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Bi-Level, S, ST, ASV??
RE: Bi-Level, S, ST, ASV??
Have spent the last couple of weeks gathering data methodically...  trying different combinations.  I will post some new charts once I get the files in a couple days... but the general take aways are:

1) Before backup rate was enabled, tried limiting to side sleeping and found that left was best, followed by right, and allowing any sleeping position including back was by far the worst.  Never able to get better than 12.6 AHI.
2) With backup rate enabled, all of the numbers got better, and the trend from #1 was still true.  Was able to get down to AHI of 6 on side.
3) Tried a cervical collar to test theory about whether back was issue because of chin drop.  With collar and without limiting sleeping position, he had the best numbers ever... AHI of 5.
4) After all the mask issues... not using F30 because of magnets, getting Quattro but too many leaks... getting Amara View in large wrong size... changing to medium... perfect!!  Almost no leaks and very comfortable.  Using non-magnetic clips.
5) Using O2 Ring every night.  Showing BEST results with collar also... no drop below 88% all night.  Only 1.8 / hour with 4% drop.

The next thing I want to look at is whether he would be served as well or better with lower pressures.  The ramp is currently set to 30 min, which should give me some good OSCAR numbers of what the lower pressures do.  If he has the same or less apneas at the lower ramp pressures, I am going to ask Dr if we can try a lower pressure to find the lowest that gives good results.  The Dr has been very helpful in keeping an eye on the reports and keeping in contact with us.  I still have the Rise time set to 500ms... wondering if I shoudl back that down to 400 or 300 to see if too large a rise time could be a bad thing... I think at this point, we are getting good numbers... and it is just a matter of small little tweaks to see if we can get under 5 consistently.

Thank you, everyone, for all of your input to help get to this point.
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RE: Bi-Level, S, ST, ASV??
What is the minimum PS level anyone has seen used with backup rate enabled, that still effectively allows the backup rate to ventilate during clear airway apneas?
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RE: Bi-Level, S, ST, ASV??
In general 8.0 is safe for some, but we have seen some as low as 6.0 with aerophagia. Depending on airway resistance and spontaneous effort results will vary which is why many are set up at much higher pressure support. About all you can do is observe and adjust.
Sleeprider
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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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RE: Bi-Level, S, ST, ASV??
Thanks!

For those of you using ST machine with backup rate enabled... do you know what the machine uses for the Ti time when the backup rate kicks in?  I am seeing normal mask pressure waveforms during normal breathing, ie about 1 second at the top of the IPAP plateau... but when I see BR kick in, the waves have a sharp peak, almost like it is using Ti min as the Ti time.  And the machine defaults to 0.3 seconds Ti min... seems to me, with BR enabled, the Ti min should be set as outlined in clinician manual... 1.0 min and 2.0 max (max defaults to 2.0 already).  Can anyone who uses ST mode with BR tell me what their Ti min is set to, and if you see the same thing with top of IPAP mask pressure waveform when BR has kicked in?

Or may be it is good that the IPAP is very short... since tidal volume drops... CO2 increases and the central goes away...

Thanks!
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RE: Bi-Level, S, ST, ASV??
Would still appreciate any user feedback on previous question.

An update on things... had ramp set at 30 minutes, and noticed that during that time, no events were occurring.  I asked Dr. to review and possibly try a period of time at a lower pressure, since mask leaks and comfort were still an issue, and the higher pressure and pressure support could be causing some of the issues... even though most nights the AHI is < 10.

They made an adjustment down to 7/12 from 7/16.  More of a jump than I would have thought... and that leaves PS at 5 with BR 14.  But first night at that level, AHI was 4.  I have always felt the titration study was incomplete... so not leaving any stone un-turned.

I guess next we will still evaluate any events during the ramp time, and see if any further adjustments can help... and if he really needs the BR... not sure if it is really doing anything with PS of 5.  And if that is the case, a different machine that actually provides differentiation between OA and CA since we are flying blind with the ST device.  No way to know if the events are obstructive or clear airway, or how to adjust accordingly.  But I guess with AHI < 5 it really does not matter?  Especially since he started at 64.4 untreated.
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RE: Bi-Level, S, ST, ASV??
I don't know for certain, but Ti Min should be the same in S or T mode. A minimum of 0.3 is the default for people with normal pulmonary function, but would be inappropriate with timed backup as the machine would quit too early. Ti Min can be set equal to Ti Max, but normally, a Ti Min of 0.8 to 1.0 is ideal with a Ti Max at 1.8 to 2.0. It somewhat depends on the respiratory rate and specific conditions being treated. Guidelines are suggested in the clinical manual.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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RE: Bi-Level, S, ST, ASV??
Sorry, hadn't checked in here for a bit. I might be off base, but I don't think times under Ramp should be used as a basis for much regarding evidence to do any adjustments or assumptions about anything. I'm under the impression that all the time while in Ramp is ruled by Ramp settings and not by any other normal therapy setting. Maybe it's different on an ST.
Dave

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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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RE: Bi-Level, S, ST, ASV??
Had been getting good results with Amara View... AHI consistently 10 or under... some nights under 5.  He wanted to try out Dreamwear nasal pillow mask.  Has used it for a few nights... all number look very good except leaks.  AHI is similar to Amara View.  And the most important numbers from the O2Ring for Oxygen saturation, have been the BEST since he started therapy... almost every night, 0 time below 90%.  And he is consistently getting 10's on the O2Ring nightly score... meaning no time below 90% and average O2 around 95%.  But the ResMed score shows 0/20 for "Adjust mask leaks"... and in OSCAR it shows high leak levels... I am trying to figure out what this means... since I know from my own experience with the pillows, that if I were opening my mouth, it wakes me up and I would know it... he does not think this is happening... the AHI numbers are pretty good... and O2 levels are great... what could be causing this level of leaking from Dreamwear pillows?


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RE: Bi-Level, S, ST, ASV??
I would appreciate anyone's feedback on this... whether the lack of UA and only Hypopneas is accurate of possibly false because of the leaks?   He gets this leak rate with both the Dreamwear Nasal pillows and the ResMed P30i.  Overall AHI numbers are good... but I want to make sure the event type info is correct and not false because of the leak rate... and then determine what to to about both... could this pattern of leaks be from mouth, or more likely from poor pillow fit?

Since the pressure change from 7/16 to 7/12 the UA events have gone down to almost none... but Hypopnea events have slightly increased... if I remember correctly, IPAP controls Hypopneas on the titration, correct?  May be trying IPAP 13 to reduce Hypopneas?  Any advice would be appreciated.

Thanks!
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RE: Bi-Level, S, ST, ASV??
On an ASV Apnoeas are measured as UA’s even with no leaks as it does not identify between OA’s or CA’s one has to assume all CA’s are treated but a closer look at the flows would be needed. If you post a graph remove the pressure line and replace with mask pressure and the zoom in on the event for us to take a look
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