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[Pressure] Should I start APAP Tuning?
#1
Should I start APAP Tuning?
I am a long time CPAP user but newly introdued to the capability of my Resmed 10 Autoset. Am now able to read my Oscar results for less that 2 weeks now and also reading lots of the Board topics and comparing others results with mine.  I have always been on fixed pressure of 11 and haven't had a sleep study in many years.  I came to take a controlled Apnea for granted but now that I can see what's going on at night I can see some episodes that I would like to control.  I have some daytime dizziness that may be some other medical condition but may also be related to CPAP issues.

I  bought a soft neck collar as recommended for keeping the chin tuck problem from creating episodes.  The isssue I have been trying to resolve is mouth breathing.  It's very hard for me to mouth breathe but I have a deviated septum and have problems when my nose blocks up.  I wake up feeling suffocated even with a full face mask F20.  I use nasal sprays when needed but it doesn't always work.

So the last three nights I have been purposely trying to mouth breath.  I seem to be snoring though the mask during periods of OA and H.  Only one of the last three nights did I not have episodes.  I trying to decide if this means I should try the APAP mode on my Autoset an increase the pressure.

Any help is appreciated.  I feel grateful to have found this Board.


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#2
RE: Should I start APAP Tuning?
I’m no expert and those who are will correct me if I’m wrong but I would say switch to auto and keep the minimum at 11 and max at 20 to start. EPR also needs to be turned on and set to 3. You have high flow limitations all night long and many OSA’s and way too many RERA’s. EPR set on 3 along with your machine being switch to auto will help with that hopefully.
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#3
RE: Should I start APAP Tuning?
Were you wearing the cervical collar on the 23rd and 26th? It appears you still had a chin tuck problem those nights. If you were, check and make sure your chin will not slide down behind the collar. We recommend wearing it loose but it is possible to have it too loose. If you haven't already, read the article on cervical collars (see link below). I agree with the suggestion that you try auto and EPR. When I first came to the forum I was on fixed pressure and changing to auto resulted in improvement. Give it a try and post your data. It's easy to switch back if it appears fixed pressure is better for you.
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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: Should I start APAP Tuning?
(11-26-2019, 12:18 PM)Osiris357 Wrote: I’m no expert and those who are will correct me if I’m wrong but I would say switch to auto and keep the minimum at 11 and max at 20 to start. EPR also needs to be turned on and set to 3. You have high flow limitations all night long and many OSA’s and way too many RERA’s. EPR set on 3 along with your machine being switch to auto will help with that hopefully.

Il looked at my settings menu and don't believe the there is EPR on the Resmed Autoset.
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#5
RE: Should I start APAP Tuning?
(11-26-2019, 12:38 PM)Melman Wrote: Were you wearing the cervical collar on the 23rd and 26th? It appears you still had a chin tuck problem those nights. If you were, check and make sure your chin will not slide down behind the collar. We recommend wearing it loose but it is possible to have it too loose. If you haven't already, read the article on cervical collars (see link below). I agree with the suggestion that you try auto and EPR. When I first came to the forum I was on fixed pressure and changing to auto resulted in improvement. Give it a try and post your data. It's easy to switch back if it appears fixed pressure is better for you.

Thanks Melman.  I had the collar on all three nights.  It was fairly loose, but don't believe I could chin tuck with it.  I'll try it tighter tonight.
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#6
RE: Should I start APAP Tuning?
(11-26-2019, 01:02 PM)jgunders Wrote:
(11-26-2019, 12:18 PM)Osiris357 Wrote: I’m no expert and those who are will correct me if I’m wrong but I would say switch to auto and keep the minimum at 11 and max at 20 to start. EPR also needs to be turned on and set to 3. You have high flow limitations all night long and many OSA’s and way too many RERA’s. EPR set on 3 along with your machine being switch to auto will help with that hopefully.

Il looked at my settings menu and don't believe the there is EPR on the Resmed Autoset.

From your numbers on the left of the graph it looks to me if you already have EPR on with a value of 3
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#7
RE: Should I start APAP Tuning?
(11-26-2019, 01:41 PM)jaswilliams Wrote:
(11-26-2019, 01:02 PM)jgunders Wrote:
(11-26-2019, 12:18 PM)Osiris357 Wrote: I’m no expert and those who are will correct me if I’m wrong but I would say switch to auto and keep the minimum at 11 and max at 20 to start. EPR also needs to be turned on and set to 3. You have high flow limitations all night long and many OSA’s and way too many RERA’s. EPR set on 3 along with your machine being switch to auto will help with that hopefully.

Il looked at my settings menu and don't believe the there is EPR on the Resmed Autoset.

From your numbers on the left of the graph it looks to me if you already have EPR on with a value of 3

You appear to be correct. The mask pressure does fill 3cm without being zoomed and not seeing the pressure chart
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#8
RE: Should I start APAP Tuning?
With fixed pressure at 11.0 and EPR 3, your event rate is pretty good other than the positional clusters, however fllow limitation is high. That may be due to the deviated septum and upper airway resistance. The Resmed Airsense 10 Autoset will respond to flow limitation by raising pressure, so in your case, a higher maximum pressure is find, but I would not set it on 20. I think for starters a pressure range of 11 to 16, EPR 3 should be fine to evaluate whether higher pressure helps. With flow limitation at this level, it might be worth having an evaluation by an ENT to see if opening up your nose might be helpful. I'm not a big fan of surgery, but if it can be kept simple, the results might outweigh the discomfort. Alternatively, a bilevel machine like the Resmed Aircurve 10 Vauto could use pressure support to significantly improve your ventilation and inspiratory flow. Pressure support (PS) is the difference between IPAP and EPAP. With the EPR you are limited to 3-cm, but with a bilevel, the difference can be much greater.

Your current bilevel pressure is 11/8, and the settings above will range up to 16/13. A Bilevel could provide pressures like 16/11, which would be PS 5, and would significantly reduce the flow liimits. This wiki article might explain it better. http://www.apneaboard.com/wiki/index.php..._and_BiPAP
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: Should I start APAP Tuning?
(11-26-2019, 02:31 PM)Sleeprider Wrote: With fixed pressure at 11.0 and EPR 3, your event rate is pretty good other than the positional clusters, however fllow limitation is high.  That may be due to the deviated septum and upper airway resistance.  The Resmed Airsense 10 Autoset will respond to flow limitation by raising pressure, so in your case, a higher maximum pressure is find, but I would not set it on 20.  I think for starters a pressure range of 11 to 16, EPR 3 should be fine to evaluate whether higher pressure helps.  With flow limitation at this level, it might be worth having an evaluation by an ENT to see if opening up your nose might be helpful. I'm not a big fan of surgery, but if it can be kept simple, the results might outweigh the discomfort.  Alternatively, a bilevel machine like the Resmed Aircurve 10 Vauto could use pressure support to significantly improve your ventilation and inspiratory flow.  Pressure support (PS) is the difference between IPAP and EPAP.  With the EPR you are limited to 3-cm, but with a bilevel, the difference can be much greater.  

Your current bilevel pressure is 11/8, and the settings above will range up to 16/13. A Bilevel could provide pressures like 16/11, which would be PS 5, and would significantly reduce the flow liimits.  This wiki article might explain it better. http://www.apneaboard.com/wiki/index.php..._and_BiPAP

Thanks Sleeprider.  The article you referenced rang some bells for me.  I may need a bipap machine.  Two questions in the meantime. You said I am limited to 3 cm of Pressure Support.  I assume that means there is an option to change it.  I don't think I want to reduce it, but I didn't think I set that level and would like to know where to find that menu item.  The second question is what chart line are you looking at to say my flow limitation is high.  Is that the flow limit line?  I would have thought that if it isn't pegged at 1, then I wasn't flow limited.  Is this line refering to me or my equipment?  From your comment, it looks like this line is for the user.

I'll try the settings you suggested and see if it helps.
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#10
RE: Should I start APAP Tuning?
EPR is similar to pressure support in bilevel. It can be set to off, 1, 2 or 3, being equal to 1, 2 or 3 cm of pressure relief on exhale. It seems confusing, but CPAP pressure minus EPR is the EPAP pressure, and if we use that terminology we can consider EPR the same as pressure support EPAP + PS = IPAP. Your current settings in bilevel notation are EPAP 8.0 cm + PS 3 = IPAP 11.0. You can imagine if you could have more pressure support available that you might be able to do well at EPAP min 8.0 PS 4 or 5 to give IPAP at 12 or 13. Pressure support does part of the work of inspiration, so since you don't work as hard, you can take in more air and overcome resistance.
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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