Dugy40 [Doug's Therapy Thread]

[jaswilliams]

I have never used a Philips machine but I was under the impression that if you just started the machine and didn’t press the ramp button then it just worked at your therapy pressure that is what you want

[SarcasticDave94]

Yes, correct there. I'd forgotten the DreamStation has the separate Ramp button. OK then if you don't want to activate Ramp, don't push the button.

I do recall when I had my Auto BiPAP missing quite a lot of therapy time by pushing Ramp then restarting Ramp when the first one ended. Chalk it up to being a noob at that time.

My mistake, OP has System One, so my info would be irrelevant.

[Dugy40]

[attachment=24134]My chart is all over the place. pressure hitting 10 alot. i know i didnt sleep well. after this session i turned machine off and slept 5 more hours. what happened? thanks
edit: also i just found ramp time set at 15 min.i changed to zero.you told me to change it but i changed ramp pressure to 4. thats the lowest itll go.

[SarcasticDave94]

A few ideas on what's going on. I could be very much off base, which would not be a first.

Point 1 is that your pressure is set to a very narrow range and low pressures. I feel a perception from you that you're dealing with very high pressure settings. However, your CPAP class can go up to 20-25 depending on exact model. I think these settings are too low to address events.

Point 2 is that your Philips Respironics System One can be slow to respond. I'm assuming this is true based on that the newer DreamStation has this flaw. With this machine, you may need higher pressure to start with than the 8 you have now. The higher setting of 10 may be limiting the machine's ability to address events. As I see it, the pressure jumps up after the events instead of during the events. Again I could be off base drastically, but I think the events that we're seeing here are the ones the machine is too slow in response to address.

Point 3 is you're missing many hours on therapy. I think the weak link is the machine itself. The ResMed CPAP would be far better at providing good to great therapy while also being drastically more comfortable.

[Dugy40]

A few ideas on what's going on. I could be very much off base, which would not be a first.

Point 1 is that your pressure is set to a very narrow range and low pressures. I feel a perception from you that you're dealing with very high pressure settings. However, your CPAP class can go up to 20-25 depending on exact model. I think these settings are too low to address events.

Point 2 is that your Philips Respironics System One can be slow to respond. I'm assuming this is true based on that the newer DreamStation has this flaw. With this machine, you may need higher pressure to start with than the 8 you have now. The higher setting of 10 may be limiting the machine's ability to address events. As I see it, the pressure jumps up after the events instead of during the events. Again I could be off base drastically, but I think the events that we're seeing here are the ones the machine is too slow in response to address.

Point 3 is you're missing many hours on therapy. I think the weak link is the machine itself. The ResMed CPAP would be far better at providing good to great therapy while also being drastically more comfortable.

Thank you for the response.   I woke up once and heard and felt the air coming out my mouth.  Could that explain any of this?  
 So anyone have a suggestion on recommended low and high pressure? 
 Also.  Could going from c flex to a flex cause any of this.  
 Seems I was fine the night before.

[OpalRose]

Air coming out of your mouth is due to your mouth/jaw dropping open while you sleep. Are you aware if you mouth breath? Although, your leak rate looks fine. I don't see any issues there.

I'm under the impression your turned Flex off... if it was on, we would see a second pressure line(Epap).

[Dugy40]

Air coming out of your mouth is due to your mouth/jaw dropping open while you sleep.  Are you aware if you mouth breath?  Although, your leak rate looks fine.  I don't see any issues there.  

I'm under the impression your turned Flex off...  if it was on, we would see a second pressure line(Epap).

I turned a flex to 1. I don’t think I turned it off.  
  I just Now set it back to c flex since no one advised me which was best.  I have it set at one.

[Sleeprider]

Based on your most recent chart, I think you need to increase pressures to minimum 9.0 and maximum 14.0. You might want to consider the Knightsbridge dual chin strap from Supplier #37. A Resmed machine would treat the hypopnea and flow limitation much more effectively with the EPR feature that offers 3-cm of pressure reduction in a bilevel, dual-pressure approach.

[Dugy40]

good morning everyone. i have a screenshot of an event? but wasnt flagged. [attachment=24148]what is it? then another full night screenshot.. how does it look? low ahi this morning. ty as always.[attachment=24149]

[Sleeprider]

Although there is no flag for an event, the machine did raise pressure. This has the appearance of an arousal coming from flow limitation and respiratory effort. Although it is not flagged, the machine made an appropriate response. Your AHI is low, but marked with flow limitation, so we will continue to say therapy is very effective, but could be more comfortable and restful with pressure support. Looks pretty good with that exception. How do you feel?