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Looking for some help - almost 5 years and not feeling a lot better
RE: Looking for some help - almost 5 years and not feeling a lot better
I don't see why you couldn't plug in the PS you've been using. Just changing to S Mode should be OK then.
Dave

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RE: Looking for some help - almost 5 years and not feeling a lot better
EPAPmin = 8.4, PS=3.6, IPAPmax = 12 - You are correct sir! You could even make it EPAP=8 PS=3.6 and IPAP max =11.6. I don't think .4 cm one way or another is a big deal at this point.
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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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RE: Looking for some help - almost 5 years and not feeling a lot better
(10-27-2020, 07:53 PM)Crimson Nape Wrote: EPAPmin = 8.4, PS=3.6, IPAPmax = 12  - You are correct sir!  You could even make it EPAP=8 PS=3.6 and IPAP max =11.6.  I don't think .4 cm one way or another is a big deal at this point.

Excellent!  Eventually it sinks in...  I will do that tonight.  Matter of fact I will do it now.  Thanks!
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RE: Looking for some help - almost 5 years and not feeling a lot better
You are becoming an expert.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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RE: Looking for some help - almost 5 years and not feeling a lot better
(10-27-2020, 10:49 PM)bonjour Wrote: You are becoming an expert.
Wish that were so...  But thank you!

Well last night was better.  Today, I woke up with a headache, which doesn't sound (or feel) good, but it's not pounding.  And even better than that, I feel less of a weariness, and the cognitive fog is much, much less this morning.  

Had a leg cramp about 5:30am, gee those are painful!  That woke me up, remember grabbing my leg to try to massage it, but I was able to return to sleep.  Strange, it did not register as any apnea event, however, the flow rate is quite strange, but it was an arousal for about 2 minutes.  Found the event both on OSCAR and on video.

I'm going to leave the settings as is for a few days.  Does that make sense?  If you think my plan is not sensible, please let me know what you recommend.  I'm the apprentice here.

It's improving a bit, and that gives me some hope.  Thanks everyone for both holding my hand and the expert guidance.  There's a way to go yet, but at least there's forward motion, and for that I am grateful.
   
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RE: Looking for some help - almost 5 years and not feeling a lot better
happydreams,
I couldn't remember if the Trigger setting was discussed. Is your Trigger setting on Medium or High?
OpalRose
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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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RE: Looking for some help - almost 5 years and not feeling a lot better
Two things that I see that can be a cause of your headaches.  1. Your Tidal Volume appears very low.  2. You're experiencing flow limitations.  Combine both and this can be the problem.  Also, this can reduce your O2 saturation levels.

There is a procedure with a CPAP called, Positive End-Expiratory Pressure ("PEEP").  PEEP maintains the patient's airway pressure above the atmospheric level by exerting pressure that opposes passive emptying of the lung. The purpose of PEEP is to increase the volume of gas remaining in the lungs at the end of expiration in order to decrease the shunting of blood through the lungs and improve gas exchange.  In normal words, it helps maintain a better SpO2 level.

To try using PEEP, you will need to move your entire pressure range upward.  I'm not aware of any math formula to calculate where to start but, based off of my usage of this procedure, I would recommend that your settings me moved to, EPAP = 11cm  IPAP = 14.6  PS = 3.6.  (I sure wish you would move this up to 4cm to make the math a little easier!)

Also, just let you know, you will at some point have to increase your PS to eliminate the remaining flow limits.

Finally, Do you have an oximeter?  Because of your headaches, I'm curious about your SpO2 levels.  Please don't rush out and by one because I asked.

Your thoughts?
Crimson Nape
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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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RE: Looking for some help - almost 5 years and not feeling a lot better
Go two days with current settings, longer is ok, then note how you feel. Take notes, here is a good place to leave them,
then
Set Trigger Sensitivity to high, same deal, Go two days with these settings, longer is ok, then note how you feel. Take notes
then
then
Set Trigger Sensitivity to Very high, same deal, Go two days with these settings, longer is ok, then note how you feel. Take notes

Determine which settings feel best, Medium, High, or Very High Trigger Sensitivity. mostly on how you feel. a little by by CAI,
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
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RE: Looking for some help - almost 5 years and not feeling a lot better
Thanks for everyone's observations.  They have been helpful.

OpalRose and bonjour, my current Trig setting is High.  It has been High for several days now.  It is much more comfortable than Medium.  I tried Very High for 3 minutes and found it almost distressing and un-natural.  I returned the machine to Trig = High.  The fiddling with settings was done at night, (after a wake up due to a CA) not under the best of circumstances, so I could see trying a change.

I seem to have low tidal volume.  Perhaps due to COPD.  I use Pulmicort to control the COPD.  

In 2015, measured on a Respironics 560, my tidal volume was 
13.33/320/480/1460  min/med/95%/max

Last night, measured on a ResMed AirCurve 10 VAuto my tidal volume was
0/340/460/700          min/med/95%/max

It doesn't seem that different, especially considering they are totally different machines!  I just took a random date from the beginning of data therapy for my 2015 example.  But it seems, over the years, that the median TV is in the 300-340 range.  

Crimson Nape, sorry about the PS=3.6!  Round numbers are nicer.  PEEP is an interesting idea.  Willing to try moving the therapy pressure range upward.  I am, however, going to stay at my current settings for a day or two.  Today has been so much better for me, despite the low headache.  After the two days I will try the experiment.  I do appreciate that PS needs to rise to combat flow limit.  (Learning so much here on AB!)  Trying to let my body adjust to various settings before changing.  

Every time I have measured my SPO2, including overnight sessions, my SPO2 has been good.  My last session in 2019 was Avg: 94.3, min: 89, %time in SPO2 drop 1.48%.  Static test awake is in the mid upper 90's.  I'd measure it again, but my CMS50F display has dimmed so far I can't read the display enough to control it.  They are only guaranteed a year.  Mine is 5 years old.  The battery is fine.  I actually took mine apart and measured some things.  Since there's no schematic available I can't really determine what's wrong, save for a dim display.  Haven't found any Youtube videos on repairing the thing.  Oh, I put it together again, and it's just as dim as before.  Just turned the CMS50F on again, and measured my rest SPO2, it was 97/98.  The green trace was invisible.  Can't see any blue either.  It was barely possible to read the menu, I had a hard time turning it off.  I'd get another unit, but have little confidence that the display wouldn't die in the future.  Wish there was a longer lasting instrument that was data friendly and inexpensive.  But I'm veering off topic.  

bonjour, I'm thinking about how to try your recommendations and Crimson Nape's, but am unsure as how I would do this.  Trying to keep the experiment as simple as possible to minimize variables.  I've partially tried varying Trig setting already, but under strange conditions.  If you think it's still worthwhile, I'll try it under a more formal sense.  Please advise.
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RE: Looking for some help - almost 5 years and not feeling a lot better
I have both a CMS-50 F and I and experienced the same degradation of the display on both. I am now using a Wellue SleepU and loving it. Many here use the O2 Ring model that, like its name, is a ring design and no wrist device. It is more expensive than the CMS-50 series but seems to be worth it. If you are entertaining the thought of getting one, look in the Commercial Forum for a discount coupon.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Beginner's Guide to Sleepyhead and OSCAR
Apnea Helpful Tips

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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