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[CPAP] A little advice
#1
A little advice
            I very much enjoy going to this forum every day and find it extremely informative and helpful.
I am 10 weeks into CPAP therapy and am getting used to it and feeling somewhat better.  My AHI is down from 81 in my overnight sleep study to under 5 every night.   My doctor is very pleased as well - although really only reads the monthly summary rather than analysing all the Sleepyhead data.
Which makes me think I could do better.  I am still having mask fit and leakage problems and I am not sure if my minimum and maximum pressures are correct and I would like the AHI down a bit more with less pressure if possible.  I don't want to fiddle around with the machine settings if I'm unsure of what I am doing.
I am wondering if the experts on the forum could kindly look at my Sleepyhead data from last night (a typically average night) and give me some thoughts on fine tuning my machine?
Many[Image: thanks.gif] thanks, 
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#2
RE: A little advice
It would be nice to see the first figure for a few days.  I would definitely increase the max to 20.  Then I would try increasing the min to 17.   The bottom line is that you need more pressure in order to get a lower AHI.
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#3
RE: A little advice
From that one night, most of your issues are with hypopneas.

Increasing the pressure to 20 advice is a good one as you hit 19 regularly.

Also, read this on how to organize your charts so the Gurus here can help you the fastest.
http://www.apneaboard.com/wiki/index.php...ganization
PaulaO2
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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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#4
RE: A little advice
My guess is that your higher pressure is driven by flow limitations and if I am right you might need a bipap. I am sure that others with more knowledge will soon advice you. The other thing that concerns me is your high respiratory rate of 27.4

What did your sleep report say and can you take a screen shot of a 2 minute segment of your respiratory rate. Also, how are you feeling when you wake up?

Car54
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#5
RE: A little advice
You can try increasing your PS a little. You are using PS only during ramp, try using it after ramp. Pressure (PS) helps control Hypopnea.
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#6
RE: A little advice
Your EPR is set to Ramp-Only at 2. Hypopnea seems to respond well to the use of EPR, so I think you should change "ramp-only" to Full Time.

You are using very high pressures and I'd like to hear some feedback on your comfort. Most people with pressure this high would benefit from a bilevel machine. You in particular would benefit because it would likely drive down your hypopnea rate.

Please the include Flow Limitation Graph. I suspect that there is something there that might explain why you pressure is frequently near your maximum setting. Again, if flow limitation is present, the EPR at full time will help.
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#7
RE: A little advice
HairPower, my doctor only reads the summaries as well, so you are not alone there. Even though I had low AHI of <=7 on CPAP, I still didn't feel good. He did another study and recommended I tried BIPAP. He gave me a loaner for a month, then ordered me one. It has helped. Ask your doctor if he would loan you a BIPAP to try. Also I have been using an ergonomic pillow that tilts my head back to keep my neck straight when i lay on my back. That also seems to help keep my airway open.
ResMed AirCurve 10 vAuto
Pressure EPAP min 4, IPAP 8, IPAP Max 14, PS 4.

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#8
RE: A little advice
(05-16-2018, 08:22 AM)Sleeprider Wrote: Your EPR is set to Ramp-Only at 2.  Hypopnea seems to respond well to the use of EPR, so I think you should change "ramp-only" to Full Time.  

You are using very high pressures and I'd like to hear some feedback on your comfort. Most people with pressure this high would benefit from a bilevel machine. You in particular would benefit because it would likely drive down your hypopnea rate.  

Please the include Flow Limitation Graph. I suspect that there is something there that might explain why you pressure is frequently near your maximum setting. Again, if flow limitation is present, the EPR at full time will help.

I have at your suggestions, changed the pressure settings to 16-20 with EPR at 2 full time.  I have also attached my Flow Limitation graph and and a segment of Respiratory rate (pre machine changes). I don't want to go down the Bipap path yet and I'll see how I go with this.  Being new to CPAP therapy, I think I am comfortable with the high pressures but perhaps ignorance is bliss.  My respiratory number in my initial sleep study before diagnosis was 75.2/hour if that means anything. Many thanks for your input.


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#9
RE: A little advice
Your EPR is still only used during the ramp. Turn it on full time to help with the hypopnea.
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#10
RE: A little advice
G'day HairPower. A couple more comments on the charts you've provided...

All charts are for the same night (14 May) so none of the recommended changes will show up yet.

Ramp is set off, so the fact that EPR is set to "ramp only" means you're not getting any EPR at all during the night.

Leaks are reasonably well under control but there is room for improvement. You're only over the red line (24 L/min) for a few minutes but there are smaller leaks occurring the whole time. These can disturb your sleep even though they don't worry the machine.

Your flow limitation chart is all over the place, as is the respiration rate and tidal volume. Your tidal volume is pretty low at 320 ml (median) and your median respiration rate is fairly high at 27. Your max respiration rate is very high. This all leads me to think that the flow limitations are affecting your breathing significantly, but also affecting the way the machine is reporting the resp rate. We've seen other members who have flow limitations which cause the flow rate graph to look bumpy, which the machine is interpreting as two separate breaths instead of one restricted breath. It would be helpful to see a snapshot of the flow rate graph during a period when respiration rate is high.
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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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