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New Guy! High AHI
#51
RE: New Guy! High AHI
Be aware that 5-20 with PS=4 is a very standard setting for a patient with OSA, and should be adjusted after getting results. CA . . . . .
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#52
RE: New Guy! High AHI
The settings given to you by the DME will fail. For greater comfort and even the possibility of efficacy, I'd like you to try a pressure range in Vauto mode of 5.0 minimum, 10.0 maximum, PS 3.0 and set the Trigger sensitivity to high, and Ti Min to 0.7.

Lower PS will avoid over-ventilation and CA should drop. A high or very high trigger sensitivity can overcome a very weak spontaneous inspiration and turn it into a breath. Ti Min means the minimum time that the Vauto will maintain IPAP pressure when it is triggered. The default Ti Min is 0.3 and is designed not to have any influence on a person the breathes normally, but a longer Ti Min will hold IPAP at least 0.7 seconds, so if you quit breathing, you still get at least that much time for inspiration. These settings are not going to solve the problem, but may cut CA events in half. This is intended to hold you over to ASV, and very few DMEs or even the doctors know how to use these settings for complex or central apnea.
Sleeprider
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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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#53
RE: New Guy! High AHI
(11-23-2019, 09:25 AM)dahornor Wrote: Fred (et al), I'm not sure I see the benefit of squashing all the OSA and upping the CA--unless the doctor and/or DME is willing to accept OSCAR as a valid source of sleep data. *I* have tons of confidence in OSCAR (I was an assembly/machine language programmer back in the early 80's) but they don't.

What you could do is download and install Resscan from http://www.apneaboard.com/forums/Forum-P...-and-Links here this is the official manufacturers software... its a pain to use and I suggest you get the 5.9 version then you wont have an issue with a password required to launch the program

But your Dr will believe reports from this.....
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#54
RE: New Guy! High AHI
Thank you, Fred and SR.

On a related issue - the DME keeps telling me that I may have false positives for CA's. They insist that the only reliable way to detect a CA is via polysomnography. What do y'all think of that argument. It seems odd to me because the CA's are clearly included in the AHI number that my ResMed is displays--and OSCAR computes. What gives with this "false positive" idea?
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#55
RE: New Guy! High AHI
It means that the CPAP machines are not detecting breathing effort therefore they are wrong.
While that is the Gold Standard that is BS. The FOT that is used by your machine is accepted.

IMHO the response than achieve a solution that works in a sleep lab, BUT that has to include an ASV Titration.
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
Soft Cervical Collar
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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#56
RE: New Guy! High AHI
FOT = "Forced Oscillation Technique"
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#57
RE: New Guy! High AHI
What you can see in your OSCAR chart is that there is zero respiratory flow at each CA event, and you can see the duration of those events. Polysomnography is a more sensitive method of testing multiple physiological responses, including oxygen saturation, sleep stage, movement respiratory flow, respiratory effort and many other issues. A CPAP machine only measures the flow rate and pressure to infer the issues, but they have been demonstrated to be accurate in monitoring apnea and reductions in flow. You may indeed have some false positives for CA, but overall, the machines are pretty accurate, and you can actually look at the flow rate to verify if respiratory flow has stopped or diminished, and the duration of that event.

You could send them a copy of this study that shows the machines accurately record events, and the biggest discrepancy in results is not flagging apnea, but the recording of hypopnea that might not be scored in polysomnography without an oxygen desaturation meeting the criteria. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767059/ Note this study was done in 2013, and a whole new generation of machines with more sophisticated event detection are now in use, including yours.

I think when the DME offers a ridiculous assertion like this, you can ask how many of their customers have a machine indicated AHI of 20 to 30 events per hour that they feel represents efficacy? Another way to refute the DME's assertion would be to wear a recording oximeter. They are not very expensive, and results can be correlated with CPAP data to show SpO2 and heart rate and how the events affect them.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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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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#58
RE: New Guy! High AHI
    Much better. Thanks, SR, for the settings suggestion.  As you predicted, CA's are about in half.  I had the best night's sleep since I got the new VAuto machine.  Onward, now to (hopefully) an ASV machine!
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#59
RE: New Guy! High AHI
Those results are better than expected. Your AHI may be consistently inconsistent with mostly central activity, but this looks promising and far more comfortable. The array of respiratory stats all look improved.
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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#60
RE: New Guy! High AHI
(11-26-2019, 01:45 PM)Sleeprider Wrote: Those results are better than expected.  Your AHI may be consistently inconsistent with mostly central activity, but this looks promising and far more comfortable.  The array of respiratory stats all look improved.

??
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