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Minimal variation in pressure, DreamStation
#1
Question 
Minimal variation in pressure, DreamStation
This is my second night of using a PAP, so I'm trying to learn and tune in my settings. My first question is related to the DreamStation only logging a 1 cmH2O variation above the minimum when set in AutoCPAP mode. I expected it to rise more than that, but I don't know if that's an incorrect assumption on my part, or else if I don't have it set correctly. (Thoughts?) I'm including a couple of screen prints from OSCAR at different zoom levels that shows the settings and results. 

   
   

FWIW, the first night (not shown) it was set at 4.0 minimum and I found that I was struggling on the inhale. The second night (shown in screen prints), I switched the min to 6.0 which was better, but I think I still need to raise it. I'm very interested in learning and fine-tuning the settings, so any feedback is welcome.



For context, my original Sleep Test Report (Philips Respironics Alice NightOne) had an AHI 55.2, OAI 11.6, CAI 0.0  and lowest Desat of 84. I'm very encouraged that even at the current setting the AHI is already in the single digits. This is far from done, but makes me hopeful.
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#2
RE: Minimal variation in pressure, DreamStation
You have 2 major problems - 1st you have positional apnea and no settings on any pap machine will help. You are getting in a sleep position that cuts off your airway. You have to find out why you are getting in that position. One major way people get into that position is sleeping on your back. Or using to high of a pillow. Either can cause chin tucking. That is when your chin drops down to your sternum and cuts off your airway. Many people have found the use of a collar helps a great deal. Please use the link at the bottom of the post to read about collars. In that link you can see people showing how they did before and with a collar. 

2nd is pressures. Change flex to 2 and raise the min to 8. Both of those will help. Those changes with fixing the positional apnea will make huge difference in your therapy.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Minimal variation in pressure, DreamStation
Thanks very much for the reply.

I presume that the clusters are what point to positional apnea. I have noticed that I can't go to sleep unless I position my chin up and away from my chest (side sleeping). I'm sure I don't stay that way, as I often wake up on my back. Also, I still have limited data, but when I look at the data from just after I go to sleep, there seems to be a period of an hour or so where no events occur, then a cluster of events occurs.

I'm going to order a collar today to see if that helps.

I'll also make the setting changes that you suggest and will look at the data again tomorrow.
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#4
RE: Minimal variation in pressure, DreamStation
When ordering a collar - measure the distance from your chin to your Sternum to get the correct height.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: Minimal variation in pressure, DreamStation
The Dreamstation Auto CPAP is mainly responsive to snoring, and you had enough that the machine should have reach the maximum pressure. A Resmed would have moved up pressure quickly. Your pressure is just too low. The minimum needs to be 8 or 9 and the maximum closer to 15.
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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#6
RE: Minimal variation in pressure, DreamStation
Ew, Respironics fatal flaw struck again it seems. By the time it decides to ramp up the event is past. That's why I call it ScreamStation or frustration factory.
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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#7
RE: Minimal variation in pressure, DreamStation
I modified the settings to 8.0 min and flex level 2. No cervical collar, yet.

Overall, the number of events is down, and I feel better this morning than I have in a very long time. A new event "clear airway" showed up, and based on some internet research this can happen with someone who just started CPAP. My plan for tonight is to leave the settings the same, but to add the collar. (FWIW, I have recently had a physical which included an EKG which was normal.)

       

I'm still working to optimize the settings, posture, etc., and I see other people who have much better numbers than I had last night, so I know I can still do better. All the same, feeling better is a big boost, and going from AHI of 55 during my sleep study to 1.64 on the third night of treatment is a big emotional and mental boost. 

I also need to work on increasing exercise and losing weight (current BMI: ~33). Feeling better will make it easier to exercise and hopefully reduce the food cravings.

I would still appreciate any other thoughts. Your suggestions have been quite helpful so far.
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#8
RE: Minimal variation in pressure, DreamStation
Looks much better, but still a lot of RERA and hypopnea. That minimum pressure of 9.0 is looking better from here, although the collar may clean up the clusters of RERA. I think you are on the right track and try the collar, but I think you will ultimately do very well at a pressure of 9.0
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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#9
RE: Minimal variation in pressure, DreamStation
I think of an AHI under 2 as good and under 1 as excellent. You do also have some other stuff going on -- flow limitations, RERAs, snores -- and when you go up to a minimum of 9 as Sleeprider suggests, some of that may improve. The CAs are negligible, I think, and may represent 'sleep-wake junk' (a pause in breathing while you're awake or half awake).

I think you're smart to change just one thing at a time. That will give you a better idea of what is causing what. I hope the collar will be comfortable and effective for you.
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#10
RE: Minimal variation in pressure, DreamStation
Recommend you turn off EZ Start as it will reduce the maximum auto pressure increases for the first few weeks of treatment. 

"EZ-Start reduces the prescribed CPAP pressure in half on the first night (Fixed CPAP mode) or reduces the maximum Auto pressure to 1cm H2O above the minimum Auto pressure (Auto CPAP mode). If the patient gets 4+ hours of sleep, the next night the pressure will go up 1cm H2O."
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