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Problems with machine change (CA's)
#1
Problems with machine change (CA's)
Hello!

Current settings: EPAP 10.4 Support 1.6 max IPAP 13.2 Ti max 2.5 Trigger V high Cycle V high.

Since switching from a Respironics System One 60 series a few months ago to a ResMed 10 V-auto I'm getting too many centrals and poor sleep. After doing some serious lurking here on the site for a month or two and reading lots of good threads, I have come to the conclusion that I could use some help beyond what has already been done/tried.

I have a Bi-PAP because a botched in-lab observed sleep study was run and my now-former provider chose to go that route. Since the machine can be set up to function like an APAP it doesn't really matter except for providing some extra treatment options that I would not have otherwise.

The other difference is between PR and RM algos. That may be some or most of the problem in my case since the pressure settings are now essentially identical to what was working okay-ish with my old machine. I also endured significant over-titration for a number of weeks and have been periodically stepping down pressure since then to get to the current settings.

Briefly, I'm getting CA clusters plus additional random CA's to the tune of of a CA index around 6. The clusters can show up anytime but are often in a period after starting therapy or restarting therapy during the night.

Leaks show up mostly after an initial disturbance. That disturbance may be a positional change where as a side sleeper the mask and pillow interact.

Hypopneas are fine at around an index of 0.5, OA's are almost non-existant with an EPAP of 10+. Flow limitations are still okay with 95% rate at <.05 nightly with IPAP capped first at 14 for a few weeks and now at 13.2 for a week. FL's are almost non-existent at higher IPAP (eg 16). Old PR machine showed consistent FL index in the low to mid teens over the years FWIW.

I changed the sensitivity on both Trigger and Cycle to high a couple weeks ago and to very high a couple nights ago. So far no change in anything but more perceived comfort. Somewhere around the high to very high is what I recall the PR feeling like. Also I increased Ti max which had only affected my wakeful breathing.

Another difference between machines is the 'rise time.' I am working under the assumption that the RM is using the 'easy breathe' and if not then the rise time is not as aggressive as the PR. Or I have forgotten how I breathed on the PR. In any case I am considering going to S mode to be able to set Rise Time. But it would be nice to get to the best pressure first since FL and CA won't be monitored in S?

Thinking of dropping support by 0.2 increments on a periodic basis. How often? How soon? Also the EPAP was raised in steps from 10.0 to 10.4 solely to help compensate for 'lack of air' when support was dropped from 3 to 2 to current.

Someone will want to see OSCAR charts or more data. I don't have the sleep study charts from 2013 and whatever passed for a sleep study this year is IMHO useless for several reasons that include EPAP never being lower than 12. Initial observation study 2013 showed mild bordering on moderate OA with no CA.

Thanks.






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#2
RE: Problems with machine change (CA's)
We rss really need to see data to help. OSCAR is completely free You can download at the top of the site.

Take a look at the link I have at the bottom of the post on charts. It also gives information on OSCAR.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
#3
RE: Problems with machine change (CA's)
Agreed we need to see the OSCAR data. One thing of note, I think you may be trying too many setting changes at once, or within a too short period of time for things to stabilize. Also, Trigger to high or very high has been noted to help CA, but Cycle edits might counteract that.

My guess, as it is right now, the change from Respironics to ResMed increased CO2 flushing, introducing treatment emergent Centrals. Even though you've been on PAP, it could be the ResMed has a higher efficiency at CO2 flushing than you're currently used to.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
#4
RE: Problems with machine change (CA's)
Hi Stacey,

Thanks for your response. Which data is it that you think is most helpful?






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#5
RE: Problems with machine change (CA's)
Try a standard OSCAR screenshot. F12 on a PC should do this for you.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
#6
RE: Problems with machine change (CA's)
Thanks Dave,

I'm not going to guess what data would be most helpful. Please give some guidance!

Your guess may be right. Hard to say. As I mentioned the current settings are pretty close to my old machine (12 with 2 A-flex is about 10.2 EPAP by what Oscar shows. Although of course it is not in lock step like RM - another difference.)

#7
RE: Problems with machine change (CA's)
(11-11-2021, 05:59 PM)SarcasticDave94 Wrote: Try a standard OSCAR screenshot. F12 on a PC should do this for you.

Sorry to be obtuse. What do you want, a daily? Timeframe? Which graphs are important to you?






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#8
RE: Problems with machine change (CA's)
Screenshot the OSCAR Daily Details tab. I forgot to state this earlier.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
#9
RE: Problems with machine change (CA's)
(11-11-2021, 05:57 PM)SarcasticDave94 Wrote: Also, Trigger to high or very high has been noted to help CA, but Cycle edits might counteract that.

Any more info on the Cycle edit effect? Had not seen that before.
#10
RE: Problems with machine change (CA's)
The charts I listed in my link. Once you have those on the screen as a full day - use the F12 key for the screenshot. Post the screenshot and any questions you want answered. We don’t have to have questions but we do need a full nights set of charts as listed in the link.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing






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