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Assistance needed for set up
#1
Assistance needed for set up
   
           
Good morning....

I posted awhile back that my dreamstation was repo'd for non compliance....Its been 4 weeks and still no new machine.
I bought a resmed elite s9 with humidifier to hold me over and last night was my first night using it.
I need some help with settings since my AHI wasnt too bad but its showing CA's which wasnt a problem for me before.

Ive attached an earlier graph with the dreamstation and my new one from last night.


Attached Files Thumbnail(s)
   
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#2
RE: Assistance needed for set up
I would drop my pressure by .5 (I'd say by 1 but your AHI is under 5 and I like to take it slow) and see how it does.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#3
RE: Assistance needed for set up
Along the same lines of though as Bonjour, you are currently at 13 cm fixed pressure with EPR at 2. Most of your events are hyopnea, and I don't think the CA cluster is of particular concern at this point. I would consider a pressure reduction to 12.4 cm as suggested by Fred, and increasing EPR to 3 and see if that resolves the hypopnea, or converts to a higher CA. I think this is potentially more comfortable and targets the cause of hypopnea which is a reduced breathing volume. This will also help your flow limitation which are present, but not shown on this chart.

Let's look at the positive side of these results. For the first time, your machine is properly showing expiration is longer than inspiration. I think flow limitation is probably less and that should help with your previous high RERA, however the S9 will not track that. Please try to include the Flow limit chart if it is available since pressure and mask pressure are fixed, those charts are less important.
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#4
RE: Assistance needed for set up
(01-07-2019, 01:27 PM)Sleeprider Wrote: Along the same lines of though as Bonjour, you are currently at 13 cm fixed pressure with EPR at 2. Most of your events are hyopnea, and I don't think the CA cluster is of particular concern at this point.  I would consider a pressure reduction to 12.4 cm as suggested by Fred, and increasing EPR to 3 and see if that resolves the hypopnea, or converts to a higher CA.  I think this is potentially more comfortable and targets the cause of hypopnea which is a reduced breathing volume. This will also help your flow limitation which are present, but not shown on this chart.

Let's look at the positive side of these results. For the first time, your machine is properly showing expiration is longer than inspiration. I think flow limitation is probably less and that should help with your previous high RERA, however the S9 will not track that.  Please try to include the Flow limit chart if it is available since pressure and mask pressure are fixed, those charts are less important.

Thanks adjusting to 12.4 and EPR at 3 tonight..lets see what happens

Also....I asked my DR to order me the Airsense 10 Auto....fingers crossed
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#5
RE: Assistance needed for set up
Good morning as suggested I put my settings at 12.4 with an epr at 3 and my a h I went up to an 11.1 
I don't have the rest of the data because my SD card had an error and it didn't read anything else so I need suggestions on what to do tonight
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#6
RE: Assistance needed for set up
Sleeprider probably knows more about this stuff than I do but with no concern about CA and some H, I would NOT have reduced my settings.

Instead I would have gone up.

You had a higher AHI (with reduction) but this does NOT prove me correct -- could be anomalous, but if you've tracking under 5 for more than a one or two nights it's more likely to mean something.

My thought would be to bump it up, 13 or a bit more, from the previous setting instead of reducing.

Do you really need EPR? I turned my off almost immediately and never needed it.
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#7
RE: Assistance needed for set up
Looking at the previous chart, The Obstructive Apnea was negligible implying that we may be able to lower pressure, Lowering pressure has a good chance of decreasing the small amount of Central Apnea that was there and increasing PS/EPR is always a good way to treat hypopnea the largest component of the previous apnea.  As Sleeprider is aware, increasing EPR can, not always, increase Central Apnea.  My plan, not stated, was to consider raising EPR on night 2. Not wrong, just different.

The other fact is that managing Central Apnea, in all of its forms, is consistently inconsistent.  That is, while the CA seemingly will look to be in control it will flare up and show more significant numbers randomly.  

Last night may or may not be a flareup.  Each of our apneas, while they have a lot of similar aspects, are different, and respond a bit differently simply because our bodies are different.  This is why we need to tweak/titrate settings for everyone. 

As SR said we will "see if that resolves the hypopnea, or converts to a higher CA"

I see 2 realistic actions, the first ride the settings as they are for another night. The second is to decrease EPR to 2.  I would likely suggest something else if I could actually see the charts.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#8
RE: Assistance needed for set up
(01-08-2019, 09:25 AM)bonjour Wrote: Looking at the previous chart, The Obstructive Apnea was negligible implying that we may be able to lower pressure, Lowering pressure has a good chance of decreasing the small amount of Central Apnea that was there and increasing PS/EPR is always a good way to treat hypopnea the largest component of the previous apnea.  As Sleeprider is aware, increasing EPR can, not always, increase Central Apnea.  My plan, not stated, was to consider raising EPR on night 2. Not wrong, just different.

The other fact is that managing Central Apnea, in all of its forms, is consistently inconsistent.  That is, while the CA seemingly will look to be in control it will flare up and show more significant numbers randomly.  

Last night may or may not be a flareup.  Each of our apneas, while they have a lot of similar aspects, are different, and respond a bit differently simply because our bodies are different.  This is why we need to tweak/titrate settings for everyone. 

As SR said we will "see if that resolves the hypopnea, or converts to a higher CA"

I see 2 realistic actions, the first ride the settings as they are for another night. The second is to decrease EPR to 2.  I would likely suggest something else if I could actually see the charts.

Fred
Thanks again for your time,
For the last few months with the Dreamstation if Im not mistaken. The EPR was off, and my AHI was under 5
IM debating on turning off the EPR tonight and leave the pressure as is at 12.4
What do you think?
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#9
RE: Assistance needed for set up
(01-08-2019, 08:44 AM)herbm Wrote: Sleeprider probably knows more about this stuff than I do but with no concern about CA and some H, I would NOT have reduced my settings.

Instead I would have gone up.

You had a higher AHI (with reduction) but this does NOT prove me correct -- could be anomalous, but if you've tracking under 5 for more than a one or two nights it's more likely to mean something.

My thought would be to bump it up, 13 or a bit more, from the previous setting instead of reducing.

Do you really need EPR?  I turned my off almost immediately and never needed it.

I believe my last machine I had the epr off...Gonna try that again
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#10
RE: Assistance needed for set up
There is no problem with trying any alternative setting. We learn what works best by trying. Good luck.
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