Dial It In Help

[chazmofo]

Hi Folks,
I've been treated for mild apnea for 23 years, mostly with fixed titration around 7-8cmH20. I recently got my replacement DS2 from Philips and got more interested in managing my own therapy since I don't see anyone regularly. I've read a lot about raising the "bottom" setting when using apap mode, or simply using cpap mode set to my historical average when using the Dreamstation as the Philips algorithms seem to lag in response comparatively. For the last several nights I have been using apap mode with a minimum setting of 7 and a max setting of 12 (average historical delivery is 8.5, or so) with relatively good results, or so I think. I still seem to average 2-3 AHI per night, and I'm wondering if you can take a look at my latest Oscar report and let me know if you see anything glaring.

   

[Sleeprider]

I think you have a pretty good grasp of the "lag" in the Respiroinics response algorithm, and when variable breathing occurs (shaded areas on your chart), the auto algorithm is taken offline in favor of the VB algorithm. http://www.apneaboard.com/wiki/index.php..._Breathing With a closer zoom of your respiration rate, we could probably tell more, but my impression based on the events and patterns here is that you would benefit from a minimum pressure of 8.0 and possibly up to 9.0. If you want to get into this a little deeper, provide a zoomed view of your chart showing a 3-4 minute segment so we can see the respiratory wave. A Resmed with EPR would likely smooth out this respiration a lot and resolve most of the events we see. The Philips machines make me nuts sometimes because there are so few options to address these problems.

[chazmofo]

Thanks for the response... I hope to get that AirSense 10 if my insurance company will play nice. Here's a zoomed view for you.

   

[Sleeprider]

Classic profile from a Philips machine! Most breaths are flow limited with irregular inspiratory peaks indicating some flow obstruction at the peak flow. The expiratory cycle is very short duration, high flow and ends with a pulse caused by the Philips Flex returning to CPAP pressure before inspiration begins. It looks pretty awful. What are your flex settings?

[chazmofo]

Flex is set to OFF.

[Sleeprider]

See if it makes any difference to set A-Flex to 1 or 2. I'm not a big fan of Flex, but it might smooth-out these transitions.

[chazmofo]

Will do. I’ll try it for a couple nights and let you know in this thread what happens.
Thanks