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New CPAP user looking for OSCAR review (no DME)
#21
RE: New CPAP user looking for OSCAR review (no DME)
(10-19-2019, 03:48 PM)WillSleep Wrote: ...
Therefore I absolutely think you should hang on the ASV until your wife's therapy is looking 2-3 weeks solid on the Autoset.   If you want I can post a Powerpoint with markup and comments on one of the earlier screenshots to explain why.  Her screenshots already looked so good most likely the Autoset will work out great for her but I would just hold onto and forget about the ASV until you guys see the the Autoset nailing it for her.  Then sell or trade the ASV.  
 
That sounds like the best plan to follow. We're both going to give the Autoset a few weeks before trading/selling the ASV. The good news is that I already have a few trade in offers for it and it has a good value being under 1000 hours.

I certainly wouldn't mind if you wanted to share more comments on the earlier screenshots. It would help to better understand and read my own charts so someday I can help others like the way you and the many other kind folks on this forum have. The Wiki has been a great resource already.

(10-19-2019, 03:48 PM)WillSleep Wrote: ...
Supersleeper has way, way more experience than I do at dialing in the Autoset so I would add his suggestion to try EPR at 3 to the top of list of test configurations to titration through and test.  

Have a great weekend!
WillSleep

Tried EPR 3 last night and I didn't like the way I was breathing with it. I'll try it again with a different mask. I'm happy to report that I responded well to a min. pressure of 11 so I'll keep dropping it by 1.0 cmH2O a night, as you suggested.

Thanks again!
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#22
RE: New CPAP user looking for OSCAR review (no DME)
(10-19-2019, 07:34 PM)walkingdead Wrote: I certainly wouldn't mind if you wanted to share more comments on the earlier screenshots. It would help to better understand and read my own charts so someday I can help others like the way you and the many other kind folks on this forum have.
 
 
Sure, Will do so in the next few days.

Update:  In addition to the wiki this is a really good thread to quickly start to ramp up on better understanding your, your wife's, anyone's waveforms.   
http://www.apneaboard.com/forums/Thread-...-Waveforms  


(10-19-2019, 07:34 PM)walkingdead Wrote: Tried EPR 3 last night and I didn't like the way I was breathing with it. I'll try it again with a different mask. I'm happy to report that I responded well to a min. pressure of 11 so I'll keep dropping it by 1.0 cmH2O a night, as you suggested. 
 
Sounds like good plans, slow, calculated, methodical experiments.    

Have a great night sleep!
WillSleep

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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#23
RE: New CPAP user looking for OSCAR review (no DME)
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?

1st night
   

2nd night
   

OAs & RERA (15 min waveform)
       

I think I need help figuring out what the min/max should be at now. My prescribed pressure is 14.0 cmH20 with EPR 2-3.
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#24
RE: New CPAP user looking for OSCAR review (no DME)
If you're asking us to coach you to results better tha 0.25 AHI, then you have unrealistic expectations. Get away from the data and go get a good night's sleep. This is nearly perfect and better than "normal". If you wanted to get CPAP therapy with a PSG result like this, they would just congratulate you on your exceptional health. What am I missing?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#25
RE: New CPAP user looking for OSCAR review (no DME)
(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

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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#26
RE: New CPAP user looking for OSCAR review (no DME)
Willsleep, I don't have any problems with your conclusions. The Vauto has much more to offer than Autoset based on inspiratory timeing (TiMin, TiMax) and trigger and cycle sensitivity, and of course more PS, adjustible in 0.2 cm increments.

The Autoset for Her algorithm does not appear to be doing much for Walkingdead, and I think similar results would be achieved with standard Autoset. For Her is mostly about a faster initial response to flow limitation and only increasing pressure on FL above 12.0 cm. Walkingdead's pressures are basically moving between 11 and 13 cm so there is not much going on, and I would consider him well titrated.

The only therapeutic reason to run Vauto is to obtain more pressure support. That said it's a superior machine, but we are really picking nits when trying to optimize to less than 0.25 AHI (1 event per 4 hours). I think we have arrived at the point of diminishing returns for optimizing these results, and if experimenting with the options on a Vauto are what Walkingdead wants, i say, welcome to the club! I just don't think there is much we can contribute to the effort because to me, this is as good as it gets.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#27
RE: New CPAP user looking for OSCAR review (no DME)
(10-21-2019, 06:22 PM)Sleeprider Wrote: If you're asking us to coach you to results better tha 0.25 AHI, then you have unrealistic expectations.  Get away from the data and go get a good night's sleep.  This is nearly perfect and better than "normal".  If  you wanted to get CPAP therapy with a PSG result like this, they would just congratulate you on your exceptional health.  What am I missing?

I'm not chasing numbers. I've learned first hand that a low AHI does not always equate to perfect treatment or exceptional health. My average AHI with the ASV in CPAP mode was 0.31 over two months at 100% compliance. The result was a trip to the ER with chest pains and a diagnosis of hypertension at 26 years old. My doctor does not believe that my sleep apnea is under control and even wants to order more sleep studies at a new clinic.

I don't have the budget for that so I'm seeking the help of people that have first hand experience and understanding of titration to make sure I'm setup for success. I truly appreciate the help that you have provided me.
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#28
RE: New CPAP user looking for OSCAR review (no DME)
I won't argue how your feel, only you know that. It appears you have very good results with CPAP from an efficacy POV. With pressure at 10-16 and EPR 3, your pressure moves within a very small range, and there are few indications you can do much more optimization with your CPAP. The next step up in PAP therapy would be with an Aircurve 10 Vauto, which could provide more pressure support and some other inspiration timing.

Don't take my post as being critical, rather I just don't see your CPAP therapy as "uncontrolled". Sleep studies should have the potential to identify issues besides AHI that contribute to adverse health impacts. Sadly, that is rarely the case. It would be very interesting to know why your doctor does not think your sleep apnea is controlled, and how he would design a sleep test to identify those problems, because I am yet to see a sleep study used for what your are describing, and it certainly is not something insurance is likely to approve.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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: New CPAP user looking for OSCAR review (no DME)
(10-22-2019, 12:10 PM)Sleeprider Wrote: I won't argue how your feel, only you know that.  It appears you have very good results with CPAP from an efficacy POV.  With pressure at 10-16 and EPR 3, your pressure moves within a very small range, and there are few indications you can do much more optimization with your CPAP.  The next step up in PAP therapy would be with an Aircurve 10 Vauto, which could provide more pressure support and some other inspiration timing.  

Don't take my post as being critical, rather I just don't see your CPAP therapy as "uncontrolled".  Sleep studies should have the potential to identify issues besides AHI that contribute to adverse health impacts. Sadly, that is rarely the case.  It would be very interesting to know why your doctor does not think your sleep apnea is controlled, and how he would design a sleep test to identify those problems, because I am yet to see a sleep study used for what your are describing, and it certainly is not something insurance is likely to approve.

I agree. I also need to give the Autoset more time to do its thing as it's only been ~2 weeks and I'm happy with where things are trending with the new machine. I personally believe that 2-3 months of a fixed 14.0 cmH20 pressure without an EPR in the ASV machine put me in this position and now I'm in "recovery" mode.

There's certainly some frustration with my doctor. Yesterday was my first follow up appointment since the sleep apnea diagnosis and it started off by him saying they have no records of my sleep study from the clinic that they referred me to. He's convinced that the therapy isn't working because my blood pressure levels are higher than in July and put me on an ACE inhibitor. I don't think it's fair of him to expect me to be all better with a CPAP in under 3 months.
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#30
RE: New CPAP user looking for OSCAR review (no DME)
I had high hopes my blood pressure would drop but during 3 years of cpap it's only gone up, even with multiple meds and even after getting my ahi mostly under 1.0. hard to imagine your doc would hang his hat on blood pressure as indicator of efficacy.
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