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Here is what a Sleep Tech Supervisor told me about my recent sleep study
#1
Exclaimation 
Here is what a Sleep Tech Supervisor told me about my recent sleep study
I had a sleep study last week. I just got the results. The Sleep Tech Supervisor called me to discuss the doctor's suggestions and findings. I talked to them for a long time and not sure what to think or believe at this point. I've been having OA's when my machine pegs out at 15 or 16, and now they want to lower my starting pressure to 4, and maximum pressure to 14, and also change PS3 to PS4.

My previous sleep study showed the most appropriate pressure was 14/10 and titrated to 16/12. So why on earth is it lower now?
Maybe due to me wearing my dental appliance?

Here is what they told me:
1. I slept for 5 hours with 1 OA, at pressure of EPAP 5, IPAP 9, PS 4, and that pressure seemed most appropriate for me.
2. My oxygen level at that pressure was around 91% at the lowest.
3. They are lowering my settings, and told me it could be my fault that by increasing my own settings, I am causing more OA's to happen.
4. They said that all BIPAP/BI-LEVEL machines should usually have PS4, and that me using a PS3 could be causing more issues. They claimed there was no reason to use PS 3 or lower, at least for me. They did say that people with COPD though or breathing issues could use PS 5 or PS 6.
5. They are lowering my settings to start at EPAP 4, IPAP 8, PS 4.
6. They claim I am not at my PRESCRIPTION settings, and this is causing the issue.
7. They said even though I slept 5 hours, they only really need 2 hours to make and adjust settings and determine optimal pressures.
8. I mentioned about maybe tucking my neck and positional may be causing apnea's, but they had no answer for that.

I don't see how LOWERING my pressure, and increasing PS to 4, will help me? I have never heard of decreasing pressure, and increasing PS to help with OA's. As you can see from this particular night back on Oct 9th, I had a lot of OA's in a row. My machine was pegged at IPAP Max 15. This particular night my heart went into ventricular bigeminy(double beats) and I called 911 due to feeling like I was going to pass out. Almost every week, I have at least one night where I have run's of OA's like this. Other nights are okay and my AHI < 2 usually.

When I had lower settings of PS 4 in the past, that caused me to have more CA's. Plus it felt like the pressure got too low when breathing out. Having starting EPAP 4, also seems low and like I can't get enough air. The tech said just to breathe deeper. The issue with lower pressures in the past, was that my oxygen levels would dip to the low 80's, same as what happens when I have OA's.

They told me to try these settings for two weeks. If I start sleeping bad again tonight, or my oxygen level dips low, I'm not sure what to do. 




[Image: GN33DGg.png]
[Image: uWVXxtv.png]
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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#2
RE: Here is what a Sleep Tech Supervisor told me about my recent sleep study
Did you get anything in writing?
Or, just a phone call...
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#3
RE: Here is what a Sleep Tech Supervisor told me about my recent sleep study
(10-15-2018, 07:00 PM)silentsnore Wrote: Did you get anything in writing?
Or, just a phone call...

Just a phone call so far. Didn't think about asking for paperwork. I will call them back tomorrow to ask for paper.
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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#4
RE: Here is what a Sleep Tech Supervisor told me about my recent sleep study
You stated

Quote:I don't see how LOWERING my pressure, and increasing PS to 4, will help me? 
I do not have your condition but my Rx was for CPAP at 19cmw,  No data until I bought an Auto CPAP on my dime which I used between May 2009 and Dec 2016.  During 2015/16 I was getting tired and I had a leak problem, and was frequently getting AHI of 10-15 AHI with a steady APAP pressure of 19 cmw so I sought help from a sleep doctor, not having a record of my original sleep study I had another without a CPAP, supposedly a split study with BiLevel Titration, I only slept for about 45 minutes because I stopped breathing over once a minute.  I went back for the BiLevel Titration and was given a ResMed VAuto.

Anyway eventually I got my leak managed (Taped then tongue technique over several months) Since my AHI was really low looked at lowering my pressures which results in typical AHI being well under .5 AHI.  My machine is currently set at 9-25 PS 4. Note that my EPAP rarely reaches 10. I easily tolerate high pressures and my pressure is very stable so I have no reason to limit it.

Point is SOME people can get better results at lower pressures.
Fred Bonjour - 1 Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

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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
RE: Here is what a Sleep Tech Supervisor told me about my recent sleep study
Thanks Bonjour. I guess I'll see how it goes tonight and for this week. I'm going to monitor my SpO2 as well. If I start feeling worse and see higher OA's, I told them I would be letting them know. Because they don't ever download the machine, unless during an appointment.
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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#6
RE: Here is what a Sleep Tech Supervisor told me about my recent sleep study
Please post your daily charts so we can help you where we can.  We should at least be able to help you formulate questions, with data to back them up, to ask your medical team.
Fred Bonjour - 1 Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download SleepyHead
Organize Charts
Attaching Charts

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: Here is what a Sleep Tech Supervisor told me about my recent sleep study
(10-15-2018, 10:38 PM)bonjour Wrote: Please post your daily charts so we can help you where we can.  We should at least be able to help you formulate questions, with data to back them up, to ask your medical team.

When you mean Daily Chart, you mean like the charts above, but for every day of the week? Or just the Overview chart? I've already sent detailed charts to my sleep doctor office. He has supposedly reviewed my bad days. But then he downloads the last 30 days, and says overall I'm fine.
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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#8
RE: Here is what a Sleep Tech Supervisor told me about my recent sleep study
Yes, like the charts above.  The summaries actually tell us little that the daily charts do not tell us.  Not every day, just to cover changes and any issues that you have.  The sequence above I have not seen and I am not sure what it means.

I would, at least for the short term follow the settings suggested, and any time you have issues post the daily charts then send your medical team questions and copies of the charts highlighting the issues.  

Often not noted is how do you feel? This is VERY Important.  Statements like "Plus it felt like the pressure got too low when breathing out".
That doesn't sound right,  Low EPAP will make it easier to exhale,  Your IPAP (= EPAP + PS which starts at 8 = 4 + 4) is generally too low at 4.  This could indicate issues with the changing from Inhalation to exhalation.  This is controlled by two additional parameters Triggering and cycling and TiControl - Inspiratory time control, but let's get the base level started before thinking of changing these.

Do you have a copy of the Clinical manual for the VAuto which describes all the settings?  
Fred Bonjour - 1 Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download SleepyHead
Organize Charts
Attaching Charts

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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#9
RE: Here is what a Sleep Tech Supervisor told me about my recent sleep study
I dont have the clinical manual, but can find it. I think It's online. So the starting pressure 4 you say is too low. EPAP 4, IPAP 8, PS 4. It felt low last night. Especially when I was trying to get to sleep. I wanted to rip the mask off since it felt like i wasn't getting enough air. It was causing some minor panic attacks in me before I went to sleep. But I eventually fell asleep. And guess what...this was one of my best nights and i feel great this morning so far.

I'm not sure why it doesn't show the EPAP line when at 4? It always showed it when set to 5 or 6. Do you think PS 4 is still too much? In the past I would get a lot of CA's which is why i had changed it to 3. Plus it felt better to breathe at 3 since im a shallow breather. But last night was good. Weird.

[Image: sqwPKUx.png]
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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#10
RE: Here is what a Sleep Tech Supervisor told me about my recent sleep study
No! 4 is too low for CPAP  This is BiPAP and your starting is really 8
On CPAP this would be Range 8-14 with EPR = 4 (CPAP cannot do this as max EPR is 3) PS of 4 working for you is a criteria for justifying the higher level BiPAP/BiLevel ResMed VAuto machine because a CPAP cannot do that.

I would stick with your current settings for a few days at least to make sure the results are not a fluke.
Take a look across your flow chart with a zoom view for stuff that doesn't approximate a sine wave, to see if you are having any issue or consistent patterns that deviate.  If you see any Post them here.

Your numbers are awesome, without showing anything else it is likely your doctors will declare you a success.  We definitely want to keep an eye on the CA events as if they increase you will likely need an even more advanced and more expensive machine such as the ResMed Aircurve ASV.  CA events are generally increased with added or fluctuating pressures though they can sometimes disappear after 1 to 3 months of PAP usage.

BTW your settings are 4 - 15 PS 4 they were not changed.

For the manual look at the top banner for the CPAP setup manuals,  You will have to send an email per the last section.  In a non-automated process, you will receive info to get the manual.
Fred Bonjour - 1 Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download SleepyHead
Organize Charts
Attaching Charts

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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