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Back to CPAP
#11
RE: Back to CPAP
Thanks, fully aligned vs the Doctors

I believe their reaction is partly because optimization for each patient would consume too much of their time (so getting the average of their patient <5 is good) but also because they know we can quickly become obsessed with data  (as Sleeprider says)

Tonight:
I will try the collar again, keeping it a bit loose
I will set my min pressure at 90% of my med which makes 7.4 (it was 6)
I will increase the max from 14 to 15( to keep a bit of room)

and  if result is not tood bad, will stick to these settings for some nights and see. At the end, I am not targeting very low AHI, but good sleep and good life, and I get those... I promise I will stop playing with the settings and just sleep Smile

Have good nights!
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#12
RE: Back to CPAP
Doc is upset ONLY because he can't charge you when you do your own adjusting. You cannot harm yourself by adjusting the CPAP.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#13
RE: Back to CPAP
Good day all

I will wait 2 more nights to post about the progresses I made following your guidances, and to post my new graphs (I have only 2 nights in)

One quick question : I have set EPR to 3 as per Gideon advise. But I have 2 options for it : Full Time or Ramp only
For now the machine is set to Ramp only. Do you an advise on the best mode to use?

Thanks
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#14
RE: Back to CPAP
Always use Full Time.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#15
RE: Back to CPAP
Full time
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#16
RE: Back to CPAP
Hello to all

Now with 4 days of tuned settings and SCC, this is where I am :

I am using the CPAP since Dec 21st 2020
On Jan 15th eve, I have applied the settings recommended by the forum members :
-Low pressure at 8 (while it was 5 before)
-EPR at 3 (while it was at 2 before), and last night I put it at "Full time" (not clear what it was at before Jan 14th as Oscar just says EPR 2 for those dates without anything more
-and a properly set SCC
 
My average indexes from Dec 21st eve to Jan 15th morning (before the tuning) were
-Hyp index : 0.47
-Obstructive Apnea index : 1.74
-Clear airway index : 0.43
-AIH : 2.64
 
From Jan 15th evening to Jan 19th morning, the same average indexes are :
-Hyp index : 0.86
-Obstructive Apnea index : 0.56
-Clear airway index : 0.9
-AIH : 2.32
 
And most important, I feel better rested.
Last night, was the most peaceful one, where no leak had disturbed me, which I believe is due to the EPR setting now to full time (several noisy leaks at certain time during the night were waking me up before)
But also, last night I have seen a value for Clear Airways at 1.4 where my average so far was 0.4 – Not sure if this is correlated to the EPR change
 
This  would tend to tell me (remember I am a newbee) that
- the pressures and the SCC have improved overall : I feel better rested and IAH got down to 2.3, so below 3 for 4 nights in a row
-I have much less obstructive apneas than average and more  hyp (maybe I managed to transform some A to H)
 
While I probably need more time to confirm a sustainable improvement, I would appreciate to have more advises to try to tune AIH down. 
For example, could I tune more (on top of having set the min pressure at 90% of med) the speed of the machine reaction to apneas : it seems to increase only slowly when it meets an OA, and not at all when it means a CA (see screenshots below)
And anything I should pay attention to vs the CA?

Anyway, a big THANK YOU for your help so far, it feels great to have you around!

   
   
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#17
RE: Back to CPAP
Your numbers are excellent. Don't fall into the trap of trying to hit zero events.

Our breathing cycle, very simplified.
CO2 in the blood, not oxygen, provide our main drive to breathe. With "high", not bad, levels of CO2 we breath to remove CO2 from our system. When CO2 levels go below your apneic apneic threshold you stop breathing, have no "need" to breathe and have a Central Apnea (one cause). We have no need to breathe until the CO2 levels once again rise, they will.

Low oxygen causes us to breathe faster, but is not the main signal to breathe.

I mention all this because CPAP itself, BiLevel, and EPR all increase the efficiency of our breathing, which increases the flushing of CO2 out of our system, which in a lucky few, not you, individuals results in the onset of a central Apnea issue.

Your Central Apnea is not an issue, but this is likely why your Central Apnea is slightly up. The OA events you have above are showing central characteristics, no recovery breaths, a gradual resumption of breathing.

I suggest you try EPR of 2 full-time.the evaluate which you feel better at.
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#18
RE: Back to CPAP
Thank you Gideon
Very instructive

I agree that I should stick to how rested I feel and not targeting 0 AIH

I see why you say that my OA have a central characteristic. I checked in previous period, and this was the case most of events below 20 seconds. When events were more than 20 seconds, then I can see the recovery breaths after them.

I will give a try tonight to an EPR 2 full time.

2 questions, by curiousity :
1 - How does the CPAP decides if an event is OA or CA?
2 - when back in 2008 I had my resmed machine or the Kaerys one (don't remembrer which one had this feature), there were talking about a "Bump" feature, something like a sudden and short increase in pressure as soon as the OA was detected to eliminate the OA. Is this feature still used by some machine manufacturers?

Thanks
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#19
RE: Back to CPAP
OA vs CA - A simple answer is the CPAP is using the air like a sonar signal.  Bounce back would indicate an OA, no bounce back equals a CA.  In actuality, Resmed's employ a unique pressure signal named, Forced Oscillation Technique (FOT).

Resmed Wrote:Central sleep apnoea (CSA) detection uses the Forced Oscillation Technique (FOT) to determine a whether a patient’s airway is open or closed during an apnoea. When an apnoea has been detected, small oscillations in pressure (1 cm H2O peak-to-peak at 4 Hz) are added to the current device pressure. The CSA detection algorithm uses the resulting flow and pressure (determined at the mask) to measure whether the airway is open or closed.

Here is the Resmed link describing all their "bells and whistles": https://www.resmed.com/ap/en/healthcare-...ology.html
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#20
RE: Back to CPAP
One of the reasons we like ResMed over other brands is that they employ a more aggressive algorithim based on flow limits, the least significant of obstructive events, and respond quickly with a pressure increase following, effectively providing a bump, though I have never heard it referred to as such before.

When you see a small rapid oscillating wave during a apnea, that is the FOT checking if the airway is open (central/clear) or restricted (obstructive)
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