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Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
#71
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Can you put the wedge under the mattress? I did that before myself, and it seemed to be better for me.
Dave

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#72
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
(01-19-2022, 12:14 AM)midwestguy Wrote: My bed is a captain's bed, which has drawers and cabinets in the base. It's very heavy
and elevating the head would be unworkable.

When I slid down the wedge, I asked the vendor's rep for advice. She said to put a pillow
in front of the wedge. It seems to work.

You may be right about the wedge not hitting my back in the right place. And I have no
pillow on top of the wedge.

I will make those adjustments.

Thanks, Geer1.

Harv

AHI of 0.98. Something worked.

Summary:

-- Thin firm pillow on the wedge

-- Wedge is about 4 inches short of lower back. Head as high on wedge as possible.

-- Continued wearing the collar, two fingers loose, per Sleeprider.

-- Changed EPR from 3 to 1, from an Albigensian tip (thanks!)

Three thumbnails: Unmodified, no zooms; a zoom at a flow disruption; a zoom at an event flag.

Haven't seen REs before.
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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#73
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Definite improvement but there is still a lot of restriction (very high flow limitation and flow rate graph just looks restricted most of the night for both inhale and exale). The reason you don't usually see rera's is because they are usually allowed to be apnea indicating what you did helped.

Keep playing around until you find what causes improvement and what makes things worse. Try making one change at a time so you have an idea what helped, if you make all the changes at once like you did last night then you have to fiddle to figure out which one helped. I imagine positional changes helped but I have a feeling the changed EPR might have as well (helped with centrals but made flow limitations much worse).

In your case solving the positional apnea side is probably key before you will be able to figure out the rest. It can be inconsistent night to night and can sway your thinking that other changes are helping or making things worse. I would focus on it the next week or so and try to maintain about a week of data showing no positional apnea clusters then once that is dialed in try making other changes.
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#74
Idea 
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
(01-19-2022, 11:42 AM)SarcasticDave94 Wrote: Can you put the wedge under the mattress? I did that before myself, and it seemed to be better for me.

Great idea, Dave!

That might fix the short length of the wedge. I'll add that to the list.
Geer1 says change one thing at a time. Easier to see what works.

Thanks
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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#75
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
I will concentrate on the positional stuff.
Leaving the current setup alone for four or five days
might show what works consistently as a baseline.

If results are inconsistent, I'll remove one change
at a time.

If they are consistent, I'll try SarcasticDave's idea
of puttting the wedge under the mattress.

Thanks
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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#76
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Midwestguy, I'll draw your attention to something else in that Jan 12 closeup of 5:08-5:12.

Which is that your machine shut itself off in the middle of a severe obstruction!

This is because you have "smart start" turned on.

This ResMed "feature" is monstrously stupid, in that it is programmed to turn the machine off at the exact moment that you need it most.

First off, how you can tell that the machine shut itself off rather than you shutting it off. Go back through your data and look at what happens when you pop the machine off using the power button. When it comes back on, it comes on at your minimum pressure (and runs ramp if you've got that turned on). Look at the pressure graph on both side of the 5:08-5:12 gap -- pressure is at ~14 on both sides, rather than coming back at 8.

You need to get SmartStart StupidStop TURNED OFF.

It appears that they fixed this in the AS11 -- it has both auto-start and auto-stop features which you can turn off and on independently. (We don't know if the auto-stop feature is still broken -- have any AS11 users seen it turn off in a situation like in MWG's data?) 

There are two conditions where the machine comes back on at the same pressure as it left off. One is if there is a power failure (you can test that by getting to a spot where your pressure is above the minimum, and you pull the cord out of the back of the machine, wait awhile, and plug it back in. You'll see that the pressure comes back where it was.) The other is if your respiratory rate goes to zero for long enough that the machine decides you're dead -- which it seems to decide when your breathing gets so shallow that it doesn't trust the readings enough to believe them. In what I see as an astonishing bad design decision, the engineers decided that if the machine can't figure out if you are dead or alive it should err on the side of dead rather than alive. Think about it -- if you were to pass away in your sleep, why would it be a problem if your cpap machine were to continue blowing pressure in the face of your corpse until someone found your body and turned the machine off?

Sometimes the engineering that you see implemented in these machines is just monstrously stupid, and this is probably the most egregious example in the ResMed world. Somebody decided that it would be really cool to have a feature where if the machine detects a person on the other end of the hose it turns the machine on automatically. This is a fabulous idea, in fact, as when you go back to sleep after a bathroom break you might be sleepy enough that you forget to hit the power button. But somewhere along the engineering process, somebody must have said "well if the machine is able to turn itself on then it needs to be able to turn itself back off" (A ResMed machine will autostart if you block the mask ports when it is blowing the cool-down cycle, which I can understand might be seen as a problem by the persnickety.) But somehow when they were done engineering this thing 8 years ago, they ended up with the "feature" that the machine decides that no one is on the other end of the hose even though the machine's sensors -- which are incredibly sensitive -- are still measuring and recording plainly obvious human breathing. AND when it gets into one of these states where it doesn't know what to do it does not flag ANYTHING in the sleep report and the only way to find it is to look at the breath-by-breath data.

But, anyway, enough of my ranting about engineering failures. None of us can do anything about ResMed's stupid engineering failure beyond shutting "SmartStart" OFF on the menu. (And if your Sleep PA objects to turning off Smart Start, that would be enough to get me to find a new Sleep PA!)
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#77
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
cathyf,

Always enjoy a good rant. Especially when it's about a screw-up.
And thanks for the fix.

Best,

Harv
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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#78
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
The attached table should explain itself.

The idea was to see if and how the meds I take
affect my sleep. Some of them are, if you'll
excuse the expression, real sleepers.

My doc and I will have a talk about Metropolol
and Duloxetine. Those two are downright scary.
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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#79
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Wow. And when I google motoprolol one of the first things I see is to tell your doctor if you have sleep apnea.
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#80
RE: Sleep PA changing pressure, wants sleep study. Can advice from here hurt my Medicare?
Bruxism mouthguards can also worsen apnea. Especially if it is holding your jaw in a specific position which if you are using both upper and lower guard like it sounds is probably more likely.

Once positional is treated or if you are having trouble doing so it might be worth a trial without the guards to see if they make any difference on cpap data.
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