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[CPAP] I want my Dreamstation back
#11
RE: I want my Dreamstation back
Flow limits are obstructive apnea, they are smaller and Untimed. They can (and do) disrupt sleep and causes you to wake up. In my signature I have how apnea is scored as ob, H and FL
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#12
RE: I want my Dreamstation back
   
I am still struggling with the AirSense10 waking me up at least once during the night.  I changed the max pressure back to 20 since it seemed to need to go so high, but with my AHI so low I wonder if I really need to do that.  I'm sure the high pressure is what is causing the breathing noise that wakes me up as it's perfectly quiet once I stop/start it again.  Also changed the ramp time to 45 minutes and the ERP to 3 even though I don't think I really need the ERP at all.  Here is my report from last night.  If you have suggestions about what else I could change, or if it would be ok to lower the max pressure I would appreciate it.  My range with the Respironics machine was 4-16 and I rarely got to 16. Thanks so much.

(not very adept at the screenshot so I hope I did it correctly)
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#13
RE: I want my Dreamstation back
Your minimum pressure is *way* to low. 

Look what happens as soon as you exit Ramp. It immediately jumps up 10, and rarely falls below. With such a low minimum pressure your machine can't respond to events fast enough. This in turn can cause your machine to use higher pressures, then it might normally need.

Higher minimum pressures will clean up that very active Flow Limitations. Id suggest 10 mabe 11, and see how it goes.

I would also suggest changing your RAMP from 45 minutes to Auto.

While in timed ramp, your machine is *not* providing proper therapy, not reporting most events. This is evident by the snores measured in ramp. Then an immediate jump in pressure and an active looking Flow Limitation. Note, during Ramp you are likely experiencing events and Flow Limitations, but the machine is just not reporting them.

Changing your Ramp will start therapy when your breathing suggests you're sleeping, or the ResMed detects you need therapy. 

AutoRamp will switch to therapy mode under the following conditions:
  • 30 breaths of stable breathing (this is the believes you're asleep threshold)
  • 30 Minutes since starting machine
  • 5 consecutive snore breaths
  • 3 obstructive apneas or hypopneas within 2 minutes
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#14
RE: I want my Dreamstation back
As I said earlier, anything that starts at 4 is not optimized.
Some changes.
1. Let's get rid of the ramp for now, bring it back for a reduced period and a higher pressure (7 instead of 4) if you need it.
2. Your Min Pressure = 4, it should be a min of 7. Min Pressure (IPAP/Inhale = 4 + EPR (3). Yours should be 9 or 10 based on your Median pressure. Set Min Pressure = 9.
3. Your EPR = 3, Fulltime. That means your min pressure (IPAP/Inhale) should be >=7 , not 4 to allow EPR to work. The 9 suggested above is better for you Flex on your PR should be a min of 6, again to allow Flex room to work.
4. Leave Max at 20, it will help us tweak your settings, Latter, based on this chart I'd set it at 16-20. The actual value does not matter since your pressure is not consistently rising to max.

5. the only stat that is "high" is your Flow Limits. The 95% FL should be <= .10. Flow Limits can be thought of as mini apneas that are not timed. They represent a restriction in your breathing. The best treatment with your machine is EPR=3 full-time but you are already there. Another, surprisingly common source of restriction is positional, specifically your chin tucking toward your chest. Try it, tuck your chin to your chest, think fetal position, does that make it harder to breathe? Either way an experiment tonight. Adjust your pillows, make them flatter, one pillow instead of two, a feather pillow instead of that firm foam pillow, you got the idea. Then let's see what happens to those flow limits.

On EPR. On ResMed EPR = 3 is the equivalent of a Pressure Support/PS = 3 on a BiLevel. EPAP/Exhale pressure is what treats Obstructive Apnea, PS or Pressure Support is increased to treat hypopneas, flow limits and a couple other things. It is the 'magic' of a ResMed CPAP/APAP machin.
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#15
RE: I want my Dreamstation back
The OSCAR screenshot is fine.

Now let's go over a few things as there are differences from Respironics. You're now attempting EPR/exhale pressure relief. That's good but the math doesn't work out with what you're trying. Move your Min pressure from 4 to 7. This allows EPR to work at it's maximum ability.

The AutoSet's absolute minimum is 4, where you have it now. But with EPR at 3, you're asking for it to drop to 1... Min pressure 4 minus EPR 3 would equal 1, but again 4 is the lowest it'll ever go. But if your try pressure 7 minus the EPR 3, you'll get 4.

And for the Max of 20, you may actually need it. Not bashing Respironics, but it's a fact the control algorithm for it is slow in response. You might not have got to 16 because the signal to get to 16 was there (need based), but the slowness of the Respironics to spool up pressure was slow and caused the event to pass before it got pressure up to 16. So the Respironics drops pressures towards your Min. as it thinks there's no longer an event. The ResMed responds faster, so it ramps pressures up. And OSCAR shots show you got 19.08 as Max. It put your pressure there for a reason.

Also of note is your Ramp. Respironics has a button to activate Ramp, ResMed doesn't. ResMed starts Ramp every time you push start. You're losing 45 minutes of therapy every time you're starting, and you're already at 4, the lowest possible. Trust me Ramp isn't needed, at least not to hold a pressure of 4 for 45 minutes. Note that some are bothered by the pressure change from Ramp to regular therapy. Seriously consider cutting Ramp time down or off altogether.

Recap of setting edits
Ramp off
Pressure 7-20
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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#16
RE: I want my Dreamstation back
Thank you both for the replies. I’m embarrassed to say that despite having used a CPAP for 10 years I realize I know next to nothing about what I should be looking for. I’ve always been monitored by PCPs who only cared about the AHI and nothing else. I will make the changes you are recommending and see what changes. 

There was just one thing I did not understand  “Flex on your PR should be a minimum of 6”. What is that?

Sorry to be so clueless. Perhaps it will turn out that the Philips recall was actually a good thing for me. 

Thanks again. 
Sally
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#17
RE: I want my Dreamstation back
Don't be sorry, just soak up the info. Once you created an account here, you're no longer clueless. You're doing something proactive about the Apnea.

I'll let Gideon explain the reference to flex. I have an idea it was headed to a similar thing with EPR. You just need to start min pressure a bit higher so EPR or flex has headroom to do the work it was meant to do.
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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#18
RE: I want my Dreamstation back
(07-01-2021, 02:24 PM)SarcasticDave94 Wrote: The AutoSet's absolute minimum is 4, where you have it now. But with EPR at 3, you're asking for it to drop to 1... Min pressure 4 minus EPR 3 would equal 1, but again 4 is the lowest it'll ever go. But if your try pressure 7 minus the EPR 3, you'll get 4.

This is not correct.

ResMeds (and most CPAPs) will never drop the pressure below their rated minimum pressure, even after applying EPR. Without adequate pressure proper CO2 venting can't occur.

The minimum pressure ResMed AirSense is 4 
The minimum pressure for ResMed AirCurve is 3
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#19
RE: I want my Dreamstation back
Yes actually I've got it correct. I stated the user is attempting to use pressure 4 and EPR 3, and in essence is asking the PAP to go to 1 which it cannot.
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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#20
RE: I want my Dreamstation back
Oh sorry, misread
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