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Last Night's Results---Newbie
#11
RE: Last Night's Results---Newbie
(03-24-2018, 01:39 PM)Ron AKA Wrote:
(03-24-2018, 01:21 PM)Sleeprider Wrote: The machine only goes as high as needed, except when the individual has persistent flow limitations or snores.  The reason I set a maximum limit is that an increase of 4-cm pressure is pretty conservative for your current 8-cm pressure, and should remain reasonably comfortable.  If you do have some issue that pushes pressure higher than that (if allowed by settings), then we should take a second look and see if the potential results are worth higher pressure.  I often find, higher pressure has diminishing returns.  Your results are pretty good, so I'm not looking for your pressure to go a lot higher.  I think a maximum of 12 should cover it, and perhaps the 10 you had in mind.

I am basing my suggestion for maximum pressure on my wife's results. She regularly goes over 19 cm (max is set at 20) and routinely gets AHI's under 1.0. I still haven't got my head around what the value would be of limiting pressure. I guess the test would be to look at when the apnea events occur in SleepyHead. If it is when the pressure is being limited, then it would seem there is a potential to reduce the number of events by letting the machine respond higher? But perhaps there is a comfort trade off between lower pressure or lower events...

Post an image.  The question is, does she need that pressure to prevent apnea and hypopnea, or does she have upper airway restrictions that cause flow limitations that cause the pressure to go so high.  Anyone routinely near 20 cm pressure should seriously consider BiPAP/VPAP therapy which would be more comfortable, and may be more effective at lower pressures with the help of pressure support.
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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#12
RE: Last Night's Results---Newbie
(03-24-2018, 02:25 PM)Sleeprider Wrote: Post an image.  The question is, does she need that pressure to prevent apnea and hypopnea, or does she have upper airway restrictions that cause flow limitations that cause the pressure to go so high.  Anyone routinely near 20 cm pressure should seriously consider BiPAP/VPAP therapy which would be more comfortable, and may be more effective at lower pressures with the help of pressure support.

Here is a night when her maximum pressure was 19.2 cm, there were zero CA events, and she got an AHI of 0.6 for the night.
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#13
RE: Last Night's Results---Newbie
(03-24-2018, 01:21 PM)Sleeprider Wrote: The machine only goes as high as needed, except when the individual has persistent flow limitations or snores.  The reason I set a maximum limit is that an increase of 4-cm pressure is pretty conservative for your current 8-cm pressure, and should remain reasonably comfortable.  If you do have some issue that pushes pressure higher than that (if allowed by settings), then we should take a second look and see if the potential results are worth higher pressure.  I often find, higher pressure has diminishing returns.  Your results are pretty good, so I'm not looking for your pressure to go a lot higher.  I think a maximum of 12 should cover it, and perhaps the 10 you had in mind.

Duly Noted Sleeprider.  Thanks!


*I'm following for the answer to Ron AKA's (wife's) circumstance... I'm just a curious newbie....  Carry on...
DreamBreather  Coffee
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#14
RE: Last Night's Results---Newbie
(03-24-2018, 03:30 PM)Ron AKA Wrote:
(03-24-2018, 02:25 PM)Sleeprider Wrote: Post an image.  The question is, does she need that pressure to prevent apnea and hypopnea, or does she have upper airway restrictions that cause flow limitations that cause the pressure to go so high.  Anyone routinely near 20 cm pressure should seriously consider BiPAP/VPAP therapy which would be more comfortable, and may be more effective at lower pressures with the help of pressure support.

Here is a night when her maximum pressure was 19.2 cm, there were zero CA events, and she got an AHI of 0.6 for the night.

Based on this, I would set the maximum to 16.  I don't think you will see additional events, but the machine is really responding fast to some snores and flow limitations.  For most of us, it is disruptive to sleep when pressure changes to much or too fast.  The machine really spiked pressure at 00:50 in response to a strong snore and OA. The resulting pressure did not appear to help anything.  I'm pretty confident that a maximum pressure of 16 will be more comfortable and not significantly increase events.  

Equally important, the minimum pressure of 6.0 is a problem that leads to some strong snores and rapid increases in pressure. At 05:00 pressure dropped near the minimum and flow limitations and snoring increased sharply driving a big pressure increase of nearly 10 cm.  That would wake most people up.  A minimum pressure of 8.0 looks like it may stop that kind of event and rapid increase.   Normally most members find they do best when pressure is allow to fluctuate within a more narrow range.  6 to 20 is too much in this case, and 8 to 16 is still on the high side.  A good night on an optimized auto CPAP or Bilevel, the pressure won't change more than about 4-cm.

The AHI in this case is excellent! If she is well rested and comfortable, all is good, but if she is feeling unrested or like she didn't sleep well, the fast, wide pressure fluctuations will be the culprit.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#15
RE: Last Night's Results---Newbie
SleepRider, your comments are helpful. Since the time of that evening I have been slowly adjusting up the start pressure, minimum pressure, and reducing ramp time. After getting that right I will look at reducing max pressure too. 

DreamBreather, hopefully this discussion is also helpful to you. My only point about starting with a high (20) max pressure is to see what pressure the machine wants to use. After that you can obviously reduce it. My thoughts are if you reduce it right out of the gate, you will not see that information in SleepyHead. But, I guess you could look for events occurring when the pressure is being limited... Although it is a bit on the technical side, I have found this link useful too.

http://www.apneaboard.com/wiki/index.php...ng_therapy
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#16
RE: Last Night's Results---Newbie
Thanks  all info is much appreciated!!
DreamBreather  Coffee
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#17
RE: Last Night's Results---Newbie
We know the machines tend to over-react if minimum pressure is too low. As you find an optimal minimum pressure, the maximum and 95% pressure will come down. The advantage, and disadvantage of the Resmed Autoset is how fast it responds to indicators of obstruction. When starting out, the machine moves fast enough to prevent most events, but it can be too abrupt or move too far. As you optimize minimum pressure, the maximum will matter less. Keep us posted on how it goes, but I don't think she will need or want pressures over 16 cm. Smile
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#18
RE: Last Night's Results---Newbie
Uhhhhmmm...

Speaking of Snores....  I took a 2 hour nap today and I snored more than I did last night in 7 hours...  Too-funny

Now, I had moved my min and max to 8 and 15 (while we all discussed 12 vs 20)... &, the pressure stayed at 9.50 for 95% of the time.

But why so much snoring??  Was I just dog tired?  Or will this require another look at the pressure settings?

I know it was just a 2 hour nap... maybe we should see how tonight goes?  However, it will include the 'nap' data (same 24 hr period).

The good, no AHI's... You were so right Sleeprider, my body needed/wanted more pressure... I think 10 would be cutting it too close for max pressure...

Here are the 2 screenshots from my nap... Let me know what you think... (Please and Thank You)
DreamBreather  Coffee
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#19
RE: Last Night's Results---Newbie
How did you full nights sleep go? Anymore screenshots to include?

As for the Snore VS2 readings I would not be too concerned about them. Here is a link that goes into great detail about this measure. I would suggest the reader's digest version is that in Auto mode your Dreamstation ignores them. And in any case nobody seems to know exactly what the relative magnitude of them means. One of the dirty tricks that computers often do to us is auto scale numbers on a graph. Those could be very low numbers that are just looking high due to the scale used. 

Much suggestion would be to leave the settings where they are for now, until you gather more data. If you lower max pressure down close to min pressure you are in effect converting your machine back to a single pressure CPAP. At some point when you have more data, it may make sense to lower the max pressure to limit pressure excursions.
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#20
RE: Last Night's Results---Newbie
I tend to tell people to turn off the VS2 graph in Sleepyhead. The machine does not change pressure on VS2 but does on VS. I have see graphs filled with VS2 and it's difficult to say whether it is something going on with the sleeper, or interference or noise in the room or even the hose dragging on furniture. Anyway, it is of very little consequence unless you learn you're keeping yourself or someone else awake. Turn of VS2, be happy with 0.00. Fantastic!
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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