP 9. use for 4 days.
2/13 -> max IPAP 17 min EPAP 10. use for 4 days.
2/17 -> max IPAP 17 min EPAP 11. use for 4 days.
2/21 -> max IPAP 17 min EPAP 12

in doing so, you might find by 2/17 your treatment seems optimal and may not see the value in making the last two adjustments.

The important thing to note is you can use your present machine to accomplish this.

Good luck.

QAL

ps. would you consider posting an overview similar to below on 2/17 for last 21 to 30 days?

If you do, please set your preference to show RDI versus AHI. [select File Preferences and select the CPAP tab, and you'll see this:]
[Image: zUPgIzU.png]

Then your Overview Tab Chart should look like this.
[Image: QodtmZQ.png]

This will help us gauge your progress on RERA and AHI.


.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#19
(02-09-2015, 05:54 AM)quiescence at last Wrote: both the titration study and our observations are consistent that you should be seeking (1) a higher start pressure, and (2) a higher max pressure. will you slowly adjust your pressure up to the prescribed pressure to see what that does?

an example adjustment plan might be -
assuming your current setting is max IPAP 14 min EPAP 8, and ramp on:

2/9 -> turn ramp off, max IPAP 15.5 min EPAP 9. use for 4 days.
2/13 -> max IPAP 17 min EPAP 10. use for 4 days.
2/17 -> max IPAP 17 min EPAP 11. use for 4 days.
2/21 -> max IPAP 17 min EPAP 12

in doing so, you might find by 2/17 your treatment seems optimal and may not see the value in making the last two adjustments.

The important thing to note is you can use your present machine to accomplish this.

Good luck.

QAL

ps. would you consider posting an overview similar to below on 2/17 for last 21 to 30 days?

If you do, please set your preference to show RDI versus AHI. [select File Preferences and select the CPAP tab, and you'll see this:]
[Image: zUPgIzU.png]

Then your Overview Tab Chart should look like this.
[Image: QodtmZQ.png]

This will help us gauge your progress on RERA and AHI.


.

Ok I'm going to raise Max IPAP tonight my min EPAP is now 9. You know I've noticed a good majority of CA is actually in periods of being semi awake such as this morning when I was anticipating waking to my alarm.

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#20
[Image: l4aTHM0l.png]


Amazing how much better this looks after a little tweak of my my pressure settings. First time under 5, wow, and I feel good also.
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