New CPAP user-question about clinical manual/changing settings

[photolabrat]

I just got my Resmed Airset 10 for her and have used it for two nights now. Sounds strange to say so soon, but I love it so much! It's easy to wear, feels good while I'm sleeping and I love feeling like I can breathe deeply and fully. But anyhoo...
I'm renting my machine from insurance while they monitor my compliance for the first 90 days. After that, I'll be renting to own. Is it safe to assume I shouldn't fiddle with any of the clinical settings while I'm still in the rental period? My machine didn't come with an SD card, only a wireless modem. Can I just buy any regular SD card if I want to start seeing my data? Or should I wait for the rental period to end for that too, since they may be spying on me? Lol.

[ApneaQuestions]

Welcome to the forum, glad to hear that the equipment is comfortable for you.

SDCArd: an old-style SD format card will work, so too will SDHC 32G or smaller.  I've also heard that SDXC can work too if you create a 32G partition.  Safest and easiest to go with the first 2 options though.

Changing Settings:  To satisfy insurance requirements, whoever is monitoring your data will want to see 4 hours usage per night for compliance reasons.  What happens next depends on how interested and caring the person is monitoring your data.  They should be wanting to see your AHI drop below 5.  Whether they care about you changing settings or not depends on the individual and the trust relationship you have with them (if any relationship at all).  I kept my sleep doctor and sleep technician in the loop and they were comfortable that I knew what I was doing and the rationale behind the changes.  I'd try to establish a good relationship with them if you can.  On the other hand, a less-caring person may just spend the minimum time possible looking at your data and not even notice that anything has changed.  I recommend calling to let them know in advance that you may need to change things.

Does that help?  There really isn't a yes/no answer on changing settings and how people will react. People are different.

In anticipation of expecting to make changes... here's my standard set of hints..

1) Upload a redacted copy of your complete sleep studies if you have any (all pages not just the summary)
2) Download OSCAR so that you can read your data
3) Configure the OSCAR UI to emphasize the important graphs and turn off things like the pie chart and calendar
4) Get the important graphs into the recommended positions
5) Upload your chart for a recent night
6) Get a copy of your clinician's manual for your machine

See my sig for handy links to do all the above.

[SarcasticDave94]

I agree with ApneaQuestion's comments. Build a good reputation and understanding with the tech and doc if possible. Otherwise, use OSCAR data to justify potential setting edits for them and yourself. That way they cannot say you don't know why the edits were done. Insurance will likely not care who did the changes, just that use compliance is met.

Best to your success

[photolabrat]

Thanks to both of you for your helpful comments!

I'll get an SD card and once my compliance period is over (30 days, 90 days, something like that), I'll start making changes if I feel I need them and if the doctor hasn't already made changes after I see her. I probably should do some more reading and research to learn if any changes are even necessary. I actually like all the settings that were set by the doctor. I'm assuming the pressure settings will get tighter after my trial period and my first visit with my doctor once she sees my results? The only thing I did was turn auto ramp off-I like the feel of starting therapy at 6 right when I get into bed-I turned it off so I could go straight to 6 after bathroom break this morning.

[Crimson Nape]

I would suggest that you obtain and start using an SD card now. This will provide you with more historical data to make better informed therapy decisions later.

[SarcasticDave94]

fwiw my ASV came with an SD card, which I began using immediately for data monitoring

Crimson Nape has a good point and you can benefit from it, if for nothing other than building a historical data file. Most PAP users find some aspect of therapy will require setting attention sooner than the next doc visit. Regardless, best wishes on the therapy. And check in every so often to let us know if it's going well.

[Sleeprider]

You can use a SD card now, and the supplier will not know. They are looking at information electronically transmitted to AirView software that they access. That data does not show the presence of a SD card. Seeing the data can help you to better understand your therapy and know if changes would be appropriate. Most people receive a machine that is set to the default values of 4.0 minimum and 20.0 maximum pressure. Eventually your settings will need to be optimized, but for now, your supplier is simply monitoring hours of use and AHI to determine efficacy. The default settings may work fine for you, but most likely you would benefit from higher minimum pressure and possibly EPR (exhale pressure relief). Changes to settings are visible by AirView. Members that need changes have sometimes just made them, and other times called to inform their doctor that they were going to make changes and why. You cannot fail compliance by changing settings; you can only fail by not using the machine. You need to know that your supplier cannot change settings without a doctor's prescription, but you can. So if there is a good reason to make a change, we can help you to understand that and either request it through your doctor, or make the changes yourself.

[70sSanO]

Just a thought. You can download both OSCAR and Rescan. I have both. I’ve used Rescan for years, but I think OSCAR is easier to use and track air flow.

Rescan is Resmed’s proprietary software. If your doctor is open about your treatment and changes going forward, nothing has the same impact as handing Rescan reports with the Resmed letterhead. You can also use OSCAR data to emphasize a issue.

I really think most doctors hear a patient, but may not really hear the words. The reports tell the story. I’ve used zoomed in screen shots to highlight a concern.

You want your doctor to know that you are investing time and effort in your therapy.

John

[photolabrat]

Thanks for all of the great advice. I'll get an SD card as soon as I can and start using it to collect data, then figure out the software. I got a call from the CPAP compliance people yesterday, so I was able to tell her that everything is peachy and I love using my machine-insurance compliance requirements are going to be cake. 

This morning I woke up and noticed that my sleep report screen showed Central AI 0.1. Obviously, I have no data to show you right now, but is this something I need to address with my doctor? It never showed up on my sleep study and this is the first time it showed up on my machine. My EPR is set to 3 per prescription, and the CPAP compliance person at the DME shop told me that the highest pressure reading that my machine showed was 12. I'm definitely feeling like I would like a higher minimum pressure. I start at 6 with auto ramp off, and notice that by the time I'm close to drifting off to sleep, or upon waking, that my pressure shows around 10, which feels super good to me. No clue if there's therapeutic benefit there, but it feels the most comfortable to breathe. I think my doctor would be fine with changing settings-we have a great relationship, but once I see her, I don't know how much management of my CPAP care she will do, or if she will kick me down to the sleep doctor (whom I haven't even met at this point.)

[ApneaQuestions]

The CA value of 0.1 is not a significant number to worry about at this stage.
It will really help to see your data as soon as you can get that organized.

A couple of comments about CA events
1) Sometimes you may turn over in bed and hold your breath as you do so. This shows up as being a CA but isn't really a CA at all... you simply held your breath.
2) Sometimes a machine may incorrectly classify an obstructive apnea as being a CA. To see if that's happened you'd need to look in detail at the flow rates in OSCAR
3) When people first begin using PAP machines they can experience treatment-emergent CAs caused by your CO2 levels decreasing as your breathing becomes more efficient. These treatment-emergent CAs often (but not always) clear up spontaneously as your body adapts to lower CO2 levels. That can take 2 or 3 months to happen. Adjustments to EPR can clear up treatment-emergent CAs but that's not necessary with a low rate of 0.1
4) In any case... 0.1 is a small number and not a concern yet.
5) See my sig for more info on treatment-emergent CAs
6) EDIT: Sometimes the first few minutes as you fall asleep and the last few minutes as you wake up can be a bit erratic and generate pseudo-events that can be ignored. So another reason to use OSCAR is to spot when the events are happening and if they can be ignored because they are "sleep-wake junk".

As always, we prefer to see the OSCAR data so that our responses are based on data and facts instead of best-guesses.
My previous post gave hints on how to do that and my sig contains handy links for OSCAR and data organization.

Good to hear that you have a collaborative relationship with the doc.

EDIT: The idea of increasing pressures to something that feels better makes sense but I prefer to see the OSCAR data before suggesting changes.
What we would be looking for is to see what pressures the machine naturally drifts up to and then we'd use that data to suggest a pressure change that gets closer to the machine's average or median values.