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[Pressure] Could someone please help with settings?
#21
RE: Could someone please help with settings?
Sorry guys.  That last screenshot was a closeup of the waveforms.  Here's the full night though.


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#22
RE: Could someone please help with settings?
Good mornng sleeprider.  Unfortunatley my lovely junk insurance plan I picked last year from work doesn't cover any kind of PAP machines.  I got lucky and got my machine from SecondWind for 350 and it only had like 200 hours on it.  Not bad I guess, right?  I did pick a different, supposedly better, plan this year.  I just have to wait for it to kick in and then I can see if they cover PAP machines.  Until then I'm stuck with the System One, but it seems to be working for now.  Gonna keep my eyes open thought for the other machines.  Thank you so much for the suggestion.
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#23
RE: Could someone please help with settings?
Chart posted.  Check it out.  She's a beaut. LOL.  First one was a closeup, but I posted again with the full night showing.  I realize that my AHI is going to change from night to night, but was getting "upset" when the first night of a changed setting was great and then the following nights were almost double or triple from the first night.  I guess I have to get into a routine of things NOT to do before bed.  I do tend to eat late, as I'm a nightshift worker, and even on my days off, I'm eating dinner later than most people.  Way later.  LOL.
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#24
RE: Could someone please help with settings?
My first choice of a machine for you is the ResMed AirCurve 10 VAuto, in the APAP line ResMed AirSense 10 AutoSet or the "for Her" variant with its extra "for her" algorithm.  I believe you will need the higher PS available with a BiLevel to best handle your RERAs.  Your "apnea" is a bit unusual in that you have more RERAs than most.

You have a lot of RERAs and your closeup shows disrupted breathing (tossing around) ending in flow limited breathing.  What do the more normal sections of your chart look like in closeup?

With the APAP, Try Flex=2 tonight and Raise your min pressure by 1 tomorrow.
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#25
RE: Could someone please help with settings?
Oh great, so your telling me i spent 350 bucks on a machine that's not going to do a good job for me.  LOL   I am going to look into get one of the other machines you suggested, if you truly think it will be a better fit for me.  My insurance doesn't cover PAP equipment, so it's out of pocket for me, but I am going to start searching for a refurbished model of the one you suggested.  Wish me luck.  
            So, if I understand correctly, only increase the flex to x2 tonight, and not the pressure, but increase the pressure to 11 tomorrow night?  I'm at a minimum of 10 right now.  
             I went through the flows close up and found some areas that are "normal".  I tried to include some normal areas with "events" in them.  Hopefully they're ok.  If not, let me know and I'll try again.  
                 Thanks so much, Bonjour.
     
                                          Brian


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#26
RE: Could someone please help with settings?
Getting a new different machine is not real high on the priority list unless you feel that your symptoms warrant it. As you know your official numbers are really good. I tend to go after RERAs pretty strongly. The important factor is how do you feel? Not how elated you are that we accomplished a good reduction in numbers that were already pretty good.
You expressed an interest in tweaking to get even lower numbers. Your machine is a really good machine, and we will tweak it as far as it will go.

After each change see how you feel, better or worse, and see what happened to the numbers. Decide if you want to tweak more or not.

When it comes time to get a new (or used) machine, then, and only then, get the ResMed AirCurve 10 VAuto BiLevel machine. It can do everything an APAP can do, and then some.

Fred
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#27
RE: Could someone please help with settings?
I forgot to say, the charts look fine. Yes, there are some issues but not the total disarray in the one brief original zoomed sample that I wanted to verify a degree normalcy throughout the night.

Your big disrupter is the RERAs, which, as I said, end in arousal.

I'm going on Vacation so look for Sleeprider to come in and help you along.

Fred
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#28
RE: Could someone please help with settings?
I really wouldn't be in a rush to change machines. Fixed pressure CPAP is considered the gold standard for most people with OSA. I also don't know where using Vauto to treat RERA is coming from?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549693/
After more than three decades from its first use, continuous positive airway pressure (CPAP) is still recognized as the gold standard treatment.

I would follow basic protocols till otherwise indicated.
https://www.resmed.com/us/dam/documents/...er_eng.pdf

Increase CPAP ≥1 cm H2O every ≥5 mins ( nightly or weekly in home titration) for obstructive apneas, hypopneas, RERAs and at least 3 min of loud or unambiguous snoring

or the philips guide.
http://c398534.r34.cf1.rackcdn.com/DOCUM...Canada.pdf
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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#29
RE: Could someone please help with settings?
Check your biLevel titration guides. Pressure Support treats Flow Limits which are a fundamental part of RERA, you increase Pressure Support (Slowly) and the Flow Limits and RERA go away.
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#30
RE: Could someone please help with settings?
The same applies to cpap and is the first choice. As I posted above, it clearly states that "Increase CPAP ≥1 cm H2O every ≥5 mins for obstructive apneas, hypopneas, RERAs and at least 3 min of loud or unambiguous snoring"

To tell someone they need bilevel, simply because they have RERA or flow limits. I haven't seen supported anywhere.

There may be some misunderstanding, because of the difference in the way Bilevel is titrated. Cpap continues to raise the single pressure for all obstructive events. Bilevel will stop the epap when the OA are cleared, one reason is emergent CA, with more epap. Then continue to raise ipap. Above which has already been set, if needed to clear any remaining obstructive events. It is prescribed because there is a real need for bilevel machine and of course it will also treat RERA and flow limits, as will cpap.
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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