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Newly diagnosed and on dream station
#11
RE: Newly diagnosed and on dream station
Your results certainly improved with pressure 8.5-15, but declined when you changed AFlex to 3. I strongly encourage you to turn down the Flex setting as I have see the Flex at 3 generally causes more problems. Your machine is not moving off of the 8.5 pressure except for the normal "tests" of higher pressure that Philips machines all do periodically. There is still some flow limitation, and I think you would may do better with a minimum pressure at 9.0. Be sure to turn flex to 1 or 2.
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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#12
RE: Newly diagnosed and on dream station
Thanks, I really appreciate the feedback! 

I'll adjust as suggested and see how I do over the next few days.

It's incredible how complex this is, and I'll keep going and learning.
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#13
RE: Newly diagnosed and on dream station
Hello,
I'm starting to understand flex a bit better IMHO, and doing as you suggested (dial flex back from 3 to 2, and minimum pressure from 8.5 to 9.)

It really helped (just one night so far) and AHI went to .55 and I managed to sleep the night.

As far as flex is considered "less is more for me", since increasing EPAP pressure from 6.6 to 7.2 seems to be a big help. I changed both variables (min pressure and flex) at once....but it certainly worked. I guess it's playing the cards you are dealt, in getting a auto cpap versus a bi-cpap.

Is it true that more OA are triggered on exhale? Or is this just a symptom of FLEX?

[attachment=11648]


Thanks
CPAP is an aerobic exersize
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#14
RE: Newly diagnosed and on dream station
OA events usually arise out of EPAP as the airway collapses at the end of expiration and at the nadir of EPAP pressure. Once that happens, the airway is closed, and respiratory effort and higher pressure just tend to reinforce the closed airway unless there is an arousal. The objective of the therapy is to keep the airway patent, so that is why all titration protocols emphasize increasing EPAP until OA is absent, then using pressure support (higher IPAP) to deal with hypopnea, flow limitations and snores. Even with CPAP, an apnea always arises out of exhale as the airway closes and prevents an effective inhale. Mechanically, the passive exhale effort creates pressure in the airway that keeps it open, but as exhale ends that pressure drops to near zero, and it is at that critical moment when tidal forces change, that the obstruction locks-in. Your machine does not provide true bilevel IPAP and EPAP, but Flex 3 does suppress pressure from returning at the end of exhale, so that probably explains why lower Flex settings are better.

Your results are fantastic and it appears the OA is fully resolved at these settings. Time will tell. Residual events, while few are hypopnea and flow limitation, so with bilevel, the next step is to increase the pressure support to 4.0. With the CPAP another 0.5 increase in minimum pressure is the alternative. Since events are so low I would consider this optional.
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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#15
RE: Newly diagnosed and on dream station
Hello,
Thank you for clearing up the flex 3 issue and approach to titration/dosing.

1. What do you recommend for reading (I'd prefer a book versus LCD monitor)? 

Last night I kept the pressure settings 9 to 15, but dropped FLEX from 2 to 1.

AHI went to 3.

2. Is this a normal variation, or did reducing FLEX cause these to trigger?

[attachment=11661]
CPAP is an aerobic exersize
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#16
RE: Newly diagnosed and on dream station
Just for documentation, these are the numbers that I'm current following:
Dreamstation auto
Min pressure 9 Max 15
Flex 2
A-FLex
O2 is set at 2

AHI 7 night average 2.09 (max 3.96 min .55)


a few observations:
1. The Dreamstation reports a fair number of events upon full awake and resumption of sleep (flow rate pattern indicates awake and I can also confirm), I'll assume these are false events, which overstates AHI, given my sleep patterns.
2. When I started to work on sleep consolidation (no sleeping during the day (coffee), therefore longer session duration ), I noticed that the events dropped and lower AHI.
3. I feel fine, but it's been a gradual change for me. I expect that the O2 numbers are good,, but I'll need to confirm with the doc at my compliance meeting.


Thanks to all on this board!
CPAP is an aerobic exersize
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#17
RE: Newly diagnosed and on dream station
5/15/19 - met with the sleep doc, basically things are going real well with a high compliance with CPAP (91%) and AHI under 3 (a high number of false positives due to my being in a waked state versus sleep), Lost ~19lbs, which brought me to 272 from 292...so that was good news for a 8-10 week number. A few items;

1. Try to avoid napping during the afternoon slump.
2. Lose more weight
3. Exersize more intensely (versus my walking)

The goal is to get uninterrupted sleep over a 6 - 7 hour period, and 20 more pounds off

Finally went over my sleep study AHI was 72.4, and O2 level was 85%., the pre-sleep study oximetry was 67%,. talk about driving a car off a cliff.
CPAP is an aerobic exersize
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#18
RE: Newly diagnosed and on dream station
"O2 is set at 2"
2lt/m? try min 11, the 95% and let me know how the recording spo2 meter goes
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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#19
RE: Newly diagnosed and on dream station
O2 is 2 lt/minute, I've had some discussion with my doc on this, a recent oximetry (with the O2 supplement) was as follows:

O2 recent study was min 88% max 98% with average 91%,. This was a Resmed meter supplied by my DME for an overnight study 2 weeks ago. so, I'll work on getting a meter..

I have one more night that I'll check at 9-15 min/max pressure, and then I'll give a shot at 9.5 - 20 for min/max pressure. The 9.5 is 2cm below my 95% pressure of 11

Thanks
CPAP is an aerobic exersize
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#20
RE: Newly diagnosed and on dream station
Have a read about fixed cpap or peep pressure and o2. The consensus is to raise o2, you raise pressure. It is the case with several people and it might be with you too.
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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