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Help understanding data field relationships in SleepyHead
#1
I've been using a Remstar Auto A-Flex for the past few years without knowing its effectiveness, though still using it all night every night. I received a new Airsense 10 Autoset through the Veterans Administration a couple of moths ago. My recent (second in 5+ years) indicated a desired pressure range of 8-16. When I met with the VA nurse/tech(?) and I indicated I felt the maximum pressure was uncomfortable, he set the machine to 8-12. I've been trying to become more proactive with my treatment and I've been manipulating the pressure settings to find the best pressure setting for me. Can someone take a look at a couple of chart shots and provide some input? Thanks in advance.

[Image: screenshot-20170716-133755_zpseqiupo37.png]



[Image: screenshot-20170716-120044_zps7ydah7me.png]
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#2
The first thing you need to do is work on the leaks.   Are you having trouble keeping the mask in place?  I also suspect you are mouth breathing.  Having alot of leaks leaves your AHI
reading suspect.

Try using a "soft" cervical collar.  This will help to keep your jaw/mouth from dropping open while you sleep.

It looks like you are using a ramp starting at 5.  Your pressure then zooms up to your max setting due to hypopneas, flow limation and reras. Remember, the machine goes to your max pressure simply because it needs to.

Your pressure settings are not optimal for you.  Try changing your minimum to 11cm and maximum to 16 to see where you pressure needs to go.  If you want to use ramp, set it to start at 8cm.
OpalRose
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#3
When your machine was set at 12cm max it was maxed out for a good portion of the night, even at 14cm it wanted to go higher for a good portion of the night and you are still having hypopneas. I think they got the max setting at 16 just about right. You're almost never at your minimum pressure I don't think you would even notice if you raised it to 10. You definitely have some mask leak issues that you could work on.
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#4
Any changes you make, do slowly. Document them. Wait at least a week between each one. At the least, 3 days if you have APAP and the data is obvious.

If you make to make changes at once, you'll not know what is truly working and what is not. Too many variables.

I'm on my phone and can't see the images, though.
PaulaO2
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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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#5
Hi summersolstice,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy.
trish6hundred
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#6
Arrow 
Thanks
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#7
(07-16-2017, 02:24 PM)OpalRose Wrote: The first thing you need to do is work on the leaks.   Are you having trouble keeping the mask in place?  I also suspect you are mouth breathing.  Having alot of leaks leaves your AHI reading suspect.

I've had problems with the Swift FX nasal pillows. I can control the leaks much better if I keep the mask quite tight but it hurts my nose. The VA has offered to order me a full face mask but as a side sleeper with a full beard I have my doubts that it will work. I did order a cervical collar though.
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#8
I agree you need to control the leaks, and a cervical collar is a great way to do that, but let's talk about your therapy results a bit. You are currently using a range of 8-12 with no EPR (exhale pressure relief), and your machine generally goes to maximum pressure very quickly. What I am going to suggest is that you use the EPR setting, which will not only be more comfortable, but will help relieve the hypopnea events. Because the pressure will be reduced during exhale on every breath, the pressure will seem lower, but we still need enough pressure to prevent obstructive events.

My recommendation is to increase your minimum pressure to 9 and the maximum pressure to 15. Turn EPR on and set it to 3. This will result in pressures of 9/6 to 15/12. As you can see the pressure is not much different than what you experience now, even at the maximum setting. This should reduce hypopnea and still prevent obstructive events. I think you will find it relatively comfortable, but we won't know unless you try. As suggested, a soft cervical collar can prevent your airway from becoming obstructed, thus reducing the pressure invoked by the auto algorithm, and it should also help with leaks.
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#9
(07-16-2017, 09:47 PM)Sleeprider Wrote: I agree you need to control the leaks, and a cervical collar is a great way to do that, but let's talk about your therapy results a bit.  You are currently using a range of 8-12 with no EPR (exhale pressure relief), and your machine generally goes to maximum pressure very quickly.  What I am going to suggest is that you use the EPR setting, which will not only be more comfortable, but will help relieve the hypopnea events.  Because the pressure will be reduced during exhale on every breath, the pressure will seem lower, but we still need enough pressure to prevent obstructive events.  

My recommendation is to increase your minimum pressure to 9 and the maximum pressure to 15.  Turn EPR on and set it to 3.  This will result in pressures of 9/6 to 15/12.  As you can see the pressure is not much different than what you experience now, even at the maximum setting.  This should reduce hypopnea and still prevent obstructive events.  I think you will find it relatively comfortable, but we won't know unless you try.  As suggested, a soft cervical collar can prevent your airway from becoming obstructed, thus reducing the pressure invoked by the auto algorithm, and it should also help with leaks.

Thanks, I had no idea about the EPR, or what it did. I ordered the cervical collar from Amazon this afternoon and made the changes in the settings as you suggested.  Thanks
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#10
(07-16-2017, 10:18 PM)summersolstice Wrote:
(07-16-2017, 09:47 PM)Sleeprider Wrote: My recommendation is to increase your minimum pressure to 9 and the maximum pressure to 15.  Turn EPR on and set it to 3.  This will result in pressures of 9/6 to 15/12.  As you can see the pressure is not much different than what you experience now, even at the maximum setting.  This should reduce hypopnea and still prevent obstructive events.  I think you will find it relatively comfortable, but we won't know unless you try.  

Thanks for the advice. I not only found the new settings comfortable, but it appears to have worked. I'm still having issues with the nasal pillows and I've ordered some larger ones in the hope that they'll work better.

[url=[Image: screenshot-20170717-142326_zpsfijmpfqn.png]][Image: screenshot-20170717-142326_zpsfijmpfqn.png][/url]
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