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Help understand, please
#1
I am a long time CPAP user for mild/borderline OSA, but stopped being followed a long time ago.  This was after I stopped using a rental company for a fixed unit and purchased an autoset unit (ResMed S9).  I have used this for approximately 7 years, and in all that time haven't bothered to look at the data. I know! The point of the story is, I just purchased a DreamStation autoset unit and decided to have a look.  I set up the Sleepyhead software and downloaded the first night's data.  Uh oh.......... 

[attachment=3423]


My understanding of the data is primitive.  I don't understand how my AHI could be elevated while using an autoset unit.  I don't know if the problem can be seen in the data posted above, but would appreciate it if one of you can advise me.  Thanks.
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#2
Welcome

Your pressure graph is all over the place, which is to be expected when using the default 4-20 settings. Most of the time, it's running at a pressure that doesn't treat your apnea well. It's best to set the minimum pressure about 2 (or possibly 3) below your 95% pressure from the data. Since your 95% pressure is 9.0, a minimum pressure of 7 would work better.

Click the CPAP setup manuals link at the top of the webpage to find out how to do the setup and order a copy of the clinician's manual.
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#3
Thanks for the quick response.  I'll give your suggestion a try.  Previously, on my prior machine, I had the range set from 10 - 20, for idiotic reasons having nothing to do with actual review of the data.  I tolerated it well but I have no idea what my AHI was or how the graphs looked.
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#4
Hi eLPete!

Big_dave is correct, you have the machine set to wide open. P-R's don't respond as fast as a Resmed does to OA's.  I would adjust your lower pressure up to around 7.5cm.  This will be at or above your median pressure and in your treatment range.  You topped out at around 10.5cm so, to allow for a little fudge factor, I'd set it at around 12cm.  This will tighten your operating range and aid the algorithm in finding the best pressure.  Get a few days time on these settings and see how you feel  and what your numbers look like.

BTW: What were your S9's settings?
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#5
I'm thinking 8.0 as a minimum. Same idea, but I think you're going to need it. Your tidal volume is awful at 280 mL. That would be appropriate for a child. If that continues, remind me we want to see a closeup (2-minute) of the flow rate.
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#6
(05-01-2017, 03:47 PM)Sleeprider Wrote: I'm thinking 8.0 as a minimum.  Same idea, but I think you're going to need it.  Your tidal volume is awful at 280 mL. That would be appropriate for a child.  If that continues, remind me we want to see a closeup (2-minute) of the flow rate.

Just out of curiosity, what is a normal tidal volume range for an adult? Thanks, Sleeprider.
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#7
this is part of a chart from a resmed titrate pdf, showing typical volume for size.
http://i.imgur.com/stb4tZk.jpg

if it continues and a reason isn't found here. , I would ask my sleep doctor about low volume, from reading, there can be a few reasons. As sleeprider said a zoom in may show something, to me it looks like there may be some breathing out through the mouth and is not being seen by the machine, it looks like there are breathe in breaths but not breathe out breaths

unusually the the respiration rate is ok. the minute vent is also down, as well as the volume. I'm really guessing, but you would expect the respiration rate to be very high to compensate, if there was a serious problem
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#8
Hi eLPete,
WELCOME! to the forum.!
Good luck to you as you continue CPAP therapy and also with getting it adjusted to better meet your needs.
trish6hundred
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#9
Thanks all.  To be continued.....
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#10
I will have to take another look, but my tidal volume does not seem to change much at all due to pressure changes.  I am about 90% of what the chart says.  And, I am above the ideal weight.  There may be a correlation due to how much body mass I have, and whether my diaphragm is effective.  Shallow breathing is usually chest breathing, and I am not sure that chest breathing is normal in sleep (expect maybe light sleep).

The AHI you exhibit is not surprising and may result in sufficient sleep quality.  You certainly did not feel you were being poorly treated, but just checked for the heck of it.

If I were you, I would be in no hurry to do much doctor consults.  Just making the slight adjustments suggested here and reviewing about 5 nights of data should be fine. An AHI under 5 is considered to be treated, though we say on the panel that effective treatment is that you slept well.  

Then at some opportune time, while already at the doc, you could mention the facts discovered - typical Tidal and Minute Volume, Respiration Rate, etc.

I have my guesses at what we will see on some close-up (2 to 5 minute) snips, based somewhat on the Insp Time and Exp Time.  I bet your body/face makes some hissing noises when breathing in and out (yes out).

Will you tell us also whether you have any Aflex setting (it would be off,1,2, or 3).

Thanks and good luck.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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