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Evaluate My Results to Determine Best Machine
#1
Evaluate My Results to Determine Best Machine
   

Hello,  This is my most recent result after my DreamStation Auto AFlex was changed to 7-12.  I am wanting to know if I have notable Flow Limitation.  FL appears on more than half of my pie chart. Not sure how to translate the data. 

I wake up a lot both on Fixed 9 (every hour) and now every 2-3 hours on Auto 7-12.  Do I need to change my pressure? Would a different machine like the ResMed Airsense 10 for Her be better or something else?  What other settings my mitigate this problem? 

I have been almost 80 days without a full night's sleep.  I have a trip coming up in about a month and am hoping to be better managed by then.  

Thank you to those who can offer suggestions.
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#2
RE: Evaluate My Results to Determine Best Machine
You can set your Flex to 2 and see if it helps your flow limitations
Overall I'm not seeing enough event marks to be overly concerned about your events.  Your Flow Limits are significant enough (I'm ignoring your Pie Chart because percentages of low numbers are meaningless) to attempt to reduce them, thus the Flex recommendation.

Flow Limits are better managed with ResMed because with their EPR you have a fixed 3 cmw to work with vs a variable 2 with Flex.  We are talking about treating Flow Limitations with pressure support or difference between EPAP and IPAP pressures.  A BiLevel machine will provide more options for these since the BiLevel PS can go much higher than 3 cmw.  I do not think you will qualify for a BiLevel machine though.  You can certainly talk to your doctor about that, the main qualifier is to fail at CPAP.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#3
RE: Evaluate My Results to Determine Best Machine
I would keep in it auto, move the min to 9 and add the flex that bonjour suggested. It takes a while to get use to cpap, some take longer than others. I would raise the min pressure till the obstructive  snore.FL.H.OA are resolved.

To go fixed you would use the 90/95% of the last 7 or 30 days, for this chart it would have been 10.5-11.

This video may help get a handle on cpap.


mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#4
RE: Evaluate My Results to Determine Best Machine
Thank you to bonjour and ajack for your insight. 

Unfortunately, I don't own the DreamStation machine yet, so I can't personally change anything.  I live fairly close to the Sleep Center, so they will change settings right away. 
I may, indeed, ask them to raise the variable numbers and the adjust the Flex.  

My insurance is requiring me to "rent" the machine for 13 months. 
The requirement is for me to use it at least 4 hours per night. 

That said, I am considering buying a ResMed as a back-up machine and/or waiting 13 months to see if this one works out okay.   Today, I had and AHI of 0.4, so I certainly shouldn't complain.  However, I still was awakened at 2:30 and again at around 4:30 and 5:30. (The ones I remember last about 5-10 minutes) I just wonder if a different algorithm would make a difference for me.  I generally feel rested, so for now it's a trade-off and I'm surviving.  I don't want to give up trying to have a full night's sleep, however.

Do you know if its common for people to wake often when first starting the CPAP? Is it the pressure, the increased change in pressure, an apnea or a combination of those things?  I had an evaluation score of 88 for my sleep study, but I slept like a log and had zero sleepy spells in the day.  On some occasions I woke up once at night.  It was actually a fluke that I even took the test.  Now, here I am on a sleep apnea forum! 

Knowing what you know of so many folks, do you commonly hear that the wake ups resolve themselves or should I expect I might have to learn to deal with it no matter what?  Thanks again....this forum is awesome.
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#5
RE: Evaluate My Results to Determine Best Machine
Like the new name. You’ve already been given good advice on the Resmed vs the Dream Station. It seems you are getting good results with the dream station. We all adapt differently to CPAP so your awakenings may subside with time. I suggest you post some OSCAR data so we can determine how well the Dream Station is working for you before buying a Resmed. I believe you posted some data in the form of a photo of your screen. It was very hard to read. It will be better if you use F12 to take a screen shot and post it as described in the link below. The screenshots are found in a screenshot folder in your OSCAR data folder. I suspect you can change the settings. I was in the same situation as you and changed settings without any problem. I think my DME and insurance only tracked compliance.
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#6
RE: Evaluate My Results to Determine Best Machine
A misconception.  The Sleep doesn't want you to make changes to your settings.  Most of their patients haven't a clue what or why to do so.  A DME cannot change the settings your doctor prescribed, it's a legal thing.  You however can.  Absolutely don't do it blindly and without knowledge.  What I suggest you can either use as talking points with your medical team, or make them yourself.  It's the knowledge that you learn that is important.  I prefer you to use them as talking points as long as your medical team is responsive and prompt.  BUT, you can change your settings anytime that you wish to.  Changing Flex/EPR or humidification should be no problem changing since they are considered as comfort settings.

Try to see what you think is waking you up.  This can provide insight.

You were waking up 88 times per hour,  these arousals were short but have a major impact on your sleep structure. Now, without them, you are used to waking up, but you are more rested so you are not immediately falling back asleep.  They should mostly go away.

It is very important to track these wake periods though.  It is possible that they are occurring from your Flow Limitations which are flows reduced by less than 50%.  These are not counted in your AHI.  The PR family of CPAP machines are IMHO not the best choice for you.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#7
RE: Evaluate My Results to Determine Best Machine
Quote:Thank you to bonjour and ajack for your insight. 

Unfortunately, I don't own the DreamStation machine yet, so I can't personally change anything.  I live fairly close to the Sleep Center, so they will change settings right away. 
I may, indeed, ask them to raise the variable numbers and the adjust the Flex. 

There is nothing preventing you from changing your own settings, so don't hesitate to do so if you wish. Just remind anyone who has a problem with it you are the one responsible for determining your treatment, not them. You don't lose the right to make the decisions regarding your treatment just because you are renting your machine. Don't let anyone make you think otherwise.

Quote:That said, I am considering buying a ResMed as a back-up machine and/or waiting 13 months to see if this one works out okay.   Today, I had and AHI of 0.4, so I certainly shouldn't complain.  However, I still was awakened at 2:30 and again at around 4:30 and 5:30. (The ones I remember last about 5-10 minutes) I just wonder if a different algorithm would make a difference for me.  I generally feel rested, so for now it's a trade-off and I'm surviving.  I don't want to give up trying to have a full night's sleep, however.

Do you know if its common for people to wake often when first starting the CPAP? Is it the pressure, the increased change in pressure, an apnea or a combination of those things?  I had an evaluation score of 88 for my sleep study, but I slept like a log and had zero sleepy spells in the day.  On some occasions I woke up once at night.  It was actually a fluke that I even took the test.  Now, here I am on a sleep apnea forum! 

Knowing what you know of so many folks, do you commonly hear that the wake ups resolve themselves or should I expect I might have to learn to deal with it no matter what?  Thanks again....this forum is awesome.

I started out with a DreamStation Pro and purchased a ResMed A10 Auto as a backup machine shortly after my insurance paid off the DreamStation. The DreamStation became my backup machine shortly after I tried the ResMed for the first time. The ResMed is much more comfortable for me than the DreamStation.

I woke up to go to the bathroom several time a night both before and for several weeks after starting treatment for my sleep apnea. It turned out that I wasn't actually waking up to go to the bathroom, but due to sleep disturbances related to my sleep apnea. The answer to your question is yes to all the above.

It takes time to get used to wearing a mask and struggling with a hose while trying to sleep as well as the pressure involved with the treatment. The good news is that once you get used to the equipment and get your treatment dialed in the awakenings, if caused by the sleep apnea and it's treatment, should be resolved.
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#8
RE: Evaluate My Results to Determine Best Machine
Bonjour,
No worries regarding changing numbers. We live in a high-end area in a very medically saturated community. Both my husband and I have medical backgrounds. That said, not one of the "professionals" I have worked with cares one iota about my follow-up care. I have been doing the research and driving my own intervention after I realized they didn't recommend anything or had no idea what to do. I found that weird. All my nurse practitioner wanted to do was put me on meds like week two (and basically send me on my way). I'm the one that asked her to change my device to Auto as an alternative. Now, when I see that I was on a fixed 9, when the Auto takes me to almost 12, it's apparent that not having enough pressure was probably torturous on my airway and my body. No wonder I was waking every hour. When I met with the DME the first time, she told me, and I quote, "You don't need the App." I went straight home and downloaded the App. Are you kidding me? Was she just too lazy to go over it? CLEARLY, this is a money-making endeavor for businesses involved. It's obvious they just want to move you through. The sleep study and follow-up titration, without other peripheral costs, was almost $6K. The sleep center does 6 of these a night. Do the math. As you know the DME gets to sell us stuff on a regular basis. Why didn't we go into this business, right? So, the bottom line is, the NP will do anything I ask her to do. She doesn't care. You are correct, the DME can't change anything without the directive to do so. I am trying to follow the rules with regard to their psuedo-care, so I can just carry the machine over there and ask for the changes. There will be no resistance. Regarding tracking, I have taken copious notes since day one. Thanks to you, though, I now know about Flow Limitations and will look for correlations.
MELMAN I can follow all the instructions to create a beautiful chart, but when clicking F12, I do not get a screenshot.
MITCHS Thanks for sharing your personal story. I adapted fairly quickly to the equipment, mostly because i was aggressive in researching and finding the right mask for me. But, it's good to know (bonjour also) that after time, I my body may adjust better to these changes in a positive way. No one would like better than to be thanking you all for a good night's sleep!
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#9
RE: Evaluate My Results to Determine Best Machine
I was using the actual F12 on my computer, not the one in the pull down menu! 
This was yesterday's result.  Today, I had a 0.4 AHI.  
That said, I now will look at Flow Limitation to see if this is the culprit. 
Hope this is a much better screen!

     
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#10
RE: Evaluate My Results to Determine Best Machine
You can change your pressure right now. even though you are renting, it is your machine. The instructions are at the top of the page, setup manuals. I would start at min ps 9, then 10 and if that isn't enough, you move closer to the 12 and try 11, you just keep closing in on the 95% pressure. Till the obstructions clear and the machine can then rise pressure if you have a bad night.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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