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Help adjusting therapy (cheyne-stokes)
#11
RE: Help adjusting therapy (cheyne-stokes)
Try the for Her algorithm, same settings. This is a 1 change at a time thing.
You are low pressure, EPR=3, and fighting flow limits, the for her should help with that.
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#12
RE: Help adjusting therapy (cheyne-stokes)
Try the for Her algorithm, same settings. This is a 1 change at a time thing.
You are low pressure, EPR=3, and fighting flow limits, the for her should help with that.

Please click the triangle or "V" between the month and year to shrink the calendar for the screenshot. This is one of the things the F12 does automatically in OSCAR.
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#13
RE: Help adjusting therapy (cheyne-stokes)
Well remember I am currently testing in cpap mode and of course you cant be in cpap mode and use "for her". 

I am pretty confident on my settings for comfort and will go back to apap mode and "for her" with a range of 6.8 (slightly lower then the 7 i am used to) - 8.8 (Slightly lower then the 9 we tested) as that seemed just a little to high. 


I will keep the epr at 3, and just keep an eye on CA's

Will post charts back each day

Thabnks again
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#14
RE: Help adjusting therapy (cheyne-stokes)
I'm no expert by any means.  Thank goodness we have people like Gideon.  Anything he writes is golden.  Just adding my 2c below as I can relate to some of the frustrations that you're going through.

First of all, we rarely talk about sleep-related activities outside of xPAP.  If I have a 'bad night', it sometimes takes me several days to get back to my 'normal' xPAP pattern.  For example, a bad sleep night becomes a significant coffee-drinking next-day.  It might even involve a mid-day nap, if possible.  It's a day filled with little energy, and little to no physical exercise throughout the day.  Then, it's an evening of lounging.  I might think I'm going to have a great sleep the next night, but it turns out bad again - for all new reasons (too much caffine, too little exercise, changing my sleep schedule, etc.).  These are many elements that contribute to a 'good sleep', notwithstanding having effective xPAP settings to sufficiently control obstructive events, etc.

I think it was SuperSleeper that advised years ago to only tinker with one setting change at a time, and in small increments - and give yourself enough time with that new setting to see how it works out (like a week, or maybe two).  Of course, I did the opposite for many months, turning the roulette wheel each night on a variety of setting changes, without giving a sufficient number of nights to see how it works out - all the while, unknowingly blowing past what might have been a great setting long-term.

Are those cheyne-stokes being flagged at the same time as spikes in leak rates?  
Also, are most of your events happening in the last 1-2 hours of sleep?  
Just wondering if those are clues to issues.
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#15
RE: Help adjusting therapy (cheyne-stokes)
I think in For Her mode you can set min = max = whatever.
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#16
RE: Help adjusting therapy (cheyne-stokes)
I am a newbie too, so I’m just adding my 2c too. I am in my second month of APAP therapy (ResMed 10 for her). I am having a blistering bout of treatment emergent central apneas, and cheyne-stokes respiration too. My initial idea was that as I was on opiates for chronic pain, that lowering my dose as much as possible would help. I was very wrong.

To speak to the point of your post, for me, the first change I made on my own machine, was to turn EPR off. I tried a few nights reducing it to 2 from 3, but no response, and I was having some nights with AHI’s in the fifties. My original sleep test result was an AHI of 26, with no central apneas. I hated to take a comfort setting away, but changing the EPR to off cut my AHI in half (my obstructive apneas are zero, or very low every night). The next change I made after a week or so was to turn ramp off. Another change I hated to make, but cheyne-stokes respiration seemed to start for me before my pressure reached 6 (my current minimum). That cut my AHI by another 50%.

I am likely a very odd case, as I was tapering off fentanyl patches onto xycodone as needed during my first trial month of CPAP (oh hindsight!). I’m sensitive to pain, and environmental issues in life in general, so, in case this helps. My AHI has nights under 5, then other nights mild or moderate central’s again. If this continues to be an issue, I’ll be posting to the board for help. But my theory is my medication change really impacted my CO2 sensitivity…

I’m interested in the N20 mask needing defined as nasal pillows. I have not read of that before. Does that help CA?
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#17
RE: Help adjusting therapy (cheyne-stokes)
If your mask stresses you out then it can have an impact on your AHI, otherwise as long as it fits you well and is comfortable mask shouldn't be a problem.

On the pain, I have bad back pain, try a tens unit to relieve your pain. I don't know anything about your pain but at least look into it.

And Please post your daily OSCAR screenshots in a new thread. Here at AB we are very data oriented.
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#18
RE: Help adjusting therapy (cheyne-stokes)
Ok last night was... well... interesting....
I am not counting the results for much other then perhaps an overall trend for tweaking min/max.

I had the cpap set too high for humidity or just incorrectly as it became a popcorn machine in sound and I had water in the tubing, thus the area in the early morning with an extended pause, getting the water out and trying to get the tube dry. I know the reports say i was at humidity of 4 that is not the case i set it to 4 for about 4 minutes to try and get the popping sounds to stop. Then put it back in auto/auto and continued the night, once I cleared the water out.

What I am seeing from last nights data as well as from last nights expierence overall is that my min is really a little to low. I felt like i wasnt getting quite enough air until i hit around 7.4 So i should tweak the min to 7.4

I also noticed that the few reras I got seem to occur when I hit the max pressure and it looks like the algorithym would like to go higher but cant due to the max limit I setl. So I should expand the top level just a tiny bit to 9.4

I was a little surprised to see that the flow limits on "for her" look considerably worse the "standard" mode and it seems to have also changed to soft as opposed to the standard autoset or regular or normal I expected. Not sure if its remembering something from past testing or if "for her" and soft just go together.

I know we really only want to make one change at a time so which should it be?
change min to 7.4 (tending toward this as ramping to 7.4 is not comfortable)
change max to 9.4 (also important as seems thats causing most of the rera's)
change "for her" back to standard
change "soft" to whatever default is

Like the above poster I want to just change it all and get one with it, but realize the benefit of patience and changing one setting at a time. BTW will leave all humidification settings on auto/auto going forward.

One last thought based on the poster who was on pain meds.....
I take tramadol and flexeril occasionally and have only taken them one time since being on cpap therapy. My AHI went from 1 or sometimes 2 (remember I have not found my golden settings yet) to kust over 20. Most of it being CA's. I dont know if this is helpful but wanted to let you know that at least in my one night case I did see a pretty major connection between taking my meds and seeing an extremely increased CA count.

Here are last nights charts:
       

Justr realized never said how I ended up feeling this morning....
Very tired, brain feels pretty fuzzy and feel very detached. Not as nautious or dizzy but not what I would call a good morning by any means.
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