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Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
#11
RE: Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
(03-23-2018, 07:04 PM)Ron AKA Wrote:
(03-23-2018, 05:34 PM)Walla Walla Wrote: Based on those charts I would have recommended moving the minimum pressure to 12cm. Everything else looks good.
Why? Because the machine is already averaging almost 12cm already. By increasing the minimum it cuts out the delay of it raising and prevent events at the lower pressures.

I think I understand what you mean. To clarify can I ask a few more questions. On the graphs which pressure are you looking at? The red trace on the Pressure graph? I am assuming the green trace is just the treatment pressure minus the starting pressure (4 cm)? On the Mask Pressure graph is the blue band essentially being painted by each inhale and exhale with the difference being the EPR setting that is used (3 cm)?

Look at the pressure graph and forget about the Mask Pressure graph.
The upper line is your IPAP/Inhale pressure, The lower line is your EPAP/Exhale pressure which is IPAP - EPR)


Are you looking for CA events which occur below the the average minimum pressure? If so, I don't see many, but there are some. More seem to occur after the get up in the middle of the night for a P break.

Your CA events are low, real low, so don't worry about them.  Your AHI is extremely good.  Just look at that number, Your OA and H events will show as tic marks and that is what your machine will respond )increase pressure) to.  False CA events can occur if you hold your breath as you are waking up or settling in, ignore all events during this period.

I believe the way the machine is set now is to start at 4 cm, and ramp up to 6 cm over 20 minutes. After that the 6 cm is the minimum. I have a recollection that when the machine was new it was originally set to ramp up to 7 cm, but after some discussion about issues my wife was having with comfort going to sleep, it was changed to 6 cm. So my thoughts are as an initial change to change the minimum pressure to 10 cm, and increase the ramp time to 30 min. Hopefully that would give her time to get to sleep before the pressure gets too high for comfort. I don't believe the S9 has the capability of the AirSense 10 to detect that you are sleeping and start the ramp based on that. That seems to be a better idea.

In any case what do you think of trying 10 cm with a 30 minute ramp? I looked back over quite a few days and the minimum pressure is a bit lower on average than the single day shown on the screen shot for March 22.

The chart says a 10 cmw minimum.  I'm not a fan of ramps, IMHO the shorter the better.  Can she read or watch TV with the CPAP running? Purpose is to get comfortable with the CPAP Get a glass of water and immerse a straw 8 inches into it then blow into it.  That is the MAX pressure the CPAP put out.
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#12
RE: Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
So I changed her machine to ramp up over 30 minutes (from 20), and increased the minimum to 9 cm. The AHI improved, but that is probably just random, as she normally gets quite a few days under 1.0. See the screenshot below. What I am seeing is significant snoring for the last 10 minutes or so of the ramp cycle. Would that be due to the CPAP not responding due to being in the ramp mode?

I think this data suggest a minimum pressure of 10, so I am thinking of changing to 10 cm with a 20 minute ramp to see how that works. Thoughts?
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#13
RE: Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
I’ve never been a fan of the ramp feature, but it is a comfort feature.  I think it is better to keep it short....20 minutes max.  

Another thing to keep in mind, is you should raise the ramp starting time closer to the minimum pressure.  If your going to move the min pressure to 10cm, start your ramp at 8cm.  Eventually, try to do without the ramp.  

Snoring, flow limation and Rera’s suggest a higher minimum pressure is needed.

Also, look at the 95% pressure reading.  This is the pressure you were at “or below” for 95% of the night.  The minimum pressure is more optimally set if two to three cm. below the 95% reading.
I think eventually the minimum pressure would be at 11 or 12.
OpalRose
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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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#14
RE: Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
(03-24-2018, 12:09 PM)OpalRose Wrote: I’ve never been a fan of the ramp feature, but it is a comfort feature.  I think it is better to keep it short....20 minutes max.  

Another thing to keep in mind, is you should raise the ramp starting time closer to the minimum pressure.  If your going to move the min pressure to 10cm, start your ramp at 8cm.  Eventually, try to do without the ramp.  

Snoring, flow limation and Rera’s suggest a higher minimum pressure is needed.

Also, look at the 95% pressure reading.  This is the pressure you were at “or below” for 95% of the night.  The minimum pressure is more optimally set if two to three cm. below the 95% reading.
I think eventually the minimum pressure would be at 11 or 12.

Thanks for the suggestions. I have set it up for tonight using a start pressure increased to 6 cm, a 10 cm minimum, and 20 min ramp time. I'll see what that does and go from there. I have to be careful not to make changes which are going to be noticed or it may not be good for my sleep quality!
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#15
RE: Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
(03-24-2018, 12:09 PM)OpalRose Wrote: I’ve never been a fan of the ramp feature, but it is a comfort feature.  I think it is better to keep it short....20 minutes max.  

Another thing to keep in mind, is you should raise the ramp starting time closer to the minimum pressure.  If your going to move the min pressure to 10cm, start your ramp at 8cm.  Eventually, try to do without the ramp.  

Snoring, flow limation and Rera’s suggest a higher minimum pressure is needed.

Also, look at the 95% pressure reading.  This is the pressure you were at “or below” for 95% of the night.  The minimum pressure is more optimally set if two to three cm. below the 95% reading.
I think eventually the minimum pressure would be at 11 or 12.

Here are the results from last night with start pressure at 7, 10 cm minimum, and 15 min ramp time. Will try 8 mm start, 10.5 min, and 10 min ramp time next to see how that goes. I think things are improving. When I look back over previous days with lower min pressure I do see a number of OA events which are occurring at less than 10 cm. I agree that she may end up with a minimum in the 11-12 range, and no ramp.
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#16
RE: Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
Looks good!

It’s how she feels that most important, and of course feeling comfortable with settings, mask, etc.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
OSCAR Chart Organization
How to Attach Images and Files.
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy
OSCAR supported machines
Mask Primer



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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#17
RE: Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
I'm sticking with the fact her pressure follows meaningless flow limitations, and a maximum pressure of 15-16 is more appropriate. Results look great.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#18
RE: Auto CPAP Optimization Guide? ResMed AirSense 10 AutoSet
(03-25-2018, 06:41 PM)Sleeprider Wrote: I'm sticking with the fact her pressure follows meaningless flow limitations, and a maximum pressure of 15-16 is more appropriate.  Results look great.

That will be phase 2 after I get the minimum pressure sorted out. My plan will be to bring the max pressure setting down and see if it creates any events in the periods of time that max pressure is limited.
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