Looking for help in refining settings

[TBrobbs]

Last night I put the pressure at 12, and used the cervical collar for much of the night. My events were 4.8, which is low for me and corrects the upward curve from the previous couple of nights. I did wake up with a massive headache from the collar again so I might have to try another brand, or maybe it’s just a matter of adjusting to it. I’m really encouraged. 

Sleeprider, I’ve attached a zoomed-in image of my Feb. 16 night. Subject to anything you might see on the zoomed in version, I’ll try switching back to Autoset with your suggested settings tonight and see how it goes. A question on that though: if I have trouble adjusting to the EPR of 3 initially, would I need to adjust the maximum pressure downward as well as the EPR (e.g., 12/14/2). Maybe it won’t be a problem though if I keep the ramp at 8 which feels really comfortable while I’m settling down for the night. 


Big thanks to all of you for your input.

Edited to add that last night my 02 levels were about the best they’ve been since I got the 02 ring three weeks ago. One drop below 4% compared to the previous night of 35 drops.

[BoxcarPete]

Keep in mind that your EPAP is reduced by EPR. So the pressure breathing in is whatever the machine says it is, and your pressure breathing out is that much minus the EPR setting. This is different from the way bilevel machines work.

For you, I think keeping pressure at 12 is fine, but Sleeprider's suggestion to change to auto mode and allow pressures up to 15 is a good one.

[TBrobbs]

Thanks, BoxcarPete. I was aware of the EPR but didn’t know how it differs from a bipap machine. I will try SleepRider’s suggested settings tonight and see how it goes.

I just read the positional info in the link SleepRider sent me. Definitely lots of improvement I can make to my sleeping position, especially with pillows. I’m sleeping with my head way too high by the sounds of it. I’ll play with that tonight too.

[TechieHippie]

You may have to wear the collar even a tad looser than you might think. I've taken to adjusting mine after I lay down to get it just right. Otherwise it feels nice and loose when I am standing but then I have next pain when I wake.

[Sleeprider]

This is a pretty good example of clustered obstructive positional apnea, where the airway is open enough for the FOT algorithm to determine an open airway, but very little air is moving.  Both sides of the apnea are clearly affected by inspiratory flow limitation, and the near-apnea at 02:06 is clearly obstructive.  The ability of a CPAP to detect central events is something they are generally pretty good at, but this is the exception.  I suspect we would see this pattern even more clearly in the CSR flag at 06:10. The forced oscillation technique (FOT) sounding is simplistic and effective in determining if an airway is open of obstructed, but it seems to be commonly fooled by a semi-closed airway from flow limitation and incomplete positional apnea. I have seen a number of examples from members posting charts, where very strong inspiratory effort continues to move air at very high resistance levels, which is why zoomed images like this are so valuable to evaluate is clusters of centrals or even flagged CSR is central or obstructive. Resmed might improve their detection algorithm if it took into account antecedent or post-event flow limitation. Until it does, this is how we do it.

[TBrobbs]

Sleeprider, thanks for that analysis and explanation. I still have soooo much to learn, but these responses are great to guide me. I’ve changed my machine’s settings to those you suggested and will try them out for a few nights, see how it goes and report back, most likely on the weekend. 

TechieHippie, I started out without even doing the cervical collar up, then when I did, probably had it on too tight for when I’m actually sleeping. I’ll try your suggestion of doing it when I’m lying down.

Thanks all, this is an incredible site. I’d been lurking for a while but sure am glad I posted.

Cheers.

[TBrobbs]

Hi, 
Last night I made adjustments based on all the feedback and on the info re positional apnea. Used the cervical collar, went from several pillows to two small ones (I’ll probably drop one eventually), and changed the settings per Sleeprider’s suggestion.

I figured it would take a few nights to adjust to the changes and to see results, but I slept reasonably well and had the best results since I’ve been on therapy. Events at 1.4 p.h. I’ve attached the info. 

Woo hoo, I slept!! And feel rested. Thanks so much to all who helped me get this result.

[TechieHippie]

If you are able to, you might reduce your ramp time. (Unless Sleeprider says otherwise of course) Remember that you have ramp even in middle of night. While I'm adjusting to pressure increases, I have a (short 5-10 minute ramp because of that and I keep the lower end of the ramp pretty close to my starting pressure. If I need more ramp time getting to sleep I just stop and restart the machine, then I relax and focus on slow even breathing.

[TBrobbs]

That makes a lot of sense. I often go the night without interruptions but adjusting to new settings I’m much more restless. I’ll adjust it down to 5 or 10 minutes as you suggested. Thank you!

[Sleeprider]

Good call by TechieHippie. An alternative in ramp is a setting called auto. It trys to detect sleep breathing and automatically resumes set pressure. If you need ramp to avoid disruption during sleep onset, that's the one to use.