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AirSense 11 95% Pressure
#1
AirSense 11 95% Pressure
Is there anyway to find out the 95% Pressure on a AirSense 11 using the touch screen or myAir App?  We can see it easily on using Oscar or SleepHQ.   My dad just changed to the AS11 and his 95% EPAP is now the same as his EPAP max.  We would like his EPAP max increased.  We have little any experience with my dad's sleep doctor and would prefer to not mention that we use either program if at all possible.

background. My dad finally was switched from the Luna 2 to the AirSense 11 last week.  Since Luna 2 did improve my dad's sleep quality and he was willing to use it, so we didn't want to rock the boat.   After a failed humidifier tank seal, rainout from unheated tubing, and supply problems we decided to try to switch to ResMed.  The DME quickly swapped machines.   With the AS11, he's able to stay asleep for longer blocks of time and his leaks are lower. However his 95% EPAP has jumped from around 10 to 12 (his max) when he switched from Luna to AS11.  Also the SleepHQ says that he is snoring during some of the time that the pressure is at 12.  

According to the 3B/React Health PapLink program, his 95% Pressure was typically about 10.  I don't have a high level of confidence in the PapLink data because the pressure changes always looked weird and didn't match with their respiratory event markers.

We would like the doctor to look at the data and make the recommendation.  At minimum we can report that he is snoring with the new machine, but we'd like to make sure the doctor looks at the actual pressure info.
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#2
RE: AirSense 11 95% Pressure
Doctors are notorious for only looking at summary data. I wouldn't hesitate to show him the OSCAR data. Make a copy of the SD card and bring that with you and simply say if you view this data with either of ResMeds products you will see the same data because OSCAR only reports the data.

Please post a copy of the Daily charts here, use F12 or Fn F12 on a Mac as that does some desired formating. Let's see what is actually going on. OSCAR increases pressure based on flow limits so if those are present that would explain why the pressures are higher. Either way I guarantee the algorithms managing pressure are different in different machines and IMHO ResMeds algorithms are the best.
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#3
RE: AirSense 11 95% Pressure
I finally got my dad's sd card data.    I can't figure out how to reduce the font so that I can get all the info in on one screen.
I appreciate any insight you can give me.


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#4
RE: AirSense 11 95% Pressure
You did a good job displaying the data. First, turn off the ramp feature. It's not doing him any favors. The Flow Limits suggest that it is driving the higher pressure. Try turning on the EPR to Full Time and set it to 3. Set the pressure range to a minimum of 13 cm and a maximum to 15 cm. This will provide an exhalation pressure range of 10 cm to 12 cm.

Try this for a day or two and see how he feels and if further tweaking is needed.

- Red
Crimson Nape
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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.
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#5
RE: AirSense 11 95% Pressure
Gideon
What do you mean by "OSCAR increases pressure based on flow limits so if those are present that would explain why the pressures are higher."?   I know the PAP machine increases pressure keep the airway open.  How does OSCAR chart the pressure differently based on flow limits?

Crimson Nape,
I'm not comfortable making to my dad's pressure settings.  He will be moving shortly and I will not be able to drive the distance to monitor him properly.   My mom does upload his SD card data for me, but it is a struggle.  Hopefully he find a good doctor when he gets to his new home. 

But do you both agree that the 12 upper limit is too low, right?

Thank you both for your help.
"
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#6
RE: AirSense 11 95% Pressure
I'm going to echo much of the same advice that Crimson Nape did.  (See his post above)

Turn off Ramp.  You also should turn on EPR set at 3 (full time).  Your current setting looks like you're trying to use EPR in Ramp only.  That does little good.

EPR is needed to tackle the Hypopnea and RERAs.  Also, the Flow Limitation is high and when the ResMed algorithm detects FL, it will raise the pressure.  He needs EPR to keep FL low.
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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.
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#7
RE: AirSense 11 95% Pressure
Pressure increases are driven by Obstructibe Apneas, Obstructive Hypopneas, and Flow Limitations. The RERAS are mostly a result of Flow Limitations. Your dad's Flow Limitations are very high. The EPR=3, Full Time, I see no issue with a higher Max value though the concept is that the EPR will tame the flow limits, eliminate the RERAS, and result in a much better feeling for your dad.
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#8
RE: AirSense 11 95% Pressure
I turned the ramp off last night. He didn't notice a difference. 
Can I adjust EPR through patient mode or is it a clinician thing?  I was look at the 398230-AIRSENSE11-CG-AMER-ENG.pdf, but am too groggy to sort the instructions out this evening.  I see that it references an advanced patient view that includes 95% Epap.
I also changed out his frame. We're 19 days late because of a supply glitch.  Hopefully it will help with the leaks.   His humidifier tank is drying out overnight, and it seems that the leaks don't help.  I switched climate control from auto to 2 to see if it helps the water usage.

Thanks all
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#9
RE: AirSense 11 95% Pressure
Over the past few days, I set EPR to 3 and the auto shutoff quit working. So tried EPR of 2 to get auto shutoff back.   Then I realized that I had accidently disabled the Smart Off option.   He is currently set for EPR  of 2 with the Smart Off enabled.  When Smart Off  was disabled, the pressure wave would float down until he put is back on and it was hard to figure out when he was having real mask leaks.

After changing the climate control from auto to 2, his humidifier tank is not drying out overnight.  But I'm not sure if that is result of the reduced leaks or the climate control change.  Now I couldn't figure turn it back to Auto.  I'll try again tomorrow.

He felt pretty good today and didn't need any naps.  I have about a week more to make any adjustments before he moves further away.   
       
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#10
RE: AirSense 11 95% Pressure
Flow limitation is very high and the EPR 3 may help some with that. What are your observations about his sleep position? Are there multiple pillows in use or a sleep position that bends the neck forward (chin-tucking)? These very high flow limitations reflect a very high respiratory effort to get a breath. This leads to the "respiratory effort related arousals" (RERA) that result in numerous arousals and very poor sleep quality. The use of EPR should not affect the AutoStart/off function. I really would like to better understand the origin of the flow limitation to help further, but our usual approach with this problem is more pressure support (difference between inhale and exhale), not less.

Given the persistence of the higher pressure resulting from flow limitation, I think increasing the pressure range to a minimum 9.0, maximum 14.0 with EPR 3 is certainly within reason.
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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.
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