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#31
Looks like your headed in the right direction. Obstructives came down a little.

I would leave it on this setting for at least a week and see if it settles anymore. If obstructives stay the same, change your minimum to 9.5. You may eventually need to be at 10cm.

I would leave the max setting as is.

Most important is how your feel. Does the higher pressure bother you at all? Sometimes it's a compromise between feeling good or dealing with a higher pressure that may not be comfortable.
You will know as you tweek settings.
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#32
Well, you're halfway there! I think the best thing would be to keep these settings for a while and get a better baseline, and give yourself more time to adjust to the pressure. After an adjustment period, you may want to incrementally increase minimum and maximum pressure by 0.5 cm until you are consistently under 2.0 AHI. Your results are very good so far. Keep at it!
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#33
(12-29-2016, 08:44 AM)OpalRose Wrote: Looks like your headed in the right direction. Obstructives came down a little.

I would leave it on this setting for at least a week and see if it settles anymore. If obstructives stay the same, change your minimum to 9.5. You may eventually need to be at 10cm.

I would leave the max setting as is.

Most important is how your feel. Does the higher pressure bother you at all? Sometimes it's a compromise between feeling good or dealing with a higher pressure that may not be comfortable.
You will know as you tweek settings.

Thanks Opal. I didn't feel as good as the night before and did feel different through the night. I have a mild congestion, so breathing wasn't as easy as usual, but again it might have to do with the new settings. I'll keep this settings for a week as you advice and I'll let you know how it goes.

(12-29-2016, 08:50 AM)Sleeprider Wrote: Well, you're halfway there! I think the best thing would be to keep these settings for a while and get a better baseline, and give yourself more time to adjust to the pressure. After an adjustment period, you may want to incrementally increase minimum and maximum pressure by 0.5 cm until you are consistently under 2.0 AHI. Your results are very good so far. Keep at it!

Thanks Sleeprider. I'll le t you know how it goes... Sleep-well
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#34
Huh

Last night wasn't good. 28 OA events =( I'm keeping the settings discussed but I'm concerned about the constant OAs.

Somehow it won't let me upload the image.

https://imgur.com/a/hGH3w

Thanks,

Diego

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#35
This result is nearly identical to the original graph you posted, so the 1-cm increase is apparently not enough. Keep in mind that using EPR of 3, means your exhale pressure may be dropping out of therapy range allowing your airway to close. Your median pressure now is 10.2/7.2. You can address this in two ways. Reduce EPR or increase pressure (IPAP). Increasing pressure will also raise the EPAP pressure on your machine. (I like pressure support, and would just increase overall pressure)

If you look closely at the flow line where you can see individual breaths at the time of an obstructive apnea, I think you will see that you exhale, and mask pressure drops as set by the EPR. An apnea occurs at that lower pressure, and pressure does not resume until you begin an autonomous inhale, at which time the mask pressure also rises. It's not coincidental that this increase of 1-cm pressure brings you to your current median pressure. This will be a better starting point, mainly because you are not having apnea precursors that the machine would otherwise use to increase pressure ahead of an event (flow limits, snores, etc).

I would add 1-cm of pressure and see if this improves again. Did you have a titration study? What was the result?
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#36
Thanks Sleeprider.

So I should increase min pressure to 10 or drop EPR to 1 (you prefer increasing pressure).

I didn't do a titration study, all I had was a home sleep test with a ApneaLink.

I'll let you know how it goes.

Sleep-well
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#37
Your link worked fine, all it needed was IMG tags. Yes, I think this points to minimum pressure being too low, and it appears that a pressure of 10 may give your machine a better start on prevention. Normally the Resmed machine reacts very quickly to obstructive events and precursors, so this is a bit unusual, and it seems you just don't snore or have flow limits ahead of an obstructive apnea.

[Image: IsFQFea.png]
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#38
I think its getting better... I had a few problems with leaks and I'm still trying to get the best fit out my mask.

https://imgur.com/a/0lWQO

I don't know how to put IMG tags =(
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#39
That appears to be quite a bit better, but the fragmented therapy isn't going to do you any favors. Objectively leaks are not much different in this latest example but that is a pretty substantial reduction of OA event rate. You can try adding back in a bit of EPR if that made things more comfortable. If you think of your Airsense 10 as "bilevel lite", then we can look at EPR in the same we we do EPAP in bilevel titration. The exhale pressure needs to be maintained high enough to prevent most OA events. Your latest graph shows your average EPAP pressure of 10.4 gets that job done. So add EPR back in, but if the OA comes back, the total pressure must be raised to prevent EPAP from being too low.

If you look at your graph in my post #37 you can see an average EPAP of 7.4 allowed a relatively high OA rate. In your most recent results, with EPAP at 10.4 things look considerably better.
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#40
(01-02-2017, 01:11 PM)Sleeprider Wrote: That appears to be quite a bit better, but the fragmented therapy isn't going to do you any favors. Objectively leaks are not much different in this latest example but that is a pretty substantial reduction of OA event rate. You can try adding back in a bit of EPR if that made things more comfortable. If you think of your Airsense 10 as "bilevel lite", then we can look at EPR in the same we we do EPAP in bilevel titration. The exhale pressure needs to be maintained high enough to prevent most OA events. Your latest graph shows your average EPAP pressure of 10.4 gets that job done. So add EPR back in, but if the OA comes back, the total pressure must be raised to prevent EPAP from being too low.

If you look at your graph in my post #37 you can see an average EPAP of 7.4 allowed a relatively high OA rate. In your most recent results, with EPAP at 10.4 things look considerably better.

Thanks Sleeprider. I put EPR on 2 last night and OA went back up a little bit (11 to 15). My EPAP was on to 9.14. I don't actually feel any difference with EPR so should I try to remove it so I can a have a lower overall min pressure? I'm going to try min pressure on 11 and EPR on 1 tonight to see if I can get OA to lower numbers.

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