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Advice on Pressures
#1
Hi Everyone, wicked board!!!

Advice on Pressures:-

I live in the UK, I see the sleep clinic once per year to have the machine checked and a short chat with a nurse. My pressures have not been adjusted since I got this machine 3 years ago.
Only just discovered (from this board) how to gain access to the clinician's menu. I'm looking at obtaining a smart card reader. In the mean time.

cpap pressure 6 - 15

30 Day readings
Press 11.2
Leak .4 l/s
AHI 11
AI 1.7
HI 9.5
This past couple of years I tend to have broken sleep wakening briefly maybe 2 or 3 times a night can't pin down why!
Don't feel I have as much energy as I used to have.
After reading a number of posts I'm wondering if I should try adjusting the settings?
Any advice would be much appreciated!

Cheers
John
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#2
(12-29-2012, 06:21 PM)roady666 Wrote: Hi Everyone, wicked board!!!

Advice on Pressures:-

I live in the UK, I see the sleep clinic once per year to have the machine checked and a short chat with a nurse. My pressures have not been adjusted since I got this machine 3 years ago.
Only just discovered (from this board) how to gain access to the clinician's menu. I'm looking at obtaining a smart card reader. In the mean time.

cpap pressure 6 - 15

30 Day readings
Press 11.2
Leak .4 l/s
AHI 11
AI 1.7
HI 9.5
This past couple of years I tend to have broken sleep wakening briefly maybe 2 or 3 times a night can't pin down why!
Don't feel I have as much energy as I used to have.
After reading a number of posts I'm wondering if I should try adjusting the settings?
Any advice would be much appreciated!

Cheers
John
Hi John. Welcome to the board. You said that you visit the sleep center once a year. But when was your last sleep study done? Before I started changing the pressures inadvertently, I would try to get another sleep study done so that you have a good baseline to start from. If you start trying to make educated guesses at pressure settings, you could do more harm than good. I went for six years without a sleep study and boy was I glad to see my doctor. My old settings were so far out in left field that I could have done some real damage trying to guess at new ones. Well, that's my two cents. Good luck. Keep us posted.Oh-jeezSleep-well
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#3
Hi roady666 and WELCOME! to the forum.!
Hang in there for more suggestions and best of luck to you.
trish6hundred
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#4
(12-29-2012, 06:21 PM)roady666 Wrote: Advice on Pressures:-
I live in the UK, I see the sleep clinic once per year to have the machine checked and a short chat with a nurse. My pressures have not been adjusted since I got this machine 3 years ago.
Only just discovered (from this board) how to gain access to the clinician's menu. I'm looking at obtaining a smart card reader. In the mean time.
cpap pressure 6 - 15
30 Day readings
Press 11.2
Leak .4 l/s
AHI 11
AI 1.7
HI 9.5
This past couple of years I tend to have broken sleep wakening briefly maybe 2 or 3 times a night can't pin down why! Don't feel I have as much energy as I used to have.
After reading a number of posts I'm wondering if I should try adjusting the settings?

John,

If your machine is set to 6-15 cm. H2O that is close to wide open. Most people find that narrowing it to a range of 5 or 6 works better.

Also, if your AHI averages 11, you need some kind of adjustment, and that probably means a higher bottom pressure. However, it looks like most of your events are hypopneas rather than obstructive apneas, and hypopneas are not as detrimental.

Does your machine indicate what range the machine ran over the course of a night? If it gives you figures for a night of, say, starting at 6 and peaking at 12, then, for at least that night, having the upper limit higher than 12 was unnecessary. Look at every day and take note of the highest pressure it got to. Then set your maximum a bit higher.

Once you know the maximum it gets to, then you know for sure that such a pressure will not harm you, so you can safely increment the lower pressure. I'd start by raising the lower pressure by just 1 cm. H2O and leave it at that for at least a couple weeks to see the trend. If your overall AHI goes down, consider increasing by another 1 cm. H2O, and so on every couple of weeks.

Above all, be scientific. Don't make two or three changes at once, because even if you get better results, you won't know which change made the difference. Make just ONE change and leave it for a couple of weeks to see what trend develops.
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#5
95% percentile pressure - at and below 11.2 for 95% of the time, indicate to me ... leave the maximum pressure unchanged

maybe increase the minimum pressure and see what happens
it ADVISED to do any adjustment in small increment over period of time

S9 measure leak in L/min _________ .4 L/s = 24 L/m

95% percentile leak ... at and below 95% of the time
Resmed define acceptable leak at and below 24 L/m
cannot tell how long stayed there without looking at the graph but might not be big deal








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#6
I agree with zonk. Your hypopnea index is high, which is an indication that the pressure is too low.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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#7
Thanks for the advice!!!

Just before getting this machine I requested they check me out again, their idea of a check was to send me home with an oximeter for one night!!!

I am going to slowly increase the lower setting and see what happens over a period of time. It would appear the only place I can obtain a data card reader is from Israel as trying to get an acr38 with the right firmware version will be difficult.

Cheers
John
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#8
Hi Roady666!
Every group has a heretic and that is me. =^.^=
All I have is a RemStar Plus (yes. dumb as a brick)
(when I can save up more I'll snag a better device but I need something *NOW*)
(I'm doing it this way since I need more time to shop for insurance and I can't afford the thousands
of $$$ required for formal studies just yet)
So I use that with a CMS50-F wearable oximeter *every night*.
I adjust pressure using a portable digital manometer so I know what I am getting as far as actual output.
I set the pressure based on number & severity of actual oxygen desaturation events.
This is harder & takes more time to deal with but... it works!
(as long as one does not suffer from neurological based central apneas!)
The folks here that run on monitoring pressures every night are experienced and wont steer you wrong.
The key word here is *nightly monitoring*.

Unfortunately most doctors and clinics dont realize this or just dont care once they have had a go at your wallet.
(Pathetic)
A yearly checkup for your machine is good, but only you can make a difference in keeping a watch over how well the machine is working for YOU.
I don't tink SleepyHead software works with the ResMed S8 so you might want to push for getting an S9 so you can start monitoring pressures and airflow.
If you can't get the S9, you might want to pick up a CMS50-F and use that for montoring how well things are going each night.
People DO change over time and their pressure needs will change accordingly.

The price for a good nights sleep is eternal vigilence.
Hang in there and keep up the good fight!

Cheers!

=^.^=





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#9
(12-30-2012, 10:06 AM)roady666 Wrote: Thanks for the advice!!!

Just before getting this machine I requested they check me out again, their idea of a check was to send me home with an oximeter for one night!!!

I am going to slowly increase the lower setting and see what happens over a period of time. It would appear the only place I can obtain a data card reader is from Israel as trying to get an acr38 with the right firmware version will be difficult.

Cheers
John
S8 autoset respond to snore or flow limitation but not to hypopnea
S8 does not differentiate between different types of apnea
hypopneas that are central in origin (not obstruction) should not be treated with increased pressure

I would suggest save your money on getting the S8 smart card reader and put towards getting an S9 autoset
if for some reason there is no hope of getting one thru NHS

probably you can get low hours used S9 autoset with humidifier and both hoses (climateline and slimline) delivered at your door US$600
see Supplier #2 http://www.apneaboard.com/forums/Thread-...plier-List


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#10
(12-30-2012, 02:59 PM)zonk Wrote: S8 does not differentiate between different types of apnea
hypopneas that are central in origin (not obstruction) should not be treated with increased pressure

Well, actually, although the S8 AutoSet II does not report obstructive versus non-obstructive events and does not support waveforms (plots) of the air Flow into and out of the lungs, and therefore is missing important tools which can help us figure out our breathing problems, it *does* distinguish between obstructive apneas versus non-obstructive apneas.

Although the S8 AutoSet II (unlike the S9 AutoSet) does not *report* a breakdown showing the number of obstructive events versus Unknown or Central events, the S8 AutoSet II (like the S9 AutoSet) only raises the pressure when it classifies an event as being obstructive in nature.

I know this because I have Complex Sleep Apnea and for years I used an S8 AutoSet II with the special card reader and ResScan software sold me by my doctor, and the machine would often decline to raise the pressure in response to clusters of apnea events. With my S9 machine, I now can see that when this occurs these are clusters of what the S9 reports as being Central Apnea events. Looking at the high rate Flow waveforms using ResScan or SleepyHead, I can now see that I often have long periods of Periodic Breathing or Cheyne-Stokes Respiration.

I have been working for 4 months on getting my Complex Sleep Apnea documented and diagnosed, getting an "ASV Titration" done and getting an Adaptive Servo Ventilation machine ordered, and I expect to receive an S9 VPAP Adapt machine soon.

I have been successful in getting a prescription for an ASV machine because of the more complete data reported by the S9 system compared to the S8 system (and because of the knowledge gained from Apnea Board), but my old S8 was not mistreating my Central Apneas by treating them like Obstructive Apneas.

Take care,
Vaughn
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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