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Newbie looking for guidance...
#1
Newbie looking for guidance...
Attached is my sleep study as well as a couple of Daily Oscar views.  This is new to me and I'm not sure how to set up the ResMed machine.  Any suggestions would be welcomed.

I know the postings are for very short nights, and the first hour is spent attempting to sleep.  It may be you'll need better data to give much assistance.  But I was very proud of getting the 4-hour night!

With so much time spent awake, is it possible to get reliable results?


[attachment=12157][attachment=12158]


.tiff   page 1a sleep.tiff (Size: 96.74 KB / Downloads: 136)
.tiff   page 2a sleep.tiff (Size: 58.8 KB / Downloads: 121)
.tiff   page 3a sleep.tiff (Size: 81.25 KB / Downloads: 111)
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#2
RE: Newbie looking for guidance...
A low apnea rate and a low pressure to clear them. You shouldn't have too much trouble. The machine is maxing out at 5.6, you can see in the left hand column, the med, 95% and max are all the same. I would lift the max pressure to 10, the machine will use what it needs to. If the pressure is an issue, you might like to raise it 1cm at a time.
Mark fit is the best thing for you to work with at this stage. There is a function on your machine that will blow high pressure, while you lay down and fit your mask. Roll over and move a lot, to check. Also mouth leaks can be an issue with a nasal mask.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: Newbie looking for guidance...
I note that the sleep study appears to show a low AHI with a high number of RERAs and flow limitations. 

Ajack, does that change your recommendation about pressure?  

And Insopita, could you post a chart tomorrow for tonight’s sleep that includes all of the the chart for flow limitations?  You can squeeze it in there by squishing some of the other charts a little. (Grab the gray horizontal edges of the charts to change their size.) You did a great job getting going with Oscar, by the way!
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#4
RE: Newbie looking for guidance...
Your Sleep Study showed a high number (RDI) of RERAs. By definition, RERAs are a series of Flow Limitations ending with Arousal.  Both your charts, though cut off, show a fair amount of Flow Limitations remaining.  The first one still had several RERAs

I would set my min pressure on 6 and set EPR to 2.  This is a paired suggestion.  This will set your initial EPAP (exhale pressure) to 4 and your initial IPAP (inhale pressure) to 6.  
EPAP pressure is what treats Obstructive Apnea, of which you have very little, the pressure difference between exhale and inhale (PS or Pressure Support on a higher level machine) treats Flow Limitations and RERAs of which you had plenty in your diagnostic study, and still have fairly high and consistent Flow Limitations from what I can see in the cut off chart on the bottom.  I do see the possibility of increasing both your min pressure to 7 and EPR to 3 depending on both how you feel and what we see in your nightly charts.

Because your numbers are low (very low) it is very important that you tell us how you feel and what you think the changes have done for you.
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#5
RE: Newbie looking for guidance...
Thank you all so very much for the feedback!  I've made some changes to my machine ... EPR which I'd never used is now set at 2.  Also, raised min to 6.  Will return tomorrow with adjusted chart.  I'm assuming I must leave the Mode on Autoset. 

Thanks, Dormeo!  I feel like I've been LIVING and BREATHING Oscar for two days now, trying to figure things out.  It's been truly interesting to learn about this therapy.  I was secretly hoping you folks would say I really didn't need it with such low apneas, but since that didn't happen, I'm committed to working this out.

See you tomorrow.....
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#6
RE: Newbie looking for guidance...
You are an example of how we are all different. If I were to only look at your AHI I would conclude that you didn't need CPAP therapy. You had extensive RERAs and by implication flow limitations neither of which are included in AHI.
Very important that you indicate how you feel including how you think the changes have impacted you.

Flow Limitation is the mildest form of restriction that we can observe behind apnea and hypopneas.
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#7
RE: Newbie looking for guidance...
Attached is last night's Daily page.  I also attached the Overview as I'm so proud of finally getting up to six hours!  However, I was awake the first hour or more, also awake in the night.  But this is progress. 

Minimum pressure of 6 was very comfortable.  Raising the maximum doesn't seem quite so intimidating with your encouragement.

Am I correct to leave the Mode on Autoset?

I did not feel any more rested this morning, though I felt lots more hopeful with your coaching!  My goal is that I'll be able to sleep more than a couple of hours in a stretch and feel at least somewhat refreshed.

Thank you again for the help.


[attachment=12166][attachment=12167]
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#8
RE: Newbie looking for guidance...
Not bad. See all the Flow Limitation that is still there?
Set EPR to 3, Min to 7, Max to 10. Another move to attack the Flow limitations by increasing your pressure support, 'cuse me your EPR (the min pressure is adjusted to make that a pressure support move). The Max pressure is increased, well because we had to increase it anyway and this should give you a little room. Really not concerned with max pressure. Min is set, and has been for many years to the machines max, but that does not mean your's should be.

Important that you state whether last nights settings or these feel better for you.
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#9
RE: Newbie looking for guidance...
Okay, I've adjusted the settings. 

Any chance I should creep up to the max 10?  Will it blow me away?

By the way, is the Flow Limitations chart supposed to be somewhat flat?

Thank you!
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#10
RE: Newbie looking for guidance...
Insopita, congratulations on your usage time! As you follow the good advice you’re receiving, and also just get used to everything, I’m betting you will start sleeping better and feeling more rested during the day.

In general, it’s good to make changes gradually and see how you feel over a period of days before making further changes. I’ll be interested to keep hearing from you about how it’s going.

The ideal flow limitation chart will be blank or will have a few scattered and small FLs. Yours strikes me as unusually active, with frequent and relatively high FLs. It’ll be good to see how they respond to the settings Bonjour is recommending.

One big reason for paying attention to the FLs is that breathing with FLs is effortful and can keep sleep from cycling through the normal stages of sleep. They are a bit like almost-apneas. So it will be good to see them getting smaller and less frequent.
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