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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
Wait a week or two then try Trigger sensitivity Very High again, a very short trial is good, just to see if you have adjusted and if it is better. I do not have a feeling it will be better,
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
(10-28-2020, 10:19 AM)Crimson Nape Wrote: 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.
Thanks for both confirming my observation and the recommendation.  I've been entertaining the notion for quite a while.  Even visited the Commercial Forum a few weeks ago.  Probably end up getting one although I'm not sure which.  

If you don't mind this slight OT conversation, how is the finger cuff on the SleepU?  Does it stay on?  For some odd reason the silicone sleeve of the CMS50F never bothered me.  Is the display decent?  As in as compared to a hobbyist cheapo display or more like say an  iPhone?  For me, even a black and white OLED display with contrast would have been good enough, as long as it was readable!

The relatively short life of the CMS50F left a sour taste in my mouth.  But then again it did last 4.5 years.  It did have some usefulness.
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RE: Looking for some help - almost 5 years and not feeling a lot better
The SleepU doesn't use the pouch type of finger probe that locates on the end of your finger.  Instead, it uses a horseshoe style design, like a clamp used to retain a florescent bulb, and attaches between the knuckle and first joint of a finger or thumb.  It has a small LED that initially displays the time then your SpO2 level and pulse.  This display shuts off until you rock your wrist to activate it.   It is bright enough that I can use it as a nightlight when I need to get up for any reason.  It also has less clock drift than my CPAP.  (I digress)  I'm unaware of any negative reports about this brand.

On another note;  As others have stated, start preparing your self to get use to the Very High Trigger setting.  Trust me on this.  Big Grin
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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RE: Looking for some help - almost 5 years and not feeling a lot better
(10-28-2020, 11:14 AM)Crimson Nape Wrote: The SleepU doesn't use the pouch type of finger probe that locates on the end of your finger.  Instead, it is designed like a clamp used to retain a florescent bulb and attached between the knuckle and first joint of a finger or thumb.  It has a small LED that initially displays the time then your SpO2 level and pulse.  This display shuts off until you rock your wrist to activate it.   It is bright enough that I can use it as a nightlight when I need to get up for any reason.  It also has less clock drift than my CPAP.  (I digress)  I'm unaware of any negative reports about this brand.

On another note;  As others have stated, start preparing your self to get use to the Very High Trigger setting.  Trust me on this.  Big Grin
Thanks for the feedback on the SleepU.  Definitely will check it out.  Hadn't wanted to spend the money, but guess I won't spend money on something else (that I probably don't really need).  Is the OSCAR integration good?

So noted on the Trigger setting.  I had played with that setting in possibly the worst of circumstances.  When the body settles, I'll try it again.  There are a lot of people saying the same thing, so there seems to be merit in giving it a try.  The worst that can happen is that it's not tolerated well and I change it back.  The best that can happen is it helps and works.  Thinking-about Sounds like a no brainer to me.  Even I can try it!

I'm into the afternoon now, and the headache is only very slight.  Seem to be more alert and functional.  I'm calling this an improvement.   Smile 
Finally, some progress.  Makes me happy.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Had a better night's sleep.  Body seems to be adapting some more.  Still woke up with some dull headache across the forehead, but I am a lot more clear headed than even yesterday.  Almost chirpy.  My spouse said to me at dinner time, you are feeling better, aren't you?  So there are outward signs as well.  Most encouraging.   like  Starting to see some evidence of elevated respiration rate and possible deeper sleep.  My original sleep study noted the poor REM percentages I had, significantly lower than normal.  

The plan is to do this at least one more night to hopefully cement the trend.  I'm aware a single night does not make for a trend, but the last 5 days have gone in the right direction.  Thank you all for your encouragement and guidance.  There's a lot further to go, but it's getting better, noticeably better.  If it keeps up, I'll be  Dancing!

   
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RE: Looking for some help - almost 5 years and not feeling a lot better
Looking better!  The CA's are diminishing.  You can go on and change your settings.  Let's try to reduce those headaches.  I am listing both a Vauto setting and the S setting counterpart.

Vauto:
  • EPAP: 10
  • IPAP max: 14
  • PS: 4
  • TiMax: 2.4 (at least)

S Mode:
  • EPAP: 10
  • IPAP: 14
  • TiMax: 2.4 (at least)
  • Easy-Breathe: ON (S Mode Only Option)
    Description: The Easy-Breathe waveform intelligently recreates a patient’s individual breathing pattern, so
    breathing feels more natural and therapy is more comfortable.

I think you know the how's and why's about the pressures now. The TiMax is the maximum length of time the A10 will maintain the IPAP pressure.  I want it longer encase it isn't allowing enough inhaled air for you.  The Easy-Breathe is one slick algorithm!  Breathing is so natural that, without hearing the air pump, I usually can't tell if the A10 is on.
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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RE: Looking for some help - almost 5 years and not feeling a lot better
Ok.  I had to read what you wrote 3 times, and then the manual a few times to get it to sink in.  Sorry I have to go over this, guess it's a personal learning style, I'm not questioning your judgement.  More of a test to see if I understand everything.  As I see it, there's several changes. 
 
The first is the pressure translation or PEEP.  Current settings are EPAP=8.4/IPAP=12.  Your recommendation is to E/I = 10/14. This is to reduce flow limiting, as I understand.  Also, we are continuing to run as non-adaptive bi-level with constant pressures for the individual E and I settings.

The second is a small change in PS from 3.6 to 4, which follows from the first.  

The third is a change in Ti_max from 2.0 to 2.4.  This allows a longer inspiration phase, which should better oxygenate me.  If it matters, I picked a random time from last evening (between events!) to measure I/E and it was 1.23.  Inspiry time was 1.345 seconds during median respiration.  During arousal, inspiry time was pretty close to 2 seconds.  Seems like a pretty benign change, with upside.

Unchanged is Ti_min=0.3, Trigger=High and Cycle=Mid.

Is my rudimentary understanding correct?

So far everything you have said to try is working and I am improving.  And I will say it again, thank you so much for your guidance!  

If there are no objections, I'll try this tonight and report back.  In the meantime, I'm going to have a much improved day!  Smile
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RE: Looking for some help - almost 5 years and not feeling a lot better
The difference between EPAP and IPAP (PS) is to address flow limitations.  Raising the overall pressure envelope is to start implementing PEEP.  This increased pressure forces your lungs to be more oxygenated or saturated.  Envision being pressure marinated. Big Grin  Also, this should increase your tidal volume. . . a good thing!  The TiMax (number of seconds) adjustment was a cautionary thought to make sure your inhalation time is long enough.  If this value is too low, the inhale pressure can drop before the patient is still inhaling.  This can cause arousals or apneas, as well as, reduced tidal volume.  Increasing the pressure range may cause you to inhale more deeply or longer. If you experience a pressure drop while inhaling, just increase this value.
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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RE: Looking for some help - almost 5 years and not feeling a lot better
(10-29-2020, 10:19 AM)Crimson Nape Wrote: The difference between EPAP and IPAP (PS) is to address flow limitations.  Raising the overall pressure envelope is to start implementing PEEP.  This increased pressure forces your lungs to be more oxygenated or saturated.  Envision being pressure marinated. Big Grin  Also, this should increase your tidal volume. . . a good thing!  The TiMax (number of seconds) adjustment was a cautionary thought to make sure your inhalation time is long enough.  If this value is too low, the inhale pressure can drop before the patient is still inhaling.  This can cause arousals or apneas, as well as, reduced tidal volume.  Increasing the pressure range may cause you to inhale more deeply or longer.   If you experience a pressure drop while inhaling, just increase this value.

Thanks for the detailed explanation!  Understand all but the last sentence.  If you experience a pressure drop while inhaling, just increase this value.

Should this pressure drop happen, what parameter's value should I increase?  Rereading again... Did you mean Ti_max, in the case of pressure drop while inhaling?  Thank you so much!
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RE: Looking for some help - almost 5 years and not feeling a lot better
He is describing the potential need to extend the inhale time, thus increase Ti Max
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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