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New to forum and to data analysis
#41
RE: New to forum and to data analysis
I'd like to see minimum pressure raised to 8.0. We have some OA that requires the higher pressure, and as we increase minimum pressure, we will be reducing pressure variation from the Autoset response. This usually results in less sleep disruptions and fewer centrals. I'm fairly certain she will end up with a minimum pressure between 9 or 10 before we really see the OA events drop out. As she adapts to this pressure it will become unnoticeable. In addition to increasing minimum pressure to 8.0, please increase the minimum ramp pressure to 6.0. I doubt she will notice it, but it will allow for a better initial mask fit to reduce leaks. If you get a complaint about comfort, reduce to 5.0 cm, but only if she complains.

The progress on AHI is very good. Good therapy on an Autoset has a distinctive look. It is a minimum pressure that prevents most events, and relatively small pressure changes through the night.
Sleeprider
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#42
RE: New to forum and to data analysis
(09-29-2020, 04:53 PM)Sleeprider Wrote: I'd like to see minimum pressure raised to 8.0.  We have some OA that requires the higher pressure, and as we increase minimum pressure, we will be reducing pressure variation from the Autoset response. This usually results in less sleep disruptions and fewer centrals.  I'm fairly certain she will end up with a minimum pressure between 9 or 10 before we really see the OA events drop out.  As she adapts to this pressure it will become unnoticeable.  In addition to increasing minimum pressure to 8.0, please increase the minimum ramp pressure to 6.0.  I doubt she will notice it, but it will allow for a better initial mask fit to reduce leaks.  If you get a complaint about comfort, reduce to 5.0 cm, but only if she complains.

The progress on AHI is very good.  Good therapy on an Autoset has a distinctive look. It is a minimum pressure that prevents most events, and relatively small pressure changes through the night.

Thank you for the suggestions. I was thinking of increasing the ramp min to 6 as a separate activity and then increase the regular min pressure to 8. Your comment on the "distinctive look" is good to know. I will be looking for less pressure changes. And as we get minimum worked on then we may be looking at reducing max.
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#43
RE: New to forum and to data analysis
As many things, numbers can be misleading. The low AHI values that she got with the new N30I mask, I think were a false indicator. We see almost no OA's. She had lots of leakage as I talked to her further she said that the mask is terrible and she is not sleeping much at all. She spent 2 days (Sept 27-28) wearing it and got good numbers but did not sleep well. So she put on a newer Phillips Wisp mask (harness and mask are very new).
The AHI went up but it appears that most of the evening they were OA's that occurred while she was sleeping. She had very little leakage most of the night and said she slept like a log - it was great. Sept 29 shows this higher AHI. With the new mask she went two more evenings with it (Sept 30 and Oct 1) and the numbers are still near 5 for AHI. But the leakage is lower.
We did go replace the N30i with a N20.  It is similar to the Phillips Wisp but supposedly has a better harness and mask. So for this evening , no changes to setting but she will wear the new mask so we can see what difference (if any) it makes.

It really looks like , moving the min pressure higher will go after those OA's and that is the next planned change. Also we will work on raising ramp min also. If I understand this correctly, you really need to be asleep in order to have an OA but you don't have to be asleep to have a CA.


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#44
RE: New to forum and to data analysis
You could produce an OA while awake, but you'd have to work at it.

As you follow your plan re raising minimum pressure on ramp and on non-ramp, keep in mind the option of small increments of .02. They may be barely perceptible and well tolerated. Let each increase sit for a few days before trying another one.

Good luck with the mask quest. I can't recall -- has she tried a nasal pillow mask? The pillows might stay in place better than the nasal-mask interface. Just a thought.
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#45
RE: New to forum and to data analysis
She has tried pillow masks and they don't work for her.
Good idea on the small increments of change in pressure.
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#46
RE: New to forum and to data analysis
1st night with new mask (Oct 2) and there were some large leaks. Shows many more CA's and a CSR. I don't fully understand what a CSR is.
I noticed the OA's are a little high still but scattered. So for the next night I increased the min pressure to 8 and the start pressure for ramp to 6.
So for Oct 3 we do see a reduction of OA's. No large leaks. She did tighten up the top of the mask harness a bit. She felt that the leaks were normal and related to shifting while on her side. During the times with many CA's she is not comfortable while sleeping.
The CA's started occurring earlier in the evening. They are usually occurring during her second sleep session (after bathroom break).
From earlier recommendations, I'm thinking that changing the EPR to 1 for this evening would be a good test to see if CA's go down.

Any other recommendations for these CA's? She even remembers weird dreams that are having her in debates with other people and that the topic is not being resolved. They seem to match the time frame of the high volume of CA's. Not sure if that is relevant but we thought it was possibly related to hear struggle breathing - more of a affect than a cause of the CA's.


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#47
RE: New to forum and to data analysis
For Oct 4 , we changed EPR from 3 to 1. No other changes. She indicated that she felt more pressure to the point that her mask would fill with pressure and then seep out the mask waking her up. She also indicated her nostrils were very dry in the morning.
I see reduction in the OA's but no real change to the CA's.
Not sure what to do from here.


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#48
RE: New to forum and to data analysis
Limit pressure to 8.0, or consider fixed pressure at 8.0/7.0 with EPR 1. Since her minimum pressure is already 8, just set the maximum pressure at 8.0 as well.
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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#49
RE: New to forum and to data analysis
I will leave advice about the settings to the experts.

CSR is Cheyne-Stokes respiration, which is a misnomer. What the green areas pick up is periodic breathing (PB). CSR is a subcategory of PB. (To tell the difference, you'd need to look at a flow-rate graph zoomed in to about 2 minutes.) CSR is associated with some chronic diseases; non-CSR PB is not. Unless this becomes a regular thing, it really doesn't need attention.

Two questions: did you and your wife ever discuss your high altitude with the doctor? And in your wife's original sleep study, what was the breakdown in her AHI (OAs, CAs, Hs)? If you don't have a copy, you can request one; in the U.S. you have a right to a copy.
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#50
RE: New to forum and to data analysis
(10-05-2020, 11:29 AM)Sleeprider Wrote: Limit pressure to 8.0, or consider fixed pressure at 8.0/7.0 with EPR 1.  Since her minimum pressure is already 8, just set the maximum pressure at 8.0 as well.

I will set the max to 8.0, leave EPR at 1. I do see that the pressure was at 10-11 a lot, thus the Exhale pressure was 9.
Do you think that the pressure being alllowed to go higher is cause of CA's.
I can also see that running this simply as a test for results will give more information. I'm guessing that the OA's will go up a little but possibly get the CA's down.


Thanks for the quick response.
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