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Appreciate help adjusting settings (UARS)
#31
RE: Appreciate help adjusting settings (UARS)
With all due respect, the first thing that needs to be done here is to get the Oxygen DeSATs managed.  After that is when to act on other issues.  including raising EPR and Pressure to better manage the Flow Limitations and all.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#32
RE: Appreciate help adjusting settings (UARS)
(09-09-2019, 08:44 AM)mper6794 Wrote:
(09-05-2019, 04:13 PM)cmcphee Wrote: Thanks, @melman. I'm not seeing an option to add RERAs. Uploaded a screenshot of the dropdown - is there a setting I'm missing maybe? Appreciate your help!

... As far as I remember, neither me, slowriter, and so many others in this forum have eever suceeded on getting this with Autoset machine, and max PS(EPR) of 3.0, whereas when you move to BPAP, and set PS: 4.0, quite often (or always?) those thresholds, particularly P95:zero , happen almost overnight, as magic!

Yes, that was the case with me!
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#33
RE: Appreciate help adjusting settings (UARS)
@bonjour - here's my data from last night with the Contec CMS-50F Oximeter:

Full night basic graphs: https://drive.google.com/open?id=1SuxbpJ...ySVKjlCnrt
Full night advanced graphs part 1 (w/ oximetry): https://drive.google.com/open?id=16odFes...ldigRWoAfP
Full night advanced graphs part 2 (w/ oximetry): https://drive.google.com/open?id=1LDE3vS...4iTQaLv0j4
Full night Ox, FL, FR next to each other: https://drive.google.com/open?id=122pVO_...Ep600IuTU3
5 min view before my first wake-up: https://drive.google.com/open?id=1AN3khC...TNp4tNcn8e

Quick note that I was up for at least an hour after my 3:30a arousal in case that impacts anything. Thanks for taking a look - eager to hear your thoughts.
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#34
RE: Appreciate help adjusting settings (UARS)
I feel much better seeing those numbers, I don't know about you. Keep an eye on it, check your O2 periodically at random and when you suspect an issue. Your Sleep Test looked nasty,

The next time you go in to see your doctor, take your oximeter and ask your doctor to check your Oxygen sat level. On another finger record on your oximeter for comparison. I'm not suspecting anything, but it's never bad to see how it compares.

Going forward, I see nothing in your numbers, they are excellent, the Flow Limits look a touch high, but nothing I'd chase without a reason. so I'll caution you about chasing numbers, symptoms now, that can de different.

Looks like you are at EPR=2. You could try EPR=3, this is because during your sleep test at CPAP = 6 and no EPR, your O2 was not good so adding the EPR (which lowered your effective pressure to 4) effectively provided 2 cmw of pressure support which could be why the O2 is so much better, but I don't know. The conclusion is that EPR=3 would not hurt and raise your min pressure from 6 to 7 would leave your EPAP at 4 but provide a boost in PS which would help the flow limitations a bit.

How do you feel?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#35
RE: Appreciate help adjusting settings (UARS)
@bonjour Yes definitely, thank you - glad to see nothing come up from the oximeter. I plan to wear it all week and will bring it with me at my next visit. I'm unfortunately already at EPR 3 and have been at pressure of 7 for the better part of the past 3 weeks. I'm still waking up multiple times a night and feel tired all day. I for sure feel better on this machine than I did without it, but I still feel like I'm operating at 50% of my brain and energy capacity. 

Also, I didn't have a CPAP on during my sleep test - it was just a take home device (quite similar to the oximeter but with an electrode on my chest). Would it be helpful if I tried turning my CPAP's pressure settings for a night to get a baseline? My insurance wouldn't cover full polysomography.

Is there anything else I can do to raise pressure but not have aerophagia shy of switching to another machine? I didn't have aerophagia until around pressure of an 11 (my range was 7-12). Other ideas for what might be causing my wake ups?

@slowriter @mper6794 I'm going to speak with my doctor about trying out the Resmed Aircurve 10 VAuto. Is there anything in addition to what I've outlined above that you recommend I emphasize with my doctor in order for her/insurance to support giving it a try?

Thanks again.
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#36
RE: Appreciate help adjusting settings (UARS)
(09-09-2019, 04:07 PM)cmcphee Wrote: @slowriter @mper6794 I'm going to speak with my doctor about trying out the Resmed Aircurve 10 VAuto. Is there anything in addition to what I've outlined above that you recommend I emphasize with my doctor in order for her/insurance to support giving it a try?

I am guessing the strategy may vary by doctor and by insurance.

In my case, I just told my doc the APAP wasn't working and I felt poor consistently. 

She actually wasn't terribly open to the argument (in part because she was looking at summary data that didn't show any problem with my numbers), but I asked if she could get the insurance company to pay for an in-lab titration study, and if while doing that, they could also try the bilevel to see if I did better on that. 

We basically agreed that was the best way to test whether my hunches were correct.

But I think my insurance is pretty good about approvals, and the doc pretty good about documenting why she's advocating certain treatment options.

Might be more difficult for you given your experience so far, but maybe others have suggestions?

Finally, though I ultimately got the prescription for the vauto (today), I actually may wait to use it, as I bought a gently used one a couple of weeks ago. Lots of people here seem to do that.
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#37
RE: Appreciate help adjusting settings (UARS)
Sometimes Flow Limitations cause wakeups, usually in conjunction with a RERA but not always.

Please check the settings that are active on your machine.
The machine says, 
Auto for Her mode
Min = 6
Max = 12

Titration protocol (Bi-Level) for Flow Limitations is to increase Pressure Support, not your base EPAP pressure.
To understand the similarities between CPAP and BiLevel I posted the following in another thread.  These are sample settings, NOT YOURS.
The important number in a BiLevel is the EPAP (Exhale pressure) number. That is what splints open the airway, not the IPAP (inhale pressure) which is called pressure on a CPAP. Per your Sleep Study your titrated CPAP pressure is 14. This should also be your EPAP pressure on a BiLevel. By standard practice pressure support (PS) is initially 4, but I'm going to use 3 right now as an example.

So on a BiLevel you would set EPAP =14 and PS=3. PS is always added to EPAP so IPAP =EPAP + PS = 14 + 3 = 17.

To match this therapeutic treatment on a CPAP we would set Pressure =17 and EPR= 3

Auto varies the base pressure, in either case, Pressure/IPAP for CPAP and EPAP for BiLevel.

Auto mode on a VAuto I would do  
Min EPAP = 12
PS = 4 (standard)
Max IPAP =20
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#38
RE: Appreciate help adjusting settings (UARS)
Cmcphee,
I emphatize with you. As I said above, after 5 months struggling, studying UARS, scrutinizing this blog trying to work out my own, I would say you have not even overcome the very first step on treating your UARS (flagged FL p95 : zero, max < 0.10, reamaining just a spiky curve), and trying the magic of the +1cm pressure (for you too, hopefuly), while moving from EPR 3 to PS: 4.0 at least. Moreover, taking into consideration your current aerophagia.Therefore, in my opinion, you definitively needs a BPAP.
What sounds very rare for me, and still not understood, in your case, is the reason why the very respectable and estimable Fred and Sleeprider (from whom I have learned so many invaluable things in this forum) keep reluctant on strongly recommending the BPAP for you.
However, would not be unplausible I have been missing something I have not even thought about, like the oxigen issue. You know, "new duck should refrain from diving deep!" Yet, I will take this risk this time: based on my experience while moving from CPAP to BPAP, with just 1.5 months of AUtoset in between, I am afraid I would have to say I lost my money with this brand new machine, kind of trap in middle of the road of CPAP to BPAP.

Good luck
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#39
RE: Appreciate help adjusting settings (UARS)
My goal was to prove that increased pressure support was working but not enough. Kind of hard to do that when you are rushing thru stuff.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#40
RE: Appreciate help adjusting settings (UARS)
(09-09-2019, 04:28 PM)slowriter Wrote:
(09-09-2019, 04:07 PM)cmcphee Wrote: @slowriter @mper6794 I'm going to speak with my doctor about trying out the Resmed Aircurve 10 VAuto. Is there anything in addition to what I've outlined above that you recommend I emphasize with my doctor in order for her/insurance to support giving it a try?

... though I ultimately got the prescription for the vauto (today), I actually may wait to use it, as I bought a gently used one a couple of weeks ago. Lots of people here seem to do that.

Also,  if your insurance company is unlikely to cover, you could just ask your doctor to write the prescription, and buy a used device from provider #2.
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