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Need help understanding my Nov. 23 charts, pls.
#21
(12-11-2016, 08:44 AM)kingskid Wrote: Vaughn, re: "Your pressure quickly goes to max (probably because of the severe Flow Limitations) and stays at max pretty much all night."

I forgot to ask about my max pressure. I frequently check my SH info on how long the pressure stays at max, and it is pretty consistent every night. Am wondering, therefore, if I should increase the max? I had started out with straight 7, then went to 7-9 and now am at 7-9.6. Had used APAP one night with moderate settings (can't remember what) and I fought the machine and got something like a 2.5 AHI and not a good night's sleeep. Just don't take to "control" very easily! I'm thinking if I set the max to maybe 10 and check it after a week or so to see the if percentage of time I'm maxing 10 out, well, maybe I need to try APAP again. It may sound silly, but because of the "control" issue, I'm a little leary of letting APAP take over..... Thoughts?

My comments were based on the data you posted for Nov 23, but now I am a little unsure whether the Machine Settings listed by SleepyHead were accurate. I don't use SH but I think if EPR of 1 was really being used (as shown in Machine Settings table in the posted SleepyHead data) then the Mask Pressure plot would show the pressure changing 1 cmH2O between inhale and exhale. Also, if the therapy mode was really Auto For Her (as shown in Machine Settings) I would expect the pressure to drift lower occasionally, but the Mask Pressure plot stays very close to max all night, as if in CPAP mode.

If EPR was off on Nov 23 apparently SH has a bug which lists EPR in the Machine Settings as being on even when actually it is off.

Assuming the therapy mode on Nov 23 was truly Auto For Her, the pressure was maxed out around 9.6 all night, and if you increase the Max Pressure only a little, from 9.6 to 10, it would likely rise to and remain around 10 all night.

Increasing the Max Pressure would be expected to help reduce the FL.

When the pressure is maxed out, increasing EPR without at the same time equally raising Max Pressure would be expected to worsen AHI because it would lower the pressure during exhalation. At the end of exhalation, just as we are trying to start inhaling, is the time apneas are most likely to start.

I suggest you consider raising together both Max Pressure and EPR by 1 each, by raising Max Pressure to from 9.6 to 10.6 and turning on EPR of 1.

Having a pressure difference of 1 between inhale and exhale would be expected to make it easier to breathe in. After a week, if you can get used to EPR of 1, you might consider again increasing EPR and Max Pressure together, to 2 and 11.6. And after another week, if you can get used to EPR of 2, you might consider again increasing EPR and Max Pressure together to 3 and 12.6.

Having a pressure boost of 1 or 2 or 3 when you inhale would do for you some of the work of breathing, reducing the effort needed to breathe, and would increase your Tidal Volume and oxygen saturation while sleeping.
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#22
(12-11-2016, 12:26 PM)vsheline Wrote:
(12-11-2016, 08:44 AM)kingskid Wrote: Vaughn, re: "Your pressure quickly goes to max (probably because of the severe Flow Limitations) and stays at max pretty much all night."

I forgot to ask about my max pressure. I frequently check my SH info on how long the pressure stays at max, and it is pretty consistent every night. Am wondering, therefore, if I should increase the max? I had started out with straight 7, then went to 7-9 and now am at 7-9.6. Had used APAP one night with moderate settings (can't remember what) and I fought the machine and got something like a 2.5 AHI and not a good night's sleeep. Just don't take to "control" very easily! I'm thinking if I set the max to maybe 10 and check it after a week or so to see the if percentage of time I'm maxing 10 out, well, maybe I need to try APAP again. It may sound silly, but because of the "control" issue, I'm a little leary of letting APAP take over..... Thoughts?

My comments were based on the data you posted for Nov 23, but now I am a little unsure whether the Machine Settings listed by SleepyHead were accurate. I don't use SH but I think if EPR of 1 was really being used (as shown in Machine Settings table in the posted SleepyHead data) then the Mask Pressure plot would show the pressure changing 1 cmH2O between inhale and exhale. Also, if the therapy mode was really Auto For Her (as shown in Machine Settings) I would expect the pressure to drift lower occasionally, but the Mask Pressure plot stays very close to max all night, as if in CPAP mode.

If EPR was off on Nov 23 apparently SH has a bug which lists EPR in the Machine Settings as being on even when actually it is off.

Assuming the therapy mode on Nov 23 was truly Auto For Her, the pressure was maxed out around 9.6 all night, and if you increase the Max Pressure only a little, from 9.6 to 10, it would likely rise to and remain around 10 all night.

Increasing the Max Pressure would be expected to help reduce the FL.

When the pressure is maxed out, increasing EPR without at the same time equally raising Max Pressure would be expected to worsen AHI because it would lower the pressure during exhalation. At the end of exhalation, just as we are trying to start inhaling, is the time apneas are most likely to start.

I suggest you consider raising together both Max Pressure and EPR by 1 each, by raising Max Pressure to from 9.6 to 10.6 and turning on EPR of 1.

Having a pressure difference of 1 between inhale and exhale would be expected to make it easier to breathe in. After a week, if you can get used to EPR of 1, you might consider again increasing EPR and Max Pressure together, to 2 and 11.6. And after another week, if you can get used to EPR of 2, you might consider again increasing EPR and Max Pressure together to 3 and 12.6.

Having a pressure boost of 1 or 2 or 3 when you inhale would do for you some of the work of breathing, reducing the effort needed to breathe, and would increase your Tidal Volume and oxygen saturation while sleeping.

Thanks for all this info, Vaughn. I checked SH for my prescription settings and on 12/28/15 I had tried APAP on that night with min 7 max 11 settings. I didn't like the struggle I seemed to have that night, so went back to CPAP modes of 7, 7.2, 7.4 or 7.6 until 8/6/16. At that time, I went APAP again and stayed at mostly min 7 max 9 or 9.6 and that's where I've been since Aug. 6. You're right; SH is reading the number 1 for EPR, but not reading that EPR was actually off. As noted earlier, I had recently turned the EPR on for one night at setting of 1, but turned it off because I wasn't sure if it was effective. Now, since you have provided info on syncing the EPR with an increased max pressure, I am going to try doing as you suggested. My mistake has been trying different settings for too short a time and not using the EPR. BTW, scratch what I said about APAP. I've been a bit confused about the APAP mode of my machine but I've actually been using the APAP mode since August 2016. I've tried to keep the min/max numbers fairly close so I wouldn't have to experience a big leap between the low and high settings. At any rate, thanks again, I am excited about trying the regimen you laid out and will post my results.

Kathy
"Freedom is the oxygen of the soul."
Moshe Dayan
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#23
(12-11-2016, 07:55 PM)kingskid Wrote:
(12-11-2016, 12:26 PM)vsheline Wrote:
(12-11-2016, 08:44 AM)kingskid Wrote: Vaughn, re: "Your pressure quickly goes to max (probably because of the severe Flow Limitations) and stays at max pretty much all night."

I forgot to ask about my max pressure. I frequently check my SH info on how long the pressure stays at max, and it is pretty consistent every night. Am wondering, therefore, if I should increase the max? I had started out with straight 7, then went to 7-9 and now am at 7-9.6. Had used APAP one night with moderate settings (can't remember what) and I fought the machine and got something like a 2.5 AHI and not a good night's sleeep. Just don't take to "control" very easily! I'm thinking if I set the max to maybe 10 and check it after a week or so to see the if percentage of time I'm maxing 10 out, well, maybe I need to try APAP again. It may sound silly, but because of the "control" issue, I'm a little leary of letting APAP take over..... Thoughts?

My comments were based on the data you posted for Nov 23, but now I am a little unsure whether the Machine Settings listed by SleepyHead were accurate. I don't use SH but I think if EPR of 1 was really being used (as shown in Machine Settings table in the posted SleepyHead data) then the Mask Pressure plot would show the pressure changing 1 cmH2O between inhale and exhale. Also, if the therapy mode was really Auto For Her (as shown in Machine Settings) I would expect the pressure to drift lower occasionally, but the Mask Pressure plot stays very close to max all night, as if in CPAP mode.

If EPR was off on Nov 23 apparently SH has a bug which lists EPR in the Machine Settings as being on even when actually it is off.

Assuming the therapy mode on Nov 23 was truly Auto For Her, the pressure was maxed out around 9.6 all night, and if you increase the Max Pressure only a little, from 9.6 to 10, it would likely rise to and remain around 10 all night.

Increasing the Max Pressure would be expected to help reduce the FL.

When the pressure is maxed out, increasing EPR without at the same time equally raising Max Pressure would be expected to worsen AHI because it would lower the pressure during exhalation. At the end of exhalation, just as we are trying to start inhaling, is the time apneas are most likely to start.

I suggest you consider raising together both Max Pressure and EPR by 1 each, by raising Max Pressure to from 9.6 to 10.6 and turning on EPR of 1.

Having a pressure difference of 1 between inhale and exhale would be expected to make it easier to breathe in. After a week, if you can get used to EPR of 1, you might consider again increasing EPR and Max Pressure together, to 2 and 11.6. And after another week, if you can get used to EPR of 2, you might consider again increasing EPR and Max Pressure together to 3 and 12.6.

Having a pressure boost of 1 or 2 or 3 when you inhale would do for you some of the work of breathing, reducing the effort needed to breathe, and would increase your Tidal Volume and oxygen saturation while sleeping.

Thanks for all this info, Vaughn. I checked SH for my prescription settings and on 12/28/15 I had tried APAP on that night with min 7 max 11 settings. I didn't like the struggle I seemed to have that night, so went back to CPAP modes of 7, 7.2, 7.4 or 7.6 until 8/6/16. At that time, I went APAP again and stayed at mostly min 7 max 9 or 9.6 and that's where I've been since Aug. 6. You're right; SH is reading the number 1 for EPR, but not reading that EPR was actually off. As noted earlier, I had recently turned the EPR on for one night at setting of 1, but turned it off because I wasn't sure if it was effective. Now, since you have provided info on syncing the EPR with an increased max pressure, I am going to try doing as you suggested. My mistake has been trying different settings for too short a time and not using the EPR. BTW, scratch what I said about APAP. I've been a bit confused about the APAP mode of my machine but I've actually been using the APAP mode since August 2016. I've tried to keep the min/max numbers fairly close so I wouldn't have to experience a big leap between the low and high settings. At any rate, thanks again, I am excited about trying the regimen you laid out and will post my results.

Kathy

Well, I experimented with using EPR and gradually increasing it and the max pressure both at the same time. Long story short, I was not satisfied with the results and am now back at the 7 - 9.6 settings. At least I know that what I have is what I should just stay with.
"Freedom is the oxygen of the soul."
Moshe Dayan
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