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Not sure if I should adjust my settings....
#1
Not sure if I should adjust my settings....
I've been on a respironics dreamstation APAP with a dreamwear nasal mask since early August. My AHI's have ranged from 11 down to 1.5 on various nights and the sleepyhead graphs seem to be all over the place.  Overall, my 30 day average hovers around 5 (pre-APAP sleep test was 35).  I have permanent atrial fibrillation (AFIB) which I think may be a cause of the shallow breathing (note: there has been no change in my cardiac measurements in 15 years...it's stable AFIB, if that makes sense).

I tried to pick a recent sleepyhead chart that looks "typical", but they really do vary quite a bit.  My respironics APAP is set with 15 minute ramp to 4.0 and the range of pressure is 4-20.  Exhale control on 2, humidity on 3 (but I don't see any water use during the night).  Near as I can tell, I'm set up with the "let the APAP figure it out" settings....which may be OK since I am down to 5 AHI...but maybe with some tweaking, I can do better.

Any thoughts on my chart?  Should I try things like shortening the ramp, raising the low pressure setting? Any thoughts/suggestions or encouragement are appreciated.

My sleepyhead chart
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#2
RE: Not sure if I should adjust my settings....
The Respironics machines are known to increase pressure slowly and reduce it as quickly as possible. For this reason it's necessary to set your minimum pressure reasonably high so that it can get up to the therapeutic pressure in time to head off those hypopneas. I'd try setting the minimum to 7.0 or 7.5, which is around the median on this chart and see how that goes.

You're also losing a lot of therapy time because of the ramp every time there is an interruption, so reduce the ramp as far as you are comfortable with - ideally turn it off completely if you can do that comfortably.

I see a lot of periodic breathing reported, which may be nothing or it may be something. It would be good if you could zoom in on some of those PB periods so we can see what's happening in more detail.
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#3
RE: Not sure if I should adjust my settings....
My impression is that you would be better off with a constant pressure of about 7.0. At lower pressures after ramp, there are a lot of flow limitations and hypopnea, then things seem to clear up until your machine drops pressure, and they return and pressure bounces back up. I think we might learn something if your would change your minimum pressure from 4.0 to 6.0, and maximum pressure from 20.0 to 8.0. This should keep you in a more suitable range. Alternatively, set minimum and maximum at 7.0 and see if constant fixed pressure does the trick. Ramp should not affect this too much, but you should eventually be able to wean off of that crutch as you adapt to this relatively low pressure.
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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#4
RE: Not sure if I should adjust my settings....
I like to take one step at a time, so based on input (so far) and general reading, I'm going to raise my minimum pressure to 6 for a few nights leaving the ramp at 15 min....and see how that works. Assuming some improvement, I'll cut the ramp time to 10...and then the third step might be to raise the min pressure to 7 or even 8. My 90% level has been pretty constant around 9. Why would lowering the max pressure have any effect. The max I've ever seen was 13...and I think I was having mask problems that night.

Does that sound reasonable...
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#5
RE: Not sure if I should adjust my settings....
I am actually recommending you REDUCE your MAXIMUM pressure to 7.0 or work with a range of 6.0 min and 8.0 max, or constant pressure of 7.0. This is based on the observation that your results show no events until your pressure exceeds 7.5 cm. My current working theory is that you don't have plain-vanilla obstructive apnea, but a complex apnea that is made worse by higher pressure. The reason to limiting pressure as part of this titration is to see if this hypothesis is true, or if the OA events come through at lower pressures.
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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#6
RE: Not sure if I should adjust my settings....
Thanks for the responses...

As I said, the sleepyhead stats/charts vary quite a bit from day to day.  I looked at some other days when I had good and bad nights (based on AHI)...and the are very different...most show many events at pressures under 7 and actually fewer at higher pressure.  It's confusing, at least to me.    I think I'll go with setting the ramp to 6 (from 4), keep the ramp time the same (15) and changing the auto minimum pressure to 6 (from 4) and see how that goes.  One step at a time....  

Don't forget I have AFIB...and that likely enters into and complicates any analysis of sleepyhead data.
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#7
RE: Not sure if I should adjust my settings....
So I changed my minimum pressure to 6...no other changes.  Result is that my average AHI is down, under 5 on almost all nights since making the change....range (.41 to 5.83 with an eyeball mean of about 3.5).

[url=[Image: U2FbulUl.png]]The chart[/url]

It does raise some (non medical) questions like why does my APAP increase the pressure when nothing seems to be happening?

I woke up about 6:15 and lay there thinking and dozing......so I think that's sort of general clutter (?).

I don't see anything that would suggest to (no idea what I'm doing) me that lowering the maximum pressure would effect anything....nor would shortening the ramp time.....but I'm certainly open to observations and suggestions.

I do thank you for the suggestion to raise the minimum to 6...that really seems to have leveled off my AHI at a lower level than when it was on 4. Hmm...should I try 7??
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#8
RE: Not sure if I should adjust my settings....
If not for the period from 06:20 to wake-up, it looks pretty darn good. I can't tell what drove pressure to 13 cm at 03:00 except for one obstructive event and snores. Any chance you are having a positional apnea issue with chin-tucking? Some members manage those episodes with a soft cervical collar.
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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#9
RE: Not sure if I should adjust my settings....
The dreamstation is slow to respond, I think everyone is polite on this point. It really does like the min pressure to be close to the average 95%. which is often used as a fixed pressure. I agree with the general 2cm below average 95%, that is suggested on this forum. It's observational and there isn't a study to support it. As there are for using the median pressure as the minimum. It will resolve most issues.

In most people, the auto algorithm of the machine won't over pressure to cause events as sleeprider suggested. You can zoom in on individual events to see if the forum can see a reason for it. Some peoples breathing pattern can trick the machine. The machine can rise to the max pressure set, be it 10, 15 or 20 and just sit around there all night. These people may be better on a fixed pressure. Which takes a couple of weeks to work out the 95% average on an auto machine and may be better to be titrated properly by a lab. The machine in auto mode, will increase pressure with snoring, flow limit, hypopnea, obstructional apnea. This is what the algorithm is designed to do. This video gives a good idea of what happens in sleep apnea.
https://www.youtube.com/watch?v=-gie2dhqP2c
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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#10
RE: Not sure if I should adjust my settings....
AJACK; Thanks for posting that video.  It was the first time I have seen it and it has a wealth of information. Okay
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