(10-21-2019, 02:22 PM)walkingdead Wrote: The last two nights I slept with a min. pressure of 10 and EPR of 3. The first night looked OK to me but last night there were two OAs for the first time since starting therapy. I'm guessing we found my minimum pressure and need to adjust?
Hi WalkingDead.
I can only dream about having AHI numbers that good when I get to become "walking dead" Lol.
Two lines of thinking: 1) AHI, Waveforms and Settings and Tradeoffs with everything else that influences Sleep, Health & How You Feel & 2) a couple questions for Sleeprider
1) AHI, Waveforms and Settings: Your could be done right there and wrap it up.
Is that prescription for CPAP. I would not at all be surprised to see a prescription for CPAP higher that what you need for and auto-adjusting machine.
In the two zoomed in screenshots at the bottom of your messages the events occurred just after small leaks ended and the waveform just prior to another looked like it was showing a small leak so yes if great numbers continue you are really close to solid base of reliable treatment.
If you want to see if you refine and get better fairly reliable settings can slowly try a one change at a time often leaving settings in place across a number of nights so you really can see the implication of the change.
1.1) Try an EPR of 2. The scores might change.
1.2) Your IPAP is still undesirably high feels a mite early to have forever fully finished Titrating to see if you can get it lower. With higher pressure it is harder to avoid leaks, reduce heart rate variability, avoid ventilator-patient dis-synchronicities, get the sleep cycles executing precisely, etc. so I would expect want to be really sure you need EPAP all of the starting EPAP you are using.
1.2.a) Somewhere along your journey I would for a night try much lower pressures just to see how the night goes. Like 6, 8, 9cm H20 Min EPAP. If you run with a starting Min EPAP of 6cm H2O and then get an ongoing AHI of 1.25 vs an AHI of .35 at 11cm H2O then I personally would want to assess the average heart rate, hear rate variability, SpO2 % desaturations, SpO2 variability, the How You Feel (HYF) score, and your sleep architecture for starting EPAP of 6cm H20 vs 11cm H20 to see which starting Min EPAP is your better choice.
1.2.b) A high starting IPAP is sometimes an unnecessary self-fulfilling prophecy of needing a higher IPAP through the night. For at least some people Peak required EPAP to knock out OAs will always be higher if the Min EPAP is higher. Sometimes dropping the starting IPAP by 2-4 cmH2O generates the nearly as good or even better AHI and Sleep. The ResMed tritation manual has us all start at 4cm H20 Min EPAP and titrate up as the need has been proven. If you have not tried the lower numbers on the Autoset how do you know they are not right for you.
3.) From the speed of the pressure rise showing in the all night screenshots I am guessing you are right now are using the "Autoset" therapy and not the "Autoset for Her" therapy setting. If you have not yet I am guessing that someday just to see the implications you might try the "Autoset for Her" therapy at these settings and starting lower at like 7 or 8cm H20 just to see how that works out. EPAP rises more slowly but the lookback is more responsive, just one breath and the inspiration trigger is more sensitive. We should expect a little different experience. I personally have not seen enough of your "zoomed into 2 mins waveflows" to say for sure I believe you would not find any advantage from that therapy mode.
Sleeprider, If you would not mind a few questions for you.
1) You know the Autoset much better than I. What inputs do you have for walkingdead on standing pat vs continuing and what additional next steps he should try.
2) When I look at the areas of his screenshots that are at his highest pressure levels I get an itching to add "try PS set to 4cm H2O" to his lest of settings to try. A quick pass through Craigslist and I saw ASVs selling for ~$400-$500 more than ResMed VAutos. So it would seem reasonable to believe WalkingDead could effectively turn that ASV into a VAuto if he wanted to.
So three questions for you (I am asking for him and also to deepen my own understanding of these machines):
1) Am I correct in assuming the VAuto is effectively a superset of the Autoset's functionality and nothing is lost by migrating from the Autoset to a VAuto?
2) Am I correct in assuming anthe only thing "Autoset for Her" has that is not in a VAuto is the slower climbing and descending EPAP and some nice Maple Leaves on the case?
2) The VAuto seems a little less constrained than the Autoset. Given the pressures WalkingDead wants to run if could chose either the Autoset or VAuto for the same cost is there any reason he would prefer the Autoset rather than the VAuto?
Thanks!
WillSleep