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Seeking confirmation if settings are correct
#1
Seeking confirmation if settings are correct
I recently picked up a ResMed Airsense 10 Autoset and have been tweaking it and wonder if there's anything else I could be doing.


I originally had a ResMed Airsense 10 CPAP set at 8.  The question is I'm noticing the pressure is maxing and should I increase it?

   
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#2
RE: Seeking confirmation if settings are correct
You numbers look very good. The only part is the flow limits - quite a few. You could raise both numbers by 1 and see after a couple of days how your flow limits are.

Good job doing very well
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#3
RE: Seeking confirmation if settings are correct
Your pressure is increasing in response to flow limitations which will probably be reduced by implementing EPR. I suggest you turn on full time EPR at a setting of 2. It should reduce the flow limitations and the few hypopnea and RERA. It won't hurt to increase the max pressure to 12 but it may not be necessary if EPR reduces the flow limitations significantly. Post OSCAR data after making a change and we can reevaluate.
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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: Seeking confirmation if settings are correct
Tks to both staceyburke and Melman for your prompt responses.

What I will do is start with the increase by one for both the min/max pressure numbers and EPR set at 2.

Will check in tomorrow with an update.
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#5
RE: Seeking confirmation if settings are correct
Just remember for each value of the EPR setting (1,2,3) will reduce your exhale pressure setting by that value. So if you use an EPR of 2 and you want your exhale pressure to start at 8, you will need to set the starting pressure to 10. Pressure - EPR = Exhale pressure.
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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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#6
RE: Seeking confirmation if settings are correct
(09-09-2020, 06:56 PM)Crimson Nape Wrote: Just remember for each value of the EPR setting (1,2,3) will reduce your exhale pressure setting by that value.  So if you use an EPR of 2 and you want your exhale pressure to start at 8, you will need to set the starting pressure to 10.  Pressure - EPR = Exhale pressure.

So if I have it right, set min pressure 10, max pressure 12 if using EPR 2?  I was considering in setting the EPR 2 with 8/10 knowing that if the min would reduce to 6 assuming that the min would return to 8 on inhale.  Am I wrong on this assumption?
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#7
RE: Seeking confirmation if settings are correct
Keep in mind that with ResMed it is the EPAP or Exhale pressure that splints open the airway, nit the IPAP or inhale pressure.  The senior people factor this into their recommendations.  Also realize that we find many people are running higher pressure than they need to because they were set up as if Pressure or IPAP is the only too to manage everything.

EPAP is used to manage OA.
PS (or EPR) the difference between exhale and inhale pressure, treats Flow Limits, RERAs, Hypopneas, and UARS.  We use EPR more as a therapeutic tool, as PS, than we use it as a comfort feature.  We view the AutoSet as a BiLevel machine with settings of 1,2, or 3.  Below is a BiLevel 101 I keep around.

BiLevel 101:
Pure CPAP delivers a single constant pressure.  This pressure is what splints open the airway.  APAP (AutoSet) is what we prefer to see as it can vary the pressure to suit the situation.  For now, let's forget about APAP.

Basic BiLevel delivers two fixed independent pressures, EPAP is Exhale Pressure and is what actually splints the Airway open, It is the equivalent of "Pressure" in a CPAP and does the same thing.  
IPAP or Inhale pressure is the higher of the two pressures.  Once the Obstructive Apneas are resolved with the Exhale pressure (EPAP), IPAP is used to resolve hypopneas, flow limits, RERAs, and UARS.
The difference in these pressures is called Pressure Support or PS.  PS is always added to EPAP by convention to get IPAP so IPAP = EPAP + PS
FYI if you were to set the EPAP = IPAP you would have a basic pure CPAP functionally.
The above info is derived from Titration guides.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#8
RE: Seeking confirmation if settings are correct
(09-09-2020, 07:18 PM)elwoodpdowd Wrote:
(09-09-2020, 06:56 PM)Crimson Nape Wrote: Just remember for each value of the EPR setting (1,2,3) will reduce your exhale pressure setting by that value.  So if you use an EPR of 2 and you want your exhale pressure to start at 8, you will need to set the starting pressure to 10.  Pressure - EPR = Exhale pressure.

So if I have it right, set min pressure 10, max pressure 12 if using EPR 2?  I was considering in setting the EPR 2 with 8/10 knowing that if the min would reduce to 6 assuming that the min would return to 8 on inhale.  Am I wrong on this assumption?

The benefit of using Autoset mode is that your pressure will change automatically to stop events. Your current pressure settings are 7.0 to 9.0 with no EPR and your AHI is actually good, but your pressure is pegged at 9.0 due to the flow limits. I think we can just open things up a bit and start with a minimum pressure of 8.0, maximum pressure of 14.0 and use EPR full time at 2 or 3.  I think you wil find this very comfortable, and it will be interesting to see your feedback.
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#9
RE: Seeking confirmation if settings are correct
(09-09-2020, 08:48 PM)Sleeprider Wrote:
(09-09-2020, 07:18 PM)elwoodpdowd Wrote:
(09-09-2020, 06:56 PM)Crimson Nape Wrote: Just remember for each value of the EPR setting (1,2,3) will reduce your exhale pressure setting by that value.  So if you use an EPR of 2 and you want your exhale pressure to start at 8, you will need to set the starting pressure to 10.  Pressure - EPR = Exhale pressure.

So if I have it right, set min pressure 10, max pressure 12 if using EPR 2?  I was considering in setting the EPR 2 with 8/10 knowing that if the min would reduce to 6 assuming that the min would return to 8 on inhale.  Am I wrong on this assumption?

The benefit of using Autoset mode is that your pressure will change automatically to stop events. Your current pressure settings are 7.0 to 9.0 with no EPR and your AHI is actually good, but your pressure is pegged at 9.0 due to the flow limits. I think we can just open things up a bit and start with a minimum pressure of 8.0, maximum pressure of 14.0 and use EPR full time at 2 or 3.  I think you wil find this very comfortable, and it will be interesting to see your feedback.

Sleeprider I did what you suggested with the EPR set full time at 2.  I noticed that the pressure is not topping out but have a few CAs.

Here is the image of my report including a sampling of two CAs:

           
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#10
RE: Seeking confirmation if settings are correct
The results actually look pretty good for this. The flow limits are less than half, and there are improvements in respiratory volume, and the OA and RERA are gone. The few CA and H events should not be a cause for concern and will likely diminish as you become more accustomed to the increased respiratory flow. The event at 21:32:55 shows a sigh or larger breath ahead of the pause in breathing, and respiration appears a bit flow-limited as it resumes. The pause at 00:26:20 shows some flow limit coming into the event with a recovery breath or larger volume, and again respiration resumes normally. Both events are minimal duration and probably occur because respiratory needs were met by the larger preceding breath, and respiration resumes with normal rate and volume (no recovery breathing). That is a long way of saying, nothing to worry about. The more important metric here, is was this use of EPR more comfortable, and did it result in improved sleep?
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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