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Mixed questions
#11
RE: Mixed questions
(06-11-2019, 10:21 PM)405. Wrote: What part of the graph did you use to make these recommendations?

The shape of the leak rate graph. I see large chunks of time where the leak rate is elevated above its baseline. You want to aim for a smooth baseline with little to no chunks of time when the leak rate is elevated.

Quote:How long are nasal pillows good for? I am going to try a new one tonight and see if that helps.

Not sure. Your leaks are too large, I think, to be caused by the nasal pillows. Unless they're popping out of your nostrils.
Sleepster
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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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#12
RE: Mixed questions
It is knowing the basics for titration.
EPAP treats Obstructive Apnea 
Pressure Support best treats Flow Limits, RERAs, Hypopneas, and Snores
Pressure Support (PS) is the difference between EPAP and IPAP.  AirSense machines are limited to 3cmw (when EPR = 3) of PS which is implemented by manipulating Pressure and EPR.
Pressure Support is added to EPAP but EPR is subtracted from IPAP or Pressure

Look at where pressure "wants to be" you want the pressure to be a bit above this to control your Obstructive Apnea.
Set EPR to eliminate Flow Limits, RERAs, Hypopneas, and Snores.  Titration protocol starts at 4cmw (for a BiLevel) then increases by 1. I choose 2 or 3 because of being a CPAP, a judgment call based on the number and size of events on the graphs.

Pressure Support (PS) is the difference between EPAP and IPAP.  

For Central Apnea you must decrease both pressure and pressure variance, so both EPR and pressure are reduced to decrease Central Events which will likely increase Obstructive events.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#13
RE: Mixed questions
405, do you do anything for leaks? Neck collar, mouth tape, tongue position, chin strap? Any of those options sound like good ones to you?
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#14
RE: Mixed questions
I have just started having problems with leaks. I have went the longest times under 5 AHI. You can see the change in prescription, does this mean I should set it back where it was? Also I put new nasal pillows on last night and tightened the headgear. I would like to think i didn't have any leaks last night. If the heated tube has a leak would it show up as a leak on Oscar? Any advice would be appreciated.


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#15
RE: Mixed questions
Increase min pressure to 14 and keep an eye on the Centrals.  
Also this shows strong positional Apnea so a loose fitting soft cervical collar (Releaf is popular) or an anti-snoring collar which has only a strap on the back of the neck (Dr Dakota is popular) to hold the chin up should be used.

Centrals have definitely increased, let's see what happens at 14.  
Centrals coming out, and essentially none at lower pressures even with EPR=3, coupled with  Your Flow Limitations, RERAs (essentially gone now), Hypopneas (now reduced) and snores, I feel if you could get a ResMed VAuto BiLevel machine you would benefit from a stronger PS (> 3) of 4 or 5.  This should allow you to, at a reduced pressure, manage your obstructive events with the reduced pressure bringing the Central Apnea back to near zero.  
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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

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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#16
RE: Mixed questions
Bonjour, I sure feel really dumb after reading all of that. I will raise the minimum to 14 and leave the Max at 18. I wonder why all of a sudden things changed? with the app on my phone, there were times when I got a score of 100.
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#17
RE: Mixed questions
The phone app is more intended to promote compliance.  I and others look at things that MyAir doesn't and for that matter, most doctors don't either.  Positional to a doctor means side, stomach, or back, not a chin tuck.  Have seen the collar reduce OA by 30 AHI!!!   We see the chin tuck, and when you know what you are looking for it is really obvious.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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

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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#18
RE: Mixed questions
I notice the AHI is down. I haven't had time to check on the collar. I didn't use a pillow last nigh. I feel like I need a certain pillow that would give me neck support. Can someone check the screenshot and make a recommendation? I'm also curous about learning so please tell me which graph made you come to the conclusion that you did.

Thanks

PS: In the group that says 'Machine Settings' / 'Patient Access', why does it say "yes"?


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#19
RE: Mixed questions
Looks great, we knocked down the pressure variance and the Central Apnea dropped.
You need that collar, The chart there is the events chart that tells us that, it would be backed up by looking at expanded views of the Flow Rate.
Read This Wiki article, especially the part about Positional Apnea which you still have here.
http://www.apneaboard.com/wiki/index.php...ng_therapy
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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

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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#20
RE: Mixed questions
Will do. I will also research the collar. I have never heard of positional apnea until now. I will also look into the collar. I did manage to get rid a lot of the leakage it looks like. By increasing the pressure I can tell it wants to leak out of muni mouth and I catch it when it does. I still feel a little tired is the positional apnea partly the reason for that?

Thank you again for all of your help.
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