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Need help to calibrate levels
#1
Need help to calibrate levels
Hello,

I have recently decided to try CPAP again. Diagnosed about 12 years ago for mild apnea but the machine they gave me is uncomfortable, so I quit after a sort time. 

I just got the Dreamstation BiPAP Pro and set the level to IPAP=10, EPAP=6 with BiFlex turned on. Oscar shows my AHI=7.98, with CA=2.79, O=1.9 and H=3.29. My first question is does this mean that I have central apnea? And if so, do I need to switch to an ASV machine?

I saw the Leak rate is at 20. Is this normal? I'm using Resmed Airfit F10 mask, btw.

My other question is if I should change the settings to get better results?

I would appreciate any help. Thanks!



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#2
RE: Need help to calibrate levels
You are currently using fixed-pressures BiPAP with EPAP 6.0 and IPAP 10.0 (pressure support =6.0), and apparently ramp is on. It will help if you minimize that monthly calendar so more settings and statistics can show. Just click the triangle next to the date.  Basic titration protocol suggests a need to increase pressure where OA are happening, so it's reasonable to increase pressure to EPAP 7.0, IPAP 11.0.  Your apnea are occurring in clusters which usually indicates you are tucking your chin or in a posture that causes the airway to be restricted (positional apnea).  If you are using multiple pillows or tend to sleep in a fetal position with your chin deeply tucked, that can cause these clusters.   Our Optimizing Therapy wiki discusses most of your questions, and even has a section on positional apnea. http://www.apneaboard.com/wiki/index.php...ng_therapy  

We need to see the full night chart and the statistics to accurately assess your leak data. Philips respironics machines report total leak, and a leak rate of 20 that includes the intentional mask vent is a good result.  Normally the leak chart shows two lines, one being total leak, and the lower one the excess leak.  This chart is the Philips Titration protocol for you your machine. The second figure is from Resmed.  Both are similar, but Philips does not discuss central events.

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Sleeprider
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#3
RE: Need help to calibrate levels
I agree with the titration protocol. Note that on these Respironics DreamStation's that Ramp may be programmed but it's a manual activation with a front Ramp button. This is assumed akin to the DreamStation I started with in 2017.
Dave

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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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#4
RE: Need help to calibrate levels
Thank you both very much for your replies. I have attached picture with more details. I try 11/7 at the beginning of the night but found it uncomfortable, so I switch back to 9/5. Then after waking up for a while, I try 11/7 again.

It seems that like before the CA events appear to concertrate in the later part of the night. Is that common with CA?

I would be very grateful for your feedbacks. Thanks a ton!


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#5
RE: Need help to calibrate levels
As you'll learn, there's not much consistency in CA. Given that the large concentration of the CA are based near the beginning of sleep session 2 within the chart, it's possible these are sleep wake junk or SWJ for short. If true, SWJ is caused by the typical uneven handoff from waking to sleeping breath patterns. Waking breaths can be much more erratic than sleeping, and transitions back and forth can cause this.

Secondly, there's what appears as some positional Apnea clusters. Take a look at my signature to find the link to a wiki involving a soft cervical collar.

Finally, you might still need to go a bit higher with your minimum pressure to reduce some events this way. Respironics machines are notorious for a weakness in the algorithm that makes the PAP slow to respond, requiring you to run higher pressures to help the machine in combating events. You might also want to review the Flex setting; flex on 3 can cause issues while flex 2 may be better.
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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#6
RE: Need help to calibrate levels
Thank you very much, Dave. Your replies are very informative to me.
I will try your suggestions and report back.
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#7
RE: Need help to calibrate levels
You're welcome. Check in with an update after next day or so usage.
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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