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New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy
#11
RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy
Hi, thanks again, I will try to purchase one of these, I'm sure my doctor will write me a script, however it will take ages for my medicare /supplemental and my equipment supplier to process everything, and I don't want to wait, so I will just bite the cost.

I think I will continue apap tonight as I had such a good night last night.

Paul
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#12
RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy
I agree your therapy will be greatly improved in both comfort and efficacy with bilevel. Let me know generally where you live and I’ll try to point you to some good deals.

As I suspected, it is your flow limitations that are the root cause of problems. We don’t know (or care) why you have chronic upper airway restriction, but this is a worthwhile discussion to have with your doctor. Show him examples and I’m sure he will agree bilevel will be helpful in your case. Once we get you setup I think you will be amazed at the difference pressure support can make in how you feel. These flow limitations can be relived to a considerable degree by use of the soft cervical collar, so let’s take another look after you have given that a try.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#13
RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy
Well, it is pretty eye-opening that the Respironics DreamStation did not flag a single incident of significant flow limits (0.0) on the Oscar graph, but they are fairly obvious looking at the 3 minute Flow rate graphs. Nay good, but thankfully, ResMed takes a different approach and gets it right.
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#14
RE: New in this forum. [Snowy2020] Need help to understand graphs and adjust therapy
Hi,

Probably does not make a difference, but I have a Philips dream machine
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#15
RE: New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy
If looking to buy look at Supplier #2 on the supplier list at the top of the site. They sell slightly used machines. VALTO for 800 no shipping charge. I bought mine there 1 month useage. Great company and machine
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#16
RE: New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy
The Philips Dreamstation and prior generations of Philips Respironics machines define flow limitation as a reduction in tidal volume that meets an event criteria, but is not hypopnea. The machine has no response to flow limitation. Resmed uses an algorithm that measures the "flatness" of the inspiratory curve, and aggressively treats it with increased pressure. The difference is simply a machine that is ineffective for people with upper airway resistance syndrome, and one that works very quickly to not only treat flow limitation, but to stop apnea and hypopnea before it happens. The Philips algorithm for obstructive sleep apnea is effective only when you set it high enough to be effective like a fixed CPAP. The auto algorithm totally fails, and the pressure delivery does nothing to actively treat flow limitation, RERA and hypopnea, while the Resmed Auto CPAP uses a bilevel (BiPAP) pressure strategy with up to 3-cm of pressure support. The difference is significant.
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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#17
RE: New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy
Hi Again,

while I  try to get approval from my doctor for the resmed bi level you suggested, I moved over to APAP for the last 2 nights.  See attachments.

From my limited understanding so far, things look a little better?


Do you have any further comments that would be helpful?

The cervical collar is arriving today.

[attachment=26392]

[attachment=26392]

thanks as always for all your help

Paul
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#18
RE: New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy
I'm sure you will see a significant reduction in the event rate and flow limits from the use of the SCC. Even without that, the AHI is acceptable, which will make getting your doctor onboard for therapy changes a challenge. Moving pressure from a minimum of 9.0 to 10.5 reduced AHI by 50% and improved other aspects of therapy including RERA and variable breathing. This does look much better, and I think we need to see how things settle out with the use of the collar before jumping into bilevel. I know from personal experience and that of many members that where flow limits are prevalent, bilevel therapy can take comfort to a new level, however, the medical system and insurance is not normally that accommodating.
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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#19
RE: New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy
Hi,

I bought a cervical collar but it seems too thick and restrictive...do they make thinner ones?  My doctor says he is not ready to support a bipap machine.

I have been playing with the apap settings and reduced the flex to 1 and had the best night ever on the 12th. See chart.

[attachment=26546]

However on the 13th, after reducing the ramp a little, with no other changes, I'm back to the same disappointing numbers. See charts.

[attachment=26547]        [attachment=26548]

Any suggestions? Should I turn off the A-flex and the ramp completely?


As always, 

thanks,

Paul
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#20
RE: New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy
The SCC will help with the obstructive clusters. We know that bilevel pressure helps with flow limitations, RERA and hypopnea. We can get similar results to bilevel with the Resmed Airsense 10 Autoset which is a CPAP machine that uses EPR (exhale pressure reduction) that is identical to the pressure support of bilevel. I think I'll just post a copy of the explanation Bonjour uses:

ResMed AutoSet Dreamstation Auto comparison
Why ResMed?
1. Faster algorithmic response to events than PR.
2. ResMed Responds to Flow Limits
PR responds to Snores
3. Lower average pressure (PR require a higher pressure to ward off obstructive events)
4. Better to avoid Aerophagia.
5. EPR provides for better treatment of hypopneas, RERAs, Flow Limits, UARS, and snores
6. EPR acts like a BiLevel up to a limit of 3cmw (1,2, or 3cmw) and a max pressure of 20 cmw
7. EPR follows your breathing whereas Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly
8. More flexibility in treating a greater variety of Apneas and respiratory events.
9. In general provides better therapy.
I have frequently told many DreamStation users that they need to get either the ReaMed AutoSet or BiLevel to get better therapy.

What is BiLevel?

BiLevel 101:
Pure CPAP delivers a single constant pressure. This pressure is what splints open the airway. APAP (AutoSet) is what we prefer to see as it can vary the pressure to suit the situation. For now, let's forget about APAP.

Basic BiLevel delivers two fixed independent pressures, EPAP is Exhale Pressure and is what actually splints the Airway open, It is the equivalent of "Pressure" in a CPAP and does the same thing.
IPAP or Inhale pressure is the higher of the two pressures. Once the Obstructive Apneas are resolved with the Exhale pressure (EPAP), IPAP is used to resolve hypopneas, flow limits, RERAs, and UARS.
The difference in these pressures is called Pressure Support or PS. PS is always added to EPAP by convention to get IPAP so IPAP = EPAP + PS
FYI if you were to set the EPAP = IPAP you would have a basic pure CPAP functionally.
The above info is derived from Titration guides.

BiLevel 102:
BiLevel models are not interchangeable. Each is designed for a specific condition.
up rate. On the most basic level this is fully applied everytime.
Backup rate is the frequency in breaths per minute that the BiLevel will initiate. The basic BiLevel does not have this feature and instead just follows your breathing with a mode called Spontaneous or "S". Timed mode or "T" initiates a 'breath' at the defined 'rate' in breaths per minute. How effective this is varies by individual and the settings defined includine EPAP, IPAP, and PS.

The Auto CPAP such as the ResMed AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea

Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.

They should be chosen to treat the specific condition that the user has, Here are the various CPAP Modes and what they are designed/intended to treat

The following info is from the ResMed Sleep Lab Titration Guide

* CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
* AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
* AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
* VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
* S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
* ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
* T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
* iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
* ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
* ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
* PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
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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