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[Pressure] Could someone please help with settings?
#11
RE: Could someone please help with settings?
Just be sure the collar is not too tight. You still want to be able to move a little.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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: Could someone please help with settings?
(06-19-2019, 07:22 PM)Bweekzzz Wrote: Thank you so much OpalRose.  You guys rock!!  So nice to know i’m not alone in this!!!  
      Darn right.  That Dreamstation is one pretty machine.  LOL. We have a couple on my ventilator unit.  Im a nurse on a vent unit, you’d think this would be a breeze for me figuring all this out.  Nope.  LOL
       I’ll take yours and ajack’s suggestions and set pressure to 10 and Aflex to 1.  Just one more question.  Do you think i should keep using the cervical collar?  Do you think it could be restricting my airway somehow?  Just a thought.  
       Again, thank you soooo much!!!

The cervical collar is for an off-book use, to keep the chin from tucking, not to support or immobilize the neck.  I should be loose fitting, not snug.

The following may help you to understand and allow you to view things more from your background as a Vent Unit Nurse.

Add 1 to your AHI.  Why? because of the RERAs which are 1+.  RERAs are best treated with Pressure Support (PS) from a BiLevel, look at the IPAP and EPAP on your machine (OSCAR) and think of it as a limited BiLevel.  You can achieve some effect similar to but different from a Bi-Level by utilizing Flex 1 or 2 (Many have issues with Flex of 3 but feel free to try.)  (ResMed with its EPR gives virtually an exact match of Pressure Support up to 3 cmw PS.  PR machines algorithmically determine how much Flex to apply depending on recent breathing history so it doesn't match PS that closely.  

Because you can gain little benefit by increasing Flex, try slowly raising pressure to decrease Flow Limits and the associated RERAs (with their associated arousal)

Just for "fun" zoom in on the Flow Rate Chart (left click multiple times), You can see each breath in extreme detail if you choose to do so.
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#13
RE: Could someone please help with settings?
Ok ajack.  Minimum pressure 10, Aflex 1, wear the collar.  Thank you so much!  You have a great night, and I’ll make sure to let you know how things go.  Crossing fingers.
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#14
RE: Could someone please help with settings?
(06-19-2019, 09:29 PM)bonjour Wrote:
(06-19-2019, 07:22 PM)Bweekzzz Wrote: Thank you so much OpalRose.  You guys rock!!  So nice to know i’m not alone in this!!!  
      Darn right.  That Dreamstation is one pretty machine.  LOL. We have a couple on my ventilator unit.  Im a nurse on a vent unit, you’d think this would be a breeze for me figuring all this out.  Nope.  LOL
       I’ll take yours and ajack’s suggestions and set pressure to 10 and Aflex to 1.  Just one more question.  Do you think i should keep using the cervical collar?  Do you think it could be restricting my airway somehow?  Just a thought.  
       Again, thank you soooo much!!!

The cervical collar is for an off-book use, to keep the chin from tucking, not to support or immobilize the neck.  I should be loose fitting, not snug.

The following may help you to understand and allow you to view things more from your background as a Vent Unit Nurse.

Add 1 to your AHI.  Why? because of the RERAs which are 1+.  RERAs are best treated with Pressure Support (PS) from a BiLevel, look at the IPAP and EPAP on your machine (OSCAR) and think of it as a limited BiLevel.  You can achieve some effect similar to but different from a Bi-Level by utilizing Flex 1 or 2 (Many have issues with Flex of 3 but feel free to try.)  (ResMed with its EPR gives virtually an exact match of Pressure Support up to 3 cmw PS.  PR machines algorithmically determine how much Flex to apply depending on recent breathing history so it doesn't match PS that closely.  

Because you can gain little benefit by increasing Flex, try slowly raising pressure to decrease Flow Limits and the associated RERAs (with their associated arousal)

Just for "fun" zoom in on the Flow Rate Chart (left click multiple times), You can see each breath in extreme detail if you choose to do so.

It's also available in the guide
https://www.resmed.com/us/dam/documents/...er_eng.pdf
page 24 CPAP titration
Increase CPAP ≥1 cm H2O every ≥5 mins for obstructive apneas, hypopneas, RERAs and at least 3 min of loud or unambiguous snoring
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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#15
RE: Could someone please help with settings?
Morning OpalRose.  Went to be earlier than usual last night.  Couldn't wait to test your guys suggestions.  LOL.  That's what I did.  Wore the collar just loose/tight enough to where it was pretty much right under my chin so I couldn't bend my chin down.  The night went great and my AHI went way down with your guys suggestions.  Not counting my chickens yet though, and gonna keep the settings for a week and see.  I'm gonna post last nights chart below in the thread so everyone can see.  Thank you so much.  I know I keep saying it, but it feels so good knowing people like you guys are here to help out and help me understand things.  Have and absolutely wonderful day!!!
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#16
RE: Could someone please help with settings?
Great, waiting to see the chart! Glad the collar works for you. Comfort is first. Smile

Just remember, there are many variables that affect AHI from night to night. Some may be: sleeping more or less hours than what is normal for you, eating or drinking late or right before bed, having colds and suffering with congestion, medications, etc.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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: Could someone please help with settings?
Good morning bonjour.  Thank you so much for helping me understand better.  It's funny, although I'm a nurse on a vent unit, when it comes to my patients I know what to do and it's like autopilot, but when it's me I totally draw blanks.  LOL. 
      If I understand correctly, if I'm still having a lot of RERA's and Flow limitations, I should increase the minimum pressure (slowly), and utilize the Aflex as a sort of "relief" from the higher pressures.  I'm gonna post last nights chart down below so everyone can see.  My OA's and Hypop's went WAY down after I changed my machine to everyones suggestions, (Min press - 10, Aflex x1) and even then I don't THINK they are real from looking at the waveforms closer at each event.  I'm pretty sure they are just from rolling over or movement somehow.  Big jagged waveform before the event and still breathing waveform during the event.  I'm gonna keep the same settings for the week, unless you guys suggest changing anything. 
        Your guys are absolutely awesome too!!  So nice to know I'm not alone in all this.  Have an absolutely wonderful day!!!
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#18
RE: Could someone please help with settings?
Good morning Jack.  Thank you so much for that link.  Totally helps me understand better what to do.  I couldn't wait to go to bed last night and test the settings you guys suggested.  LOL  My AHI went way down last night.   I wore the cervical collar just loose/tight enough to be right under my chin.  
   I'm gonna post last nights chart down below, so everyone can see. Although I am still showing some RERA's and Flow limitations, which I understand can be helped with a higher minimum pressure and Aflex,  I'm not changing any settings, unless you guys think I should.
   Have an absloutely amazing day Jack!!!
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#19
RE: Could someone please help with settings?
Ok everyone.  As promised, here's last nights chart from Sleepyhead.  I still use it, because my lovely computer won't take the screenshot with Oscar.  Drum roll please.  Aint she pretty.  LOL   My AHI went way down and only a couple OA's and hypop's through the entire night, and even then, looking at the waveforms much closer I'm pretty sure they werent' real one's anyway.  I am still showing some RERA's and some FL's, (increase min pressure by half step tonight?) but all in all I am sooooo happy after looking at last nights results.  Unless you guys think I should, I'm going to keep the same settings (Min press - 10, Aflex x1) .
     Every last one of you have an absolutely amazing day!!!  You ALL deserve if for the help you provide in this community!!!!!


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#20
RE: Could someone please help with settings?
(06-20-2019, 09:08 AM)Bweekzzz Wrote: Good morning bonjour.  Thank you so much for helping me understand better.  It's funny, although I'm a nurse on a vent unit, when it comes to my patients I know what to do and it's like autopilot, but when it's me I totally draw blanks.  LOL. 
      If I understand correctly, if I'm still having a lot of RERA's and Flow limitations, I should increase the minimum pressure (slowly), and utilize the Aflex as a sort of "relief" from the higher pressures.  I'm gonna post last nights chart down below so everyone can see.  My OA's and Hypop's went WAY down after I changed my machine to everyones suggestions, (Min press - 10, Aflex x1) and even then I don't THINK they are real from looking at the waveforms closer at each event.  I'm pretty sure they are just from rolling over or movement somehow.  Big jagged waveform before the event and still breathing waveform during the event.  I'm gonna keep the same settings for the week, unless you guys suggest changing anything. 
        Your guys are absolutely awesome too!!  So nice to know I'm not alone in all this.  Have an absolutely wonderful day!!!

You are starting to do quite well with your Philips PRS1 Auto-CPAP, but for the longer term, or if you find some good DME coverage for a new machine, I'd like you to consider getting a Resmed Airsense 10 Autoset, or Resmed Aircurve 10 Vauto.  These sometimes come up on Craigslist or Offer-up and other places as well.  The reason is that both of these Resmed machines offer true bilevel pressure support (I assume you know what that means).  The Airsense 10 Autoset uses EPR of provide up to 3 cm of exhale pressure relief, and the Aircurve 10 Vauto is a bilevel without limits to inspiratory pressure support.  These machines are both very different from your Philips Respironics with Flex in their efficacy for treating flow limitations, hypopnea and RERA.  No need to rush out and do this, but it's pretty clear you would benefit from the way these machines deliver pressure and pressure support.  I suspect you have some upper airway restriction, and bilevel pressure is the best way to address it comfortably.  Take a look at our Upper Airway Resistance (UARS) wiki http://www.apneaboard.com/wiki/index.php...ome_(UARS)

Just a thought...since you are in the medical business in a related field, I would not hesitate to get acquainted with a local DME that does CPAP and bilevel supply, and ask them to keep an eye out for a returned or repossessed machine they might be able to offer at a steep discount. You might find the RT working in CPAP DME work has some interesting insights as well.
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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