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Need set-up help for ResMed Airsense 10 for Her
#21
RE: Need set-up help for ResMed Airsense 10 for Her
Looks very good for events. It would be better to use the attachment feature to post a screenshot image (.png) rather than a pdf report. The F12 button on your computer saves the screenshot to a subdirectory of Sleepyhead in your Documents folder, and it can be uploaded from there.

The chart suggest you have some remaining flow limitations, and I suspect that is what is driving your pressure to the maximum setting. It would be helpful to see the flow limit graph included. I suspect you may eventually want to use EPR at 3 and perhaps allow 1 additional cm of maximum pressure. Fantastic results, and much better than mine from last night. Hopefully you feel as good as this looks.
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#22
RE: Need set-up help for ResMed Airsense 10 for Her
>>>How do you feel?

I usually change from side to side during the night and know it when it happens. Usually I fall right back to sleep. Last night I was more fully awakened when turning over, and once or twice I had an itch under the mask which startled me when my finger hit the mask. I even lifted the mask to scratch it which may have lead to the big leaks. I think that's what awakened me more than usual.

I also know the mask I borrowed from the doctor's office fit better than the new one the DME gave me. I never had to adjust that one. This takes a few adjustments even when putting it on so I don't get air blown in my eyes. I was hoping it would get better over time, and it seems to be getting better (or maybe I just want it to be better).

>>>would be helpful to see the flow limit graph included

I'll see if I can find it.
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#23
RE: Need set-up help for ResMed Airsense 10 for Her
Is this the flow chart you were looking for?  If not, where can I find it?

I couldn't get to the screen shots through sleepyhead, so hopefully this .png works.


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#24
RE: Need set-up help for ResMed Airsense 10 for Her
I raised my pressure from 7-12 to 8-13 and raised the EPR from 2 to 3.  I'm still hitting the upper limits of my pressure.

Any ideas why?


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#25
RE: Need set-up help for ResMed Airsense 10 for Her
We knew you would hit the upper limit because of the flow limitations, but this pressure range results in essentially a zero AHI, so higher pressure is not the answer anyway. This is pretty typical of the Autoset, and for those with persistent flow limitations. We use as much pressure support or EPR as is available on that machine to minimize flow limits, but limit the maximum pressure because it's more comfortable and you don't need it. I think you're home for now with regard to settings.
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#26
RE: Need set-up help for ResMed Airsense 10 for Her
Am I understanding this correctly?  Flow limitations are the start of events.  The machine detects them and increases the pressure to try to avoid the events.  In my case, the upper limit of pressure is enough to avoid almost all events, so there is no real value in increasing the pressure further.

Is that correct?

>>>for those with persistent flow limitations

What causes persistent flow limitations?

Thanks for your help!  I'm totally new at trying to read and understand these charts and understand the traits I display.
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#27
RE: Need set-up help for ResMed Airsense 10 for Her
Events (OA, Hypopnea), Snores, and Flow Limits all drive responses in terms of pressure. I do suggest that you drop Mask Pressure and move Flow Limits to your main chart and squeeze snores in too. We don't need a lot of detail on Flow Limits or snores.

In your case Flow Limits, you can think of them as mini Hypopneas, are what is driving your pressure. The high pressure is a question of comfort for you on this machine, you can drop it as long as your AHI does not significantly rise.

Treat for Flow Limits is to increase Pressure Support (EPR) but that is maxed out. If you are not tolerant of this CPAP it is likely that an Auto-BiLevel without backup such as the ResMed VAuto, could reduce the flow limits with higher than 3 PS (Pressure Support). I don't think you need this machine.

Fred
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
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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#28
RE: Need set-up help for ResMed Airsense 10 for Her
(01-20-2019, 11:12 AM)duncanblizzard Wrote: Am I understanding this correctly?  Flow limitations are the start of events.  The machine detects them and increases the pressure to try to avoid the events.  In my case, the upper limit of pressure is enough to avoid almost all events, so there is no real value in increasing the pressure further.

Is that correct?

>>>for those with persistent flow limitations

What causes persistent flow limitations?

Thanks for your help!  I'm totally new at trying to read and understand these charts and understand the traits I display.
Here are the definitions.  For obstructive events the cause is identical.  To have "Clinical Significance" they need to have either an arousal or an Oxygen DeSAT associated with them.
We do not believe that your Flow Limits are causing either
  • Apnea: 80% to 100% reduction in airflow for >= 10 seconds

  • Hypopnea: 50% to 80% reduction in airflow for >= 10 seconds

  • Flow Limitation: <50% reduction in airflow for >= 10 seconds
As you see the difference is in the amount of flow reduction associated with them.
In short, your assumption about not needing increased pressure is correct.

I will add that this is not necessarily the case with everyone.

Fred
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
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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#29
RE: Need set-up help for ResMed Airsense 10 for Her
You should read the Flow Limitation wiki http://www.apneaboard.com/wiki/index.php...Limitation

If you zoom in on your flow rate chart in Sleepyhead you will see the signature flattening of the inspiratory wave-form of flow limitation. This is caused by an upper airway restriction that may or may not respond to higher pressure, however it will respond to higher pressure support. That is why people with Upper Airway Restriction Syndrome (UARS) do very well with bilevel machines. http://www.apneaboard.com/wiki/index.php..._and_BiPAP

In your case, everything looks pretty good at this point. Good tidal volume, respiration rate, minute vent and very very low AHI. Without much doubt, most of your events in a diagnostic sleep study was hypopnea arising from UARS. You fortunately got one of the best CPAP machines for treating this. You would probably have better results with the Aircurve 10 Vauto because you could use more inspiratory pressure support. My recommendation is that you simply keep the current settings for a while and don't worry about it. If eventually you want to evaluate the comfort and efficacy of higher pressure, you're free to use a higher maximum pressure. The machine will increase pressure to whatever setting you set because of the FL. This is pretty common on the forum and most people that have chronic FL prefer to use the EPR to minimize it, and restrain maximum pressure.
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#30
RE: Need set-up help for ResMed Airsense 10 for Her
I had no events last night, but it was a poor night's sleep.  I've been trying to read a lot and better understand my data particularly flow limitations.

Can you help me understand why the flow rate is so erratic?  I'm guessing the mask pressure changes are reflecting the flow rate.  There were no snores.

Can we tell if the flow limitations are inspiratory or expiratory?  If so, how can we differentiate them?

Are there other graphs I should be including to better understand this?

Thanks!


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