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CPAP Therapy Analysis & Settings Advice..please!
#11
RE: CPAP Therapy Analysis & Settings Advice..please!
Looking back over these charts, I think your sweet spot is going to be about EPAP min 9.0, PS 4.0 and IPAP max at 15. I think your pressure will hold pretty steady at PS 4 as this should treat flow limitations. Your flow chart shows some variable flow throughout the night which I'm not sure we can address, but we can take a closer look and see what might be causing it. Overall, your AHI is very low and respiratory statistics look good. Your focus should be on comfort rather than the numbers or even dipping too far into chart analysis. There is no feedback at all on your subjective concerns with your sleep quality, comfort or other issues of importance to consider, rather your discussion is mostly about the settings, changes and the charts. You need go get back to the main objectives we have in any optimization and that is going to mean sticking with some settings over a long enough period of time that you can establish a baseline to compare any subtle changes that we may try later.
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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#12
RE: CPAP Therapy Analysis & Settings Advice..please!
Sleeprider....Thank very much for your analysis and will proceed as you have advised. Should I leave the machine at the max IPAP of 20 or 25 or switch to your advice of 15.
Was having issues with inhalation/breathing whereas I felt I was not inhaling long enough. In reading various posts and articles I have changed Trigger to high, Ti max to 3.2 with Ti min at default of 0.3. Very small sample size so far but at this point all seem to have helped the issue unless you have opinions or additional changes to experiment with. Should I leave these and Ti min as is, any tweaks recommended. I did change the hose, filter, cleaned the ports and humidifier and changed the headgear on my Dreamwear mask to the "headgear with arms". Seems to be a better fit and all decreased my leak values to a 95% weekly average of 1.45l/min from 22.80l/min previous 60 day average....yeah ! 
Thanks
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#13
RE: CPAP Therapy Analysis & Settings Advice..please!
I don't want the machine wandering off into place it does not need to go...stick with 15; but I'll be surprised if you need even that. If the longer TiMax made you more comfortable, then go with it, but you have never used more than 2.4. I use a high trigger and like it. Again, if it works for you it's great. If you feel out of sync then you can always go back to medium. Settings are best changed after establishing a baseline, deciding where you want to take your therapy to make it more comfortable or effective, then making one change at a time. Especially as you approach optimum settings, you need to slow down and not react to every thing you see or feel. Some people are reluctant to make any changes, and some are overly reactive. I think in the long run, you need to be patient and analytical and make changes with a plan. We're not into playing Roulette.
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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#14
RE: CPAP Therapy Analysis & Settings Advice..please!
Update: Have resisted changing settings for the past two weeks and thought I post a reply with my charts from the last three nights. 
Additional settings include Ti Max 2.4 / Ti Min default setting 0.3 / Both Cycle and Trigger are set to med.
Overall I feel better but still feel a little tired and not feeling refreshed or alert upon waking. Around mid afternoon if reading, working on the laptop or watching TV I can fall asleep or nap easily in my chair. One of my concerns is that I seem to want to have a longer inhale while breathing in. There also seems to be a slight pause after exhale before I transition to inhaling. Are my breathing cycles indicating any issues. Could this be that I am too efficient on my breathing, CO2 level issues. My breaths seem short if that makes any sense. Anyways, can I get some feed back on these charts in regards to flow limits, inspiration time and any other issues. Any advice and comments are greatly appreciated. 
   
   
   
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#15
RE: CPAP Therapy Analysis & Settings Advice..please!
My impression is that your breathing is highly variable in both volume and timing on a breath to breath basis. These "shaggy" wave-forms are something we see fairly often, and they are sometimes associated with disrupted sleep; however, I have no idea how to use a CPAP/BPAP to stabilize the flow rate. We take away obstruction, flow limitation and optimize to the best of our abilities with the tools available, but some people exhibit these variable flow rates and low event rates. The only way to understand it better is to zoom in far enough to where the wave-forms are able to be read individually. a 3 minute segment of the flow rate may give us some better insight, but I'm not going to promise we know what to do with it. It is very unlikely we are going to make much difference with TiMin or TiMax settings, as your normal respiration falls within those limits and the machine triggers and cycles based on spontaneous effort. We can affect the trigger and cycle sensitivity, but so far, we really don't have a strategy available for variable breathing with no pattern of central or obstructive events.
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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#16
RE: CPAP Therapy Analysis & Settings Advice..please!
Thank you for replying. I expanded the flow rate some but having an issue getting a "3 minute segment for your review. Other than that, overall, how do my charts look after two weeks of steady and constant settings. Would recommend any TiMax / Min , cycle or trigger settings I may try one at a time to get a better breathing pattern that suits me. What is your meaning on "My impression is that your breathing is highly variable in both volume and timing on a breath to breath basis" ? Is that good or bad. Are my inspiration times tolerable or in a normal range. My breaths seem short or shallow if that makes any sense. 
What can I try. 
[attachment=47538]
   
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#17
RE: CPAP Therapy Analysis & Settings Advice..please!
One more if it helps...
   
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#18
RE: CPAP Therapy Analysis & Settings Advice..please!
The close ups show a normal flow morphology and the segments don't have the variable flow I would have expected to see. To get zoomed views of a specific length, you can use the Events Tab on Daily results. At the bottom of the Events tab is a slider that lets you select the view, and you can pan across the chart to see any segment at that zoom level.
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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#19
RE: CPAP Therapy Analysis & Settings Advice..please!
Sleeprider, thank you very much for your help, advice and concerns regarding my therapy. I have attached 3 minute charts from two nights. Tell me what you think. Overall my numbers appear to be on the positive side of things but still feel tired upon waking and not alert. Also my afternoons get overtaken by fatigue that I could nap at a drop of a hat if I allowed myself to do so. Was hoping something in my charts would indicate a solution to my problem. I have virtually eliminated my mask leaks, resisted setting changes, worked on mouth breathing and positional issues to better enhance my therapy....but still tired, UGH!!
I feel it may be breathing issues in regards to spontaneous breaths and cycles being out of sync. If so, what changes should/could I consider. Do all my other "numbers" on the right side of my charts fall within normal ranges. Getting frustrated. I'm tired of being tired ! 
  https://imgur.com/1gc2MiX
  https://imgur.com/viCWPgp

https://imgur.com/1gc2MiX
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#20
RE: CPAP Therapy Analysis & Settings Advice..please!
Bump !
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