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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
Thanks.  
My current settings are: PS=3.2 over 8.4-13.  Trig=High, TiMin = 0.7 (was 0.3), TiMax = 2.4, Cycle = Med. 

So the recommendation is to only set Cycle = Low.  This should extend (increase) inspiration time.  That will tend to make my I/E closer to 1, right?  Is that the intent?
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RE: Looking for some help - almost 5 years and not feeling a lot better
Without talking settings at all for a second. Shouldn't the flow rate have a bit more time at the exhale? Maybe it doesn't mean anything, but the pattern seems to me as too quick in the negative exhale area and a quick and sharp return to inhale. What I'm trying to describe is I didn't think exhale and inhale both would have sharp pointed rate peaks, but the exhale peak should be a bit more drawn out then head back up on the inhale.

I do see what Crimson Nape is meaning to try in getting more inhale. I am not intending to project what I like to see in my patterns or what I do see as also being good for others. At least I try not to.
Dave

OSCAR
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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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RE: Looking for some help - almost 5 years and not feeling a lot better
Dave, that's what I was trying to point out.  Exhale is kind of short.  It's indicating mouth breathing.  Maybe there's insufficient time to exhale CO2?  Can't really tell without sort of integrating the areas under the curve of the flow rate.  This isn't my field of expertise, so I'm grasping at straws.  

If I were to put on an analytic hat, I'd love to get access to the raw data values representing the flow rate.  (Export data samples from trace?)  Then it would be easy to compare the positive going areas with the negative going areas.  If everything were equal (and it rarely is) the areas should be equal.  If not, then perhaps there could be build up in bloodstream of too much CO2 (or insufficient CO2) changing the signals to breathe.  This is speculation on my part, but some of this could be true.

I guess in the end I'll have to try both and see what happens.  My initial guess was the opposite of Crimson Nape's.  Of course, I'm the apprentice, so I know I don't know much.  I'll try Crimson Nape's way first.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Unfortunate, I don't know yet those deep hidden aspects of timing and such, but I need to. When I get the machine that enables me to edit the timing aspects, I will find out by trying the settings to see and feel what changed.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: Looking for some help - almost 5 years and not feeling a lot better
Seems like a dark art...  Wish the whys and hows were a little better explained in the manual.  That way, us amateurs could make slightly better choices, rather than randomly poking about in the dark!
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RE: Looking for some help - almost 5 years and not feeling a lot better
At least you know what a guinea pig feels like. It would be nice if they would at least give you a coffee for the involuntary test subject time and effort.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: Looking for some help - almost 5 years and not feeling a lot better
you don't have to change any of these settings blind. as you use the machine, you'll notice if there's a problem with timing. for example, I felt my inhale was being cut off prematurely so I extended ti max. as I said above, try using the machine awake or maybe a dozing nap. pay attention to how it feels. if fine, don't change anything. if not, change one thing at a time.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Just tried changing Cycle = Low.  At least while awake, nothing seemed bad.  Honestly couldn't tell if anything had changed.  I'll try it tonight, with only that change.  We'll see what happens when asleep and when I mouth breath.  Trying so set up the machine so I can tolerate Trig=Very High so I can reduce centrals.  So far I only last an hour or two.

Natural breathing cycle is pretty different between mouth and nasal breathing.  Nasal cycle is much closer to 1:2, mouth is closer to 1:1.4, much faster exhale, overall slightly faster BPM.  At least for me (while awake).  Everyone may differ.  My exhale is weak especially at the end of the exhalation.  Also might explain why my night breathing BPM is elevated from wake.  While I am awake I nasal breathe.  Asleep, after less than 30 minutes, I am exhaling through my mouth it seems.
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RE: Looking for some help - almost 5 years and not feeling a lot better
Last night made only one change.  Cycle=Low.  This single setting nearly halved my CA events from 16 to 9.  CAI = 2.03, vs CAI = 1.12.  Of course, other events went up, but the total number of events was identical on both nights (23).  If I understand this correctly, we can reduce H, OA & UF2 with this machine with appropriate settings.  The Vauto just can't directly control CA.

AHI=2.36, TTIA=04:52 last night vs
AHI=2.66, TTIA=05:34 two nights ago

Night felt comfortable.  

I woke up and stayed in bed a few minutes.  Was awake, but wanted to record what my respiration rate would do, it seems to go down when awake.  (Go figure - what a contrary person!)  This matches up with the beginning of the sleep session, where my RR is also low.  (11-14 BPM for awake test session, and 11-12 BPM for start of sleep session)

Observations: Some pressure waveform clipping during OA cluster at 04:28.  Perhaps not enough pressure range allowed?  Kind of busy night with flow limits.  Maybe need more PS?  Video shows post apnea movement for first OA at 4:28.  Likewise for OA cluster (2) at 04:47.  OA at 5:33 caused arousal.  But CA at 05:34 was positional.  (CA followed movement) Legs were uncovered and I moved them to be back under the covers.  Last CA cluster at 05:51 had post apnea movement as well.  Palate prolapse seems fairly well controlled, only counted 6 breathes for the entire session.  (This is better than before.  It's good enough now.)  Inspiration peaks could use a little more rounding, but are quite improved from non-ResMed era.

OSCAR question: How is flow limit max scored?  On the graph there is a flow limit of 0.82, yet flow limit max is scored at 0.16.  Is the flow limit an index?  (flow max/hours of session ?)  At least for me, the flow limit reporting statistics doesn't seem sensitive enough.

Current settings:
VAuto, PS 3.2 over 8.4-13
Trig=High, TiMin=0.7, TiMax=2.4, Cycle=Low

Suggestions for improvement?  I'd like to drive H+OA+UF2 down some more, without increasing CA.  If I could reduce the non CA events by 50% it would be great.  Willing to give Trig=Very High a go again, hope it can help with the CA.

As for how do I feel question.  A little better.  Lungs are feeling less over inflated (sore).  Woke up on my own (before alarm clock), seemed to move through morning ok.  Still a slight headache, but lower pressure on sinuses.  More clear headed.  Generally headed in the right direction.  But, I managed to cut myself shaving this morning.  Gee, that's a heck of a reminder to be totally alert in the morning!  Still a ways to go.  More confident there is sufficient control available on the VAuto for me.  
   
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RE: Looking for some help - almost 5 years and not feeling a lot better
Since you're so sensitive to the PS, you might try bumping it up to 3.6 to reduce the flow limitation.  I think I'd try moving your EPAP min to 9.0.  This should help in reducing the hypopneas and OAs.  Have you looked at a 2-minute window to see the shape of your flow rate waveform?  It should be more rounded at the top.  

Breath rate - Our breathing while awake is very erratic as opposed to a more rhythmic waveform while asleep.   That is why many experience events at the beginning and end of a sleep session.  This phenomenon is known as "Sleep-Wake-Junk" (SWJ).  Because of you reporting a slower rate while awake, got me to pondering the effect of adjusting the Ti min value to better control a hyperventilating condition while asleep.  This could cause the CAs.  Something else cam to mind while analyzing this data.  The Insp and Exp times listed are the direct opposite of the respiration rate listings.   In order to have a higher bpm, your Insp and Exp times have to reduced.  I never thought about that until now.

The Flow Limit reporting discrepancy. The Max value is a 99-percentile value. This strips out artifacts that have no real benefit, since they  are a one off thing.  Consider leaks;  You are more focused on the maximum leak value during the night as opposed to the value of pulling the mask away from your face for an adjustment, which would be the actual maximum value.

I don't understand your fixation on UF2s.  We are trying to work on the dollars and you are worried about the pennies.  I regard addressing UF2s as fine-tuning, that only comes after addressing the major events.  But that's just me.

Side Notes:
To avoid a "Do-as-I-say and not-as-I-do" scenario, I set my Cycle to Very Low to see what the actual result would be.  It's one thing to read its definition and another to actually experience it.  While the definition states that it reduces the sensing of flow reversal, it feels more like it decreases or slows the rate of the pressure drop. Of course, this only has this effect if you don't exceed your Ti max setting.  If you exceed this time limit, then it is no different from any other Cycle setting.  The Flow Rate waveform bears this out as well.   This means, in order for it to have a constant effect,  you need to set the Ti max to a value you will never exceed.  The end result of reducing its sensitivity is to produce a more rounded inhalation waveform.

Next, I'm going to test the result of increasing the Ti min setting to see if I can adjust the respiration rate.  If my theory is correct, increasing this value would retard the bpm and reduce a hyperventilation/CA condition.

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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