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Resmed sleep therapist adjustements
#21
RE: Resmed sleep therapist adjustements
Coffee Good Morning everyone

Here are my latest results
   

I put EPR back on and the OA are back as well.

Here are the things i have to take into consideration. 
  • I tolerate fixed pressure up to 10 but i suffer from chronic rhinithis. I have severe problemes with my sinuses. This was one of the reason my pneumologist gave me a prescription with lower pressure for auto.
  •  Expiratory Pressure Relief is meant for comfort by lowering the pressure at expiration time
Knowing this: if i see no difference when EPR is on or not would't it be better to turn off EPR than increase my pressure? Dont-know  Just asking

Another important thing is there was one more RERA from the standard autoset. Would autoset for her have handled that better?

Thank you
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#22
RE: Resmed sleep therapist adjustements
You are experiencing a median pressure of 7.0, and with EPR on your EPAP at that pressure is only 4.0. That is not enough to stop your OA events, but at least if you set the minimum pressure at 7, you would get ahead of most events and stabilize the pressure changes. In addition with your fixation on a minimum pressure of 5.0, your EPAP doesn't even move until minimum pressure is 7.0.

I have said this in each of my posts before, you need higher minimum pressure, and it need not be uncomfortable.
Sleeprider
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#23
RE: Resmed sleep therapist adjustements
(05-30-2020, 06:34 AM)Sleeprider Wrote: In addition with your fixation on a minimum pressure of 5.0, your EPAP doesn't even move until minimum pressure is 7.0.

I just need to understand the details before i make a move. I need to be able to explain to my sleeptherapist and pneumologist.
Adjusting the pressure is the next step. I need to show them i tried their suggestions before.

 When you are saying: your EPAP doesn't even move until minimum pressure is 7.0.
I don't understand that part.

Thanks for taking the time to explain.
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#24
RE: Resmed sleep therapist adjustements
With a minimum pressure of 5.0 and EPR at 3, your pressure starts at 5.0/4.0, and increases to 6/4, 7/4, before EPAP finally lifts to 8/5, 9/6 etc. Your therapist turned off EPR because you have OA, and it is the EPAP pressure that treats OA events. EPR makes your CPAP less effective at treating OA when pressure are low. Your therapist had the right strategy, and it did improve your AHI, however EPR does make therapy more comfortable, and can treat flow limitations and the RERA and hypopnea that may arise out of flow limitation. A rule of thumb is to set minimum pressure at 4.0 + EPR. For EPR 1, minimum pressure is 5, for EPR 2, minimum is 6, and EPR 3 minimum is 7.

If you use EPR, you must compensate for the reduced EPAP pressure by increasing IPAP pressure. If you want to see graphically how this works, look at the Mask Pressure graph in your charts. It starts off as a thin line at 5/4, and eventually reaches full height at 7/4, then lifts off the EPAP pressure of 4.0, only when pressure rises above 7.0. Really, if you don't get a conceptual handle on how these settings work, just use your therapist's settings. They will work better. At this point you are not using your therapist's nor my recommendations...you're on your own.
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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#25
RE: Resmed sleep therapist adjustements
(05-30-2020, 07:02 AM)Sleeprider Wrote: With a minimum pressure of 5.0 and EPR at 3, your pressure starts at 5.0/4.0, and increases to 6/4, 7/4, before EPAP finally lifts to 8/5, 9/6 etc.  Your therapist turned off EPR because you have OA, and it is the EPAP pressure that treats OA events.  EPR makes your CPAP less effective at treating OA when pressure are low.  Your therapist had the right strategy, and it did improve your AHI, however EPR does make therapy more comfortable, and can treat flow limitations and the RERA and hypopnea that may arise out of flow limitation.  A rule of thumb is to set minimum pressure at 4.0 + EPR. For EPR 1, minimum pressure is 5, for EPR 2, minimum is 6, and EPR 3 minimum is 7.

If you use EPR, you must compensate for the reduced EPAP pressure by increasing IPAP pressure.  If you want to see graphically how this works, look at the Mask Pressure graph in your charts.  It starts off as a thin line at 5/4, and eventually reaches full height at 7/4, then lifts off the EPAP pressure of 4.0, only when pressure rises above 7.0.  Really, if you don't get a conceptual handle on how these settings work, just use your therapist's settings. They will work better.  At this point you are not using your therapist's nor my recommendations...you're on your own.

Maybe i did't explain well enough. Once i can explain fully explain this, my therapist is open minded and will adjust my prescription. In any case i intend on trying min pressure at 7 with EPR. So those are trial and error and experiment to better understand.
I can see most of my OA happen when my pressure is below 7. And that is really interesting


You are rigth about another thing. I have been off the cpap terminology for over 6 years. That's why i'm asking many questions. So i can get a good conceptual handle.
With EPR , at 5 ipap i get epap 4 at 6 ipap get epap 4.5. So it does seem to influence even below 7. Withouth EPR epap is = to ipap. However I don't understand how EPR with IPAP below 7 would influence my need for higher pressure or not.
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#26
RE: Resmed sleep therapist adjustements
Ghandi download/request the clinical manual from the link at the top of the page that will show you how you can make your own changes and provide some interesting reading to help you get upto speed, also checkout the wiki also at the top of the page to provide ifmormation on the terms used and hopefully answer some of your questions
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#27
RE: Resmed sleep therapist adjustements
The primary pressure that matters for the treatment of OSA is the EPAP or Exhale pressure.   EPAP is what 'splints' the airway open, not the IPAP.  Adding EPR SUBTRACTS from the defined Inhale/IPAP pressure of '7' and to maintain that same 'splinting' pressure you need to increase IPAP by the amount of EPR.
ResMed's EPR is also an (unofficial) therapeutic setting.  It impacts your therapy in many good ways which is why we like it.  

Titration step 1: Find the EPAP pressure that manages your Obstructive Apnea. Note: This is Pressure on a CPAP, and here EPAP=IPAP
Titration step 2: Keeping the EPAP the same, find the IPAP pressure that manages your hypopneas, flow limits, RERAs.  Your choices are 0,1,2,3 cmw difference with ResMed EPR
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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#28
RE: Resmed sleep therapist adjustements
(05-30-2020, 01:42 PM)bonjour Wrote: The primary pressure that matters for the treatment of OSA is the EPAP or Exhale pressure.   EPAP is what 'splints' the airway open, not the IPAP.  Adding EPR SUBTRACTS from the defined Inhale/IPAP pressure of '7' and to maintain that same 'splinting' pressure you need to increase IPAP by the amount of EPR.
ResMed's EPR is also an (unofficial) therapeutic setting.  It impacts your therapy in many good ways which is why we like it.  

Titration step 1: Find the EPAP pressure that manages your Obstructive Apnea. Note: This is Pressure on a CPAP, and here EPAP=IPAP
Titration step 2: Keeping the EPAP the same, find the IPAP pressure that manages your hypopneas, flow limits, RERAs.  Your choices are 0,1,2,3 cmw difference with ResMed EPR

Thanks a lot Fred! This is highly appreciated Smile  
I will keep you posted with the results.

(05-30-2020, 12:50 PM)jaswilliams Wrote: Ghandi download/request the clinical manual from the link at the top of the page that will show you how you can make your own changes and provide some interesting reading to help you get upto speed, also checkout the wiki also at the top of the page to provide ifmormation on the terms used and hopefully answer some of your questions

Thank you jaswilliams. Will do!
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#29
RE: Resmed sleep therapist adjustements
Good Morning everybody!

I kept the EPR on and i adjusted pressure from 5 to 7.
I had very good night of sleep. Dreamed a lot. This is usally a good sign for me. It means i complete the sleep cycle and get to the REM sleep.

Here are the concrete results.     
Really few OA. It is the lowest AHI in 6 years since i've had a cpap machine.

Thanks for your recommendations. If you have any comments or suggestions don't hesitate.
Thanks  


PS: i'm just on regular autoset. What would autoset for her do different?
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#30
RE: Resmed sleep therapist adjustements
Stay with the current settings for a few more nights to get a baseline. Autoset for her reacts more to flow limitation, and you don't really need that. These results are exactly what we want to see, and for the record, "I told you so".
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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