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Advice for new users wanting to "tweak" settings
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StuUnderPressure Offline

Members

Posts: 52
Joined: Jun 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage SoftGel with Camo Headgear
Humidifier: ResMed H5i Heated Humidifier
CPAP Pressure: 13 - 19
CPAP Software: ResScan

Other Comments: ResScan Version 4.3.0.7081

Sex: Male
Location: U.S.A.

Post: #11
RE: Advice for new users wanting to "tweak" settings
(09-26-2012 09:43 AM)SuperSleeper Wrote:  Until someone, somewhere does a comprehensive study proving that higher CPAP pressures actually induce true central events

I am also skeptical of the theory that higher pressures actually induce centrals.

Does the higher pressure actually induce Centrals OR does it merely sufficiently treat the OSA & therefore leave the already existing Centrals?
09-26-2012 11:38 AM
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Sleepster Offline
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Moderators

Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #12
RE: Advice for new users wanting to "tweak" settings
It makes the number of central apneas increase. By quite a large amount in some cases.

A few months ago someone posted an article about BiPAP-induced CSA. It was real, as confirmed by sleep studies, not just by a PAP machine that records clear-airway events.

The next time I see that article I'm going to save it. I don't recall if any of the CA events were accompanied by oxygen desats or how long they lasted.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
09-27-2012 06:50 AM
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Remfan Offline

New Members

Posts: 3
Joined: Sep 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift LT
Humidifier: ResMed H5i
CPAP Pressure: 4 cmH2O
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Corvallis, Oregon, USA

Post: #13
RE: Advice for new users wanting to "tweak" settings
Had a recent full night sleep study which found only obstructive and not central apnea.
Started on APAP at min 7, max 12 cmH2o pressures.
Immediately took care of almost all obstructive issues,
and generated consistent and significant (AHI 12.9) central apnea events
(or at least what the machine calls central apnea).
I conclude that excess pressures (for a given individual) can indeed induce central apnea,
or what gives every appearance of being central apnea.
I am frankly too spooked to continue at the same pressure settings,
(as I'm not too keen on waking up dead...)
though I do not know what setting might be both safe and effective.
09-27-2012 11:51 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #14
RE: Advice for new users wanting to "tweak" settings
(09-24-2012 07:48 AM)jdireton Wrote:  Your profile says you have an S9 Escape Auto. This machine doesn't collect efficacy data, only usage (compliance) data, so what are you basing your decisions on?
The S9 Escape Auto does score AHI but not the breakdown. No central apnea detection or leak and no mask fit or smartstart features either
Basically its a brick that does auto and report AHI and how many hours used each night
09-28-2012 01:59 AM
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Remfan Offline

New Members

Posts: 3
Joined: Sep 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift LT
Humidifier: ResMed H5i
CPAP Pressure: 4 cmH2O
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Corvallis, Oregon, USA

Post: #15
RE: Advice for new users wanting to "tweak" settings
Follow up report: changed settings to max 8 min 4 cmH2O last night.
Brought AHI down to 6.3, of which 5.6 is still central...so I will set the max pressure even lower tonight.
But the key point is this: lower pressure = less central apnea (for me).

Excess O2 saturation is one pathway to central events....where the CNS is actually doing what it is supposed to do.
And then there is another pathway to central events due to a CNS malfunction.

So I am tweaking settings in the first month...out of sheer necessity.
And I might (or might not) take some heat for this from my doc.
Safety trumps protocol.
09-28-2012 12:42 PM
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BabyDoc Offline

Preferred Members-2

Posts: 184
Joined: May 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model:
Humidifier: ResMed H5i with Climateline Tubing
CPAP Pressure: 6.0 -16.0 CM
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Beachwood, OHIO

Post: #16
RE: Advice for new users wanting to "tweak" settings
Actually, a true central apnea is a non-obstructive hypoxic event, where not only is there a total cessation of breathing for at least 10 seconds, but along with that there is a drop in the oxygen saturation of at least 10 percent of the baseline saturation. In order to know if the "clear away or open airway" events that your machine records were significant, you would need to have simultaneous pulse ox data. That isn't wouldn't be that difficult to do, especially with SleepHead software and an inexpensive CMS50 D+ pulse oximeter. Frequent significant drops in your pulse ox, whatever the cause, obstructive or central, aren't good for you.
09-28-2012 02:35 PM
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PaulaO2 Offline
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Posts: 8,067
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #17
RE: Advice for new users wanting to "tweak" settings
Here's my notes in the med history I keep for myself.

CPAP level 5 resulted in 97% O2 saturation, breathing stopped 13 times an hour
CPAP level 7 resulted in 90% O2 saturation, breathing stopped 36 times an hour

Nearly all of the 36 AHI were central events while the 13 were obstructive.

My O2 dropped quite a bit at the higher pressure.

However, the doc set the machine to 8 then, 3 months later, raised it to 10.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
09-28-2012 03:13 PM
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Sleepster Offline
Wiki Editor
Moderators

Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #18
RE: Advice for new users wanting to "tweak" settings
(09-28-2012 12:42 PM)Remfan Wrote:  Follow up report: changed settings to max 8 min 4 cmH2O last night.
Brought AHI down to 6.3, of which 5.6 is still central...

The thing is, there's no way to safely draw the conclusion that the change in pressure caused that drop in your AHI.

It's more likely you adapting to the therapy. It's very common for the AHI to just drop like that on its own.

Quote: so I will set the max pressure even lower tonight.

Not a good idea, in my opinion.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
09-28-2012 03:20 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,067
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #19
RE: Advice for new users wanting to "tweak" settings
Especially if you are going by just one night of data.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
09-28-2012 03:23 PM
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Remfan Offline

New Members

Posts: 3
Joined: Sep 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift LT
Humidifier: ResMed H5i
CPAP Pressure: 4 cmH2O
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Corvallis, Oregon, USA

Post: #20
RE: Advice for new users wanting to "tweak" settings
Thanks for the guidance,
and even more, for the goodwill behind it!

I gather that:
we are working with a non-linear system - output is sometimes not proportional to input;
and the system takes a while to come to dynamic equilibrium.
Furthermore, there are hazards of excess as well as hazards of deficiency with respect to treatment pressures.

I'm trying to thread a moving needle,
and will proceed with these provisos in mind.
09-28-2012 07:23 PM
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