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Friends new gear setup - fixed pressure?
#1
Friends new gear setup - fixed pressure?
I had a friend come visit a few days ago and she has a new apap - recently diagnosed.  She had questions I could not answer and so I'm posting for her.  She had a split night study and was shipped a machine by her provider via Apria.  No follow up, no explanation nada.  I read the first few nights of data on her card and don't know what to make of them - maybe you all can help.  

Her pressure is fixed and she says she's exhausted when she wakes although also remarked that she felt super well rested after the second half of her sleep study.  She is using nasal pillows.  When I initially saw these I suggested she call per provider and ask some questions.  Her provider said her prescription says "7" and that no follow up is needed after she received her machine, until one year from now.

Why would pressure be fixed?  How do these look to you?

Should she push for some follow up? What questions should she ask ?

           
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#2
RE: Friends new gear setup - fixed pressure?
Her pressure is fixed because thats how they set it, you or she can go into her settings (its in the provider settings) to adjust it to auto and give her a range. I just did that for my husband, he was given the exact same machine to replace a failing fixed pressure machine, and the DME just set it to his original prescription.
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#3
RE: Friends new gear setup - fixed pressure?
Yes I understand that it can be changed but I am unwilling to suggest changes as I am not her Dr. It is her very first cpap - not replacing anything. After contacting her Dr once already (and being waved off) she isn't feeling very confident about continuing. My question is: should she persist? I thought her daily reports looked a little odd but her dr says everythings fine (not sure based on what info however...)
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#4
RE: Friends new gear setup - fixed pressure?
One of the folks whos better at reading the charts will come along and make suggestions. I'm still new at this myself. I can tell you though, with her AHI so low she's likely to not get much help from her doctor. As far as they're concerned with that low AHI she's doing fine.
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#5
RE: Friends new gear setup - fixed pressure?
Based on the excellent AHI ALL the setting changes are optional and I'm offering them based on her feeling of being exhausted.

Fixed pressure because that is, I'm sure, her Titration Sleep Study recommended Fixed because they rarely recommend Auto mode, Your doctor, in a similar manner, prefers Fixed mode.  Besides they look at averages of AHI and not on what happens thru the night.

The charts show a considerable amount of flow limitations throughout the night.  I cannot see if there are any arousals at this scale though there certainly could be. 
Flow limitations are best managed with Pressure Support, a difference between Inhale and Exhale pressures.  The other fact to be aware of that it is exhale pressure that manages obstructive events.

Fixed Pressure
Set pressure to 9 in fixed mode and set EPR to full time and EPR =2.  Note that EPR will take 2 cmw off of your Inhale pressure whenever you exhale and 9 - 2 = 7 your current pressure thus no effective change in your OSA treatment.  The higher inhale pressure should help with your flow limits.

Auto Mode
set EPR to full time and EPR =2.  Same reasons as above.
Set your pressure range as 6 to 12.   6 because with EPR of 2 it is the minimum I'm comfortable with and it is lower than your current 7. This will start you out with inhale at 6, exhale at 4, the machine's minimum

Two options, both are targeting comfort, but without compromising therapy.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#6
RE: Friends new gear setup - fixed pressure?
What we have here is a Resmed Airsense 10 Autoset that has been handcuffed to provide fixed pressure. Interesting that during the ramp, the machine provides 1-cm of EPR (exhale pressure relief), and no EPR is provided during therapy (full time). As a result, flow limitations are pretty high and this results in an inverse inspiration/expiration time. I think your friend NEEDS EPR, but is other wise pretty well treated at 7.0 CPAP pressure.

Let's change things up a bit. Set the mode to Autoset so pressure automatically adjusts. Set the minimum pressure to 6.0 and maximum pressure to 12.0 and use EPR full time at 2 in the comfort settings. I would turn off Ramp, but if it is needed, set the Ramp on, auto mode at a starting pressure of 6.0. This is not much different than Fred's suggestion above, but puts the machine in auto mode and allows a higher final pressure.
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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#7
RE: Friends new gear setup - fixed pressure?
(04-19-2019, 07:46 PM)bonjour Wrote: ... The other fact to be aware of that it is exhale pressure that manages obstructive events ...

I didn't know that. How does that work?
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#8
RE: Friends new gear setup - fixed pressure?
StevesSp -- just in case you don't know this already, Bonjour and Sleeprider are 2 bona fide experts in this area.  You and your friend are getting top-notch advice.
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#9
RE: Friends new gear setup - fixed pressure?
(04-19-2019, 08:47 PM)AndyB Wrote: StevesSp -- just in case you don't know this already, Bonjour and Sleeprider are 2 bona fide experts in this area.  You and your friend are getting top-notch advice.

You're confusing me with the OP.
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#10
RE: Friends new gear setup - fixed pressure?
(04-19-2019, 08:50 PM)StevesSp Wrote:
(04-19-2019, 08:47 PM)AndyB Wrote: StevesSp -- just in case you don't know this already, Bonjour and Sleeprider are 2 bona fide experts in this area.  You and your friend are getting top-notch advice.

You're confusing me with the OP.

Yep -- sorry, I meant to direct this to sansnap.
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