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Any tips for fitting a ResMed P10 nasal pillow mask?
#21
You did change the machine from "Nasal Mask" to "Pillows," correct?
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#22
spycar, what is the breakdown of the AHI? Any chance you can post a daily graph?
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#23
(09-23-2016, 10:57 AM)edfreeman Wrote: You did change the machine from "Nasal Mask" to "Pillows," correct?

Yes I did, but thank you for asking, as it is the sort of mistake I might have easily made.

Bill
(09-23-2016, 12:03 PM)Sleeprider Wrote: spycar, what is the breakdown of the AHI? Any chance you can post a daily graph?

Hey Tom,

Here is last night's graph (the worst AHI yet).

Appreciate any insights.

Bill

[Image: 09_22_16Daily.jpg]
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#24
Here is a screen shot of the previous night (better).

One difference was last night (6.64) I'd raised the Min. Pressure to 7. The previous night the Min. Pressure was 6 for (4.67 AHI). Not sure it that is a factor (or not). Last night I also raised the beginning pressure of the ramp.



[Image: 09_21_16Daily.jpg]
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#25
People smarter than me will comment on your graphs.

I have read that rating pressure can result in CA's increasing. This increase can be temporary until your body adapts to the change.
I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
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#26
Spycar, the graphs look great. Drop back on the EPR to 2 or 1 and it should clear up a bunch of those CA events. You can probably go ahead and set your max APAP pressure at 12 for now.
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#27
(09-23-2016, 02:49 PM)Sleeprider Wrote: Spycar, the graphs look great. Drop back on the EPR to 2 or 1 and it should clear up a bunch of those CA events. You can probably go ahead and set your max APAP pressure at 12 for now.


Tom,

The EPR is what makes exhaling easier, correct?

I remember how uncomfortable the test machine was (same ResMed 10 Auto I have now) when I used it (no relief).

So I'll try 2 first. Why does this help with CAs?

A graph can "look great" but have high AHIs? What looks good about the graph?

I feel very far from being able to read the significance of the data.

Bill

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#28
No guarantees but pressure differential IPAP/EPAP tends to expel more carbon dioxide, which drives the respiratory rate for most of us. If I wanted to have a lot of CA, all I have to do is increase the pressure support on my bilevel. I recently reduced from 4 to 3 to kill off the CA. For me, it reduced the AHI from mid to high 2.x to less than 0.5. Pressure support is comfortable, but if it washes out the CO2, then there tend to be transient centrals. That is what I'm seeing in your data. As pressure gets higher and EPR at 3 is in full effect, you seem to have more events. So, the idea here is to see what we get with a bit lower pressure support (EPR).

Another point, is when you finish exhalation, you will have 1-2 cm more pressure to prevent OA events. Take a look at any of your events, and I'll bet they always occur after you exhale, and don't inhale. Obstructive or central, it is always true. Having that little bit of extra pressure at the end of exhale can make a big difference. Not to get too technical, but Respironics machines always return to IPAP by the end of exhalation, regardless of Flex setting. Resmed does not increase to IPAP pressure until you initiate your next inhale. Not everyone responds the same, but I'd be willing to bet, cutting EPR a bit will show an improvement.

This affect on AHI, and especially CA is not necessarily permanent. After some weeks or months, you might be able to add the EPR back in and not have a lot more events. It's part of the adaptation period, and if you did nothing it would probably slowly improve. You will have to judge if improving the "numbers" is offset by a loss of comfort.
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#29
(09-23-2016, 05:22 PM)Sleeprider Wrote: No guarantees but pressure differential IPAP/EPAP tends to expel more carbon dioxide, which drives the respiratory rate for most of us. If I wanted to have a lot of CA, all I have to do is increase the pressure support on my bilevel. I recently reduced from 4 to 3 to kill off the CA. For me, it reduced the AHI from mid to high 2.x to less than 0.5. Pressure support is comfortable, but if it washes out the CO2, then there tend to be transient centrals. That is what I'm seeing in your data. As pressure gets higher and EPR at 3 is in full effect, you seem to have more events. So, the idea here is to see what we get with a bit lower pressure support (EPR).

Another point, is when you finish exhalation, you will have 1-2 cm more pressure to prevent OA events. Take a look at any of your events, and I'll bet they always occur after you exhale, and don't inhale. Obstructive or central, it is always true. Having that little bit of extra pressure at the end of exhale can make a big difference. Not to get too technical, but Respironics machines always return to IPAP by the end of exhalation, regardless of Flex setting. Resmed does not increase to IPAP pressure until you initiate your next inhale. Not everyone responds the same, but I'd be willing to bet, cutting EPR a bit will show an improvement.

This affect on AHI, and especially CA is not necessarily permanent. After some weeks or months, you might be able to add the EPR back in and not have a lot more events. It's part of the adaptation period, and if you did nothing it would probably slowly improve. You will have to judge if improving the "numbers" is offset by a loss of comfort.

I will try it, and thank you for the explanation. I'm mildly concerned that it was the feeling the machine was beating me to the punch (meaning hitting me with inhale pressure before I felt ready for it) that made the sleep study machine uncomfortable for me. In comfort terms, I like the machine following my breathing lead.

But I am in this to do the best for my health. So I'll make the suggested changes and report back tomorrow.

Thanks.

Bill
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#30
I'll look forward to your updates. I'm sure you will do fine, taking things gradually.
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Organize your SleepyHead Data
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