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Finetuning Settings
#1
Ohmy 
So, it's been over a month since I started using my machine (3 weeks on new mask). So far results have been good. My RDI is constantly under 1, mostly flow limitations and hypopneas, with the occasional CA, OA, or RERA. My AHI in my sleep study was very low (0.4), it was my RERAs that were concerning (RDI was 18.6). Now, I don't know how accurately these can be flagged with just the info recorded by the machine...

I feel that all in all, treatment is going well, leaks aren't a problem, and I've managed to find what I think are the proper comfort settings for me. I still feel quite tired and wake up often though. So, my question is: should I try slowly increasing the minimum pressure (by 0.5 increments) to see if it makes a difference or just let it be? Increasing the pressure from 5 to 7 did not really change my RDI numbers and the machine hardly ever increases the pressure during the night to counter events... but then again it didn't at 5 either.

I can't find tons of info on how to fine-tune optimal pressure settings for UARS, so that's why I'm consulting you experts!

Here are all my settings, a chart of a typical night, and an overview of the past couple of weeks:

Min. pressure: 7
Max. pressure: 15
A-Flex: 3
System One Resistance: X2
Mask: AirFit P10 for Her (XS)
Heated Humidifier: 3
Heated Tube: 5

[Image: T5024zs.png]

[Image: t7Mo3fn.png]

[Image: O2Ag3O8.png]

Thanks
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#2
Hi Geniale:
You can find out how to post 3 screenshots from this short tutorial by Paula:
http://www.apneaboard.com/forums/Thread-...13#pid3213

Regards,

Mongo
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
(03-05-2016, 01:30 PM)justMongo Wrote: Hi Geniale:
You can find out how to post 3 screenshots from this short tutorial by Paula:
http://www.apneaboard.com/forums/Thread-...13#pid3213

Regards,

Mongo

That's exactly what I did... I have no idea why it does that. If I right-click "open image in new tab", I can see the picture, so I'm not sure why it's not working. Could Dropbox be the problem?

EDIT: I confirm, the problem was indeed Dropbox. When hosting the pictures on Imgur, it works just fine!
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#4
if you right click and copy image address from the dropbox image you will get a link like (entire link not showing...):
https://photos-6.dropbox.com/t/2/AAA0SiQ...e=1280x960

If you use that link in the img tags it will display inline; like so:



(03-05-2016, 01:20 PM)Geniale Wrote: Screenshot 1
[Image: LCI0zRLmebh0g7NuBDCCwXLsjLTGAwHNIe2JPNNQ...e=1280x960]
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#5
and yes - imgur is much more simple... you can just copy the whole tag for "BBCode" on the right of the image Smile
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#6
I would suggest you try a fixed pressure of 7 and evaluate for a week. in your current setting, The bumping up and down of pressure may be causing microarousals and messing up your sleep architecture. I was in similar shoes as you are with the same equipment. The move to constant pressure finally did the trick for me. You may want to set the machine In apap mode with max = min = 7 and run it for at least 10 days to evaluate the effect. And the only variable you should evaluate is 'how do you feel in the morning' and 'how do you feel during the whole day'. Don't even look at AHI fluctuations unless they go beyond 5/hr.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#7
You're still getting a little bit of snoring (VS2) which could maybe benefit from a slightly higher pressure. Or as AshSF suggested, those bumps in pressure could be causing disturbance.

One other thing that I noticed - and I'm not sure if this is within normal limits - is that your respiration rate seems a bit high and your tidal volume is a bit low. In other words, fast, shallow breathing. Perhaps somebody who is more familiar with these factors could comment?
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#8
Hi Geniale,

Your RDI is already wonderfully low, so I an not necessarily suggesting any change, but to answer your question in general, for avoidance of RERA it is helpful to have higher pressure, or at least higher pressure during inhalation.

I believe an A-Flex or C-FlexPlus setting of 1 would be the best 'Flex settings for preventing RERA, because A-Flex or C-FlexPlus settings of 1 and 2 and 3 all provide at least 2 cmH2O pressure relief during exhalation but the higher pressure for inhalation lasts the longest when the A-Flex or C-FlexPlus setting is 1.

A-Flex or C-FlexPlus settings of 2 and 3 provide additional exhalation pressure relief, but toward the end of inhalation the higher inhalation pressure lasts less time, dropping off sooner toward the end of exhalation as our rate of inhalation reduces.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#9
(03-05-2016, 10:32 PM)AshSF Wrote: You may want to set the machine In apap mode with max = min = 7 and run it for at least 10 days to evaluate the effect.

Would it not be best to place it in CPAP mode in that case?
Or is there difference in a CPAP setting versus an APAP setting with the same min and max pressures?

(03-05-2016, 11:46 PM)DeepBreathing Wrote: You're still getting a little bit of snoring (VS2) which could maybe benefit from a slightly higher pressure. Or as AshSF suggested, those bumps in pressure could be causing disturbance.

That night was exceptionally high (for me) in snores... usually I get between 0-2 events a night.

(03-05-2016, 11:46 PM)DeepBreathing Wrote: One other thing that I noticed - and I'm not sure if this is within normal limits - is that your respiration rate seems a bit high and your tidal volume is a bit low. In other words, fast, shallow breathing. Perhaps somebody who is more familiar with these factors could comment?

That is one thing that I've also noticed and is concerning to me. I've tried to find normal limits, but have yet to find much info on the tidal volume values... I don't know what long/short term effects of fast shallow breathing are and how to change that.


(03-06-2016, 02:19 AM)vsheline Wrote: I believe an A-Flex or C-FlexPlus setting of 1 would be the best 'Flex settings for preventing RERA, because A-Flex or C-FlexPlus settings of 1 and 2 and 3 all provide at least 2 cmH2O pressure relief during exhalation but the higher pressure for inhalation lasts the longest when the A-Flex or C-FlexPlus setting is 1.

I cautiously tried setting the machine back to A-Flex 1 last night and I tolerated it fine. I had originally changed it to 3 when switching to nasal pillows because I was getting major anxiety, but now that I'm used to the mask, I seem to have no problem with a lower flex setting. I will look at my data shortly to see if it made any difference, though I doubt I can really tell from my numbers. I just have to try it out longer term and see how I feel...
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#10
(03-07-2016, 11:14 AM)Geniale Wrote:
(03-05-2016, 10:32 PM)AshSF Wrote: You may want to set the machine In apap mode with max = min = 7 and run it for at least 10 days to evaluate the effect.

Would it not be best to place it in CPAP mode in that case?
Or is there difference in a CPAP setting versus an APAP setting with the same min and max pressures?

The therapy will be the same. But in the apap mode, the machine collects more data than in the Cpap mode. That data is useful in fine tuning your pressure as you move forward.

Also, as vsheline suggested, you should use aflex at any setting (1,2 or 3).
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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