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JasonR newbie... looking for advice!
#1
JasonR newbie... looking for advice!
Hi All! I've been using a trial DreamStation Auto CPAP with the Wisp nasal mask for 2 weeks now and am still getting used to it. I found this forum not long after being diagnosed with OSA. It's amazing reading some of the people's stories and how much you all have helped them. I'm hoping you won't mind taking a look at my charts and giving me some pointers. I'm not getting the great nights sleep I thought I would be! haha... baby steps I know!

   

   

   

Thanks

JasonR
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#2
RE: JasonR newbie... looking for advice!
Welcome to the board!  There are a lot of very smart people here that will help you.  

The main problem you have is positional apnea. Positional apnea is when you get into a position where you cut off your own airway. NO CPAP MACHINE can help this, you have to find out why your airway was cut off and not allow it to continue. If you sleep on your back stop. It is a major cause but not the only one. Your pillow may be to high and causing it. 

Anytime your chin is down to your  Sternum you are “chin tucking “ and cutting off your airway. If neither the sleep position or pillow are the problem then you may need to wear a collar. See the link to collars at the bottom of the post. In it there are charts showing people chin tucking - without collars and the same people with collars. 

You can spot positional apnea in the “O” or “H” row.  When it is clustered together shows positional apnea.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: JasonR newbie... looking for advice!
Your other major event are centrals- I think you can help those by decreasing flew to 1. Centrals can not be helped with a simple clap machine but we can try to avoid them.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: JasonR newbie... looking for advice!
I agree that you are experiencing positional apnea. Your chart also shows a lot of clear airway events that may be central apnea. CA increase with pressure variation. I suggest you narrow your range or run at a fixed pressure and see what happens. Your minimum pressure is too low. I suggest you change it to 7.
Be sure to read the article on positional apnea    http://www.apneaboard.com/wiki/index.php...onal_Apnea and the article on soft cervical collars (link below).

You mentioned a trial. Is it possible get a Resmed Airsense 10 Autoset? The Resmed machine provides better therapy than the dreamstation for most. The Resmed auto algorithms are sensitive to flow limitation, hypopnea and snores so the machine increases pressure quickly before an obstructive apnea occurs.  By comparison, the Dreamstation is much slower to increase pressure, and tends to reduce pressure too quickly, allowing many more obstructive apnea and hypopnea to occur.
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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: JasonR newbie... looking for advice!
Hello Jason, This is advice of a more general nature. The path to successful CPAP therapy is often long and tortured. People often have to solve several problems along the way, and it takes time and persistence. Don't give up! Keep working at it and asking questions.
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#6
RE: JasonR newbie... looking for advice!
I agree with the above advise, and particularly, that you will need higher minimum pressure. The Philips Dreamstation Auto CPAP is simply not suited to such low pressure settings because it will not increase pressure fast enough, or keep it once it finds the best pressure. You will ultimately need 7 or 8 cm minimum pressure. Your Flex level is at 3. You need to turn that down to 1 or 2 and that will help the centrals. Flex attempts to time the pressure changes for inspiration and expiration, and A-Flex at 3 can simply get out of sync with your needs. So increase minimum pressure and decrease the Flex setting. At that point if we still see obstructive events in clusters, we will consider positional aids.
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: JasonR newbie... looking for advice!
Thank you everyone for the suggestions!

I have the trial machine for about 3 months and then I must choose my permanent machine. Given the feedback here, the ResMed AirSense 10 Autoset makes the most sense.

I'll tweak my settings and report back in a few weeks.
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#8
RE: JasonR newbie... looking for advice!
Just thought I would give a quick update of the past 3-weeks. On the DreamStation, I lowered the Flex to 2 and it made a huge difference with my AHI. After a few days, I lowered it to 1 and was averaging 6 AHI - good but not great.

Last week, I contacted my DME to see if I could switch to a ResMed Autoset 10 for the trial and they agreed. They actually had a For Her version in stock. The fist night I had a "rain out" due to the humidity being set to 8 instead of auto (oops!). I also turned off the ramp after the first night. Other than that, my AHI is averaging 0.49 with this machine! I'm amazed at what a difference it has made! To be honest, I'm kind of questioning how simply changing to this machine could make such a huge difference! but I'll take it!

Sleep-well

   

   

   

Thanks
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#9
RE: JasonR newbie... looking for advice!
OK yes, that change just because of swapping the DreamStation to ResMed is real. I've seen it almost every time that the swap takes place. Alright this is much better, but I see one area we can go from great to excellent.

Edit your Min pressure from 4 to 7 so that you realize the power of EPR 3. It's a math thing. The AutoSet FH or standard AutoSet is the same on this. Min pressure minus EPR number equals x. In my suggested 7 minus EPR 3 gives the AutoSet minimum 4. This works according to the math. Your current setup is this Min pressure of 4 minus EPR 3 equals 4 because the PAP can't go below the lowest physical pressure of 4.

So recap, only one change, bump the pressure of 4 to 7. Relax. Now you can feel EPR 3 actually work.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: JasonR newbie... looking for advice!
I'll add that setting the min pressure to 7 will also reduce your pressure fluctuations.

The flow limit chart is missing. On it you will see that your pressure increases when flow limits show there. Yours are very good.
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