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Trying to narrow in on optimal settings
#11
RE: Trying to narrow in on optimal settings
It’s good you’re not bothered by leaks. And the fan idea was not one I had heard before—thanks!
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#12
RE: Trying to narrow in on optimal settings
OSCAR is maintained, bugs and issues are fixed. In SleepyHead is shut down. We have enhancements planned and intend to add more devices over time.

Take very close note of how you feel and any changes that occur because that is what will determine completion.
From a numbers point of view you are great. I might even try to lower your pressure. BUT . . . ONLY because of your symptoms I'm going to suggest raising pressure. 10 with EPR =3 is a safe place, but increase pressure by .4 cmw and re-evaluate, possibly repeat a few times. Try 3 nights at each setting, now is not a time to hurry, even a week at each setting is fine.
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#13
RE: Trying to narrow in on optimal settings
so...

last 2+ years on CPAP with fixed pressure (anywhere from 7.0 to 10.0, trying to find best)

sleep doctor set up machine at 8.0 fixed based on a sleep study 15 years ago. seemed to provide good AHI numbers so all was good and said see you in a year. guess not all is as good as i hoped. (lived with untreated SA for 13 years until it got to point were i had to do something so...)

last three days changed to APAP mode at 8.0 min to 20.0 max and EPR at 3.0. results:

day one: pressure at 95% = 12.36
             max = 14.56

             next morning "How do you feel" = 7/10 (striving for a 10)

day two: pressure at 95% = 10.20
              max = 11.54

              next morning = 5/10

day three: pressure at 95% = 10.36
                max = 11.60

                next morning = 6/10

the increase in pressure from previous 10.0 fixed pressure has virtually eliminated all events. AHI below 0.4 very night

so far, not really feeling any better. been kind of a roller coaster ride for the last year. one day feeling better and hoping for a turn towards better days, then fall right back. I know 3 days is a small sample, but its a start

been researching and studying flow limitations and trying to understand it all. i can see/recognize it on my sleepyhead charts now. 

if, as Bonjour suggested, should slowly increase pressure until flow limitations improve, should i switch back to a fixed pressure and go from there or ?? 

should i spend a few more nights in APAP mode as i have been doing to accumulate more data? 

why such small increments in raising pressure? i've change pressure in past by 1.0 in a single night and doesn't bother me (at least consciously, maybe sub-consciously?)

from what i am learning, flow limitations show up when exhaling? so would we not want the least amount of pressure to be fighting against when exhaling? would not lowering pressure be better so with EPR at 3.0 would be the least resistance? 
Am I exceeding the capabilities of what my machine can do (EPR maxed out at 3.0)? BiLevel necessary?

so many questions, still downloading and reading articles as well as other board members posts trying to get a better understanding. 

thanks to all,

Dave
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#14
RE: Trying to narrow in on optimal settings
A few comments from my limited knowledge base. Bonjour will have to offer the expert advice and fuller understanding.

Flow limitations show up as limitations on inhalation, not exhalation. If you scroll through a zoomed-in view of your Flow Rate in some heavy FL periods, you will probably see this. What should be a nice smooth curve up and then down is instead a plateau, or a pointed peak, or a double peak. You are using extra effort to complete the inhalation, compared to the normal, smooth curve.

FLs reflect some narrowing of the airway, and so in general, higher IPAP pressure is a likely solution. For example, if the muscles in the back of your throat relax some, but not enough to cause an obstructive event, that would be a FL, and as others an obstructive event, more pressure would stent your airway open better. For some people, swollen nasal tissues may be the culprit. Harder to say whether pressure helps there.

It’s tough to know what the cause might be when you don’t feel rested during the day despite having good AHI numbers. Maybe it’s the FLs, or maybe it’s something else. Frequent waking due to pain? Kids? Frequent urge to urinate? Restless legs? Side-effects of medication? Poor “sleep hygiene”? It’s a dauntingly long list.

My own approach is to work on what I know I can do. Allergy shots to reduce nasal congestion. Dutiful sleep hygiene. Physical therapy for hip pain. Slowly, slowly inching up pressure for FLs.

It sounds as though you could increase your pressures a bit more aggressively than some people, but for the reason you give (possible subtle disturbances) I wouldn’t go up terribly fast.

Good luck, and keep us posted.
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#15
RE: Trying to narrow in on optimal settings
This video gives a good description on FL
https://www.youtube.com/watch?v=-gie2dhqP2c

To get the best from fixed cpap and auto. You could put your min pressure at your 95% average. A recommended pressure for fixed and let the auto work from there, for when you have a bad night
https://aasm.org/resources/practiceparam...rating.pdf
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#16
RE: Trying to narrow in on optimal settings
Dormeo:

flow limitations happening on inhale clears up my understanding a lot. i can see that on my flow charts and makes sense now. doesn't look like i am having difficulty exhaling so maybe not a problem or EPR at 3.0 is doing its job. seems to me that I should steadily raise my pressure and see what effects on flow limitations that has.

i spent the last year exploring other conditions that could be causing my issues. all the usual blood tests and eventually did find out i had a vitamin D deficiency. now that is under control (loving the spring/summer sun!) and not feeling sickly anymore, just way much daytime tiredness. taking no medications, no kids, one wife, three cats (had multiple cats for past 20 years and never has caused any issues), good sleep habits so that is why i am back exploring CPAP treatment. figure get flow limitations under control, see how i feel, and go from there

AJack:

viewed the video. helped me clear up my understanding of flow limitations so thanks for that. printed article but still need to read. 

I believe you are suggesting leaving my machine in APAP mode and raising minimum pressure from 8.0 to my 95% max (around 10.5 now) and raising that pressure over the following days/weeks to see what effects that has. will leave max pressure at 20.0
does that sound correct? seems logical to me

upon further review of my charts, looks like my flow is pretty decent at beginning of sleep but eventually get erratic and becomes flow limitations pretty much the rest of the night. if that is what is effecting me, no wonder i feel so much daytime tiredness

and finally, my sleep doctor called to schedule my yearly checkup appointment. I said no thanks. guess I'm committed myself to the Sleep Apnea Board for my future treatment plans (and that is not a bad thing!!)
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#17
RE: Trying to narrow in on optimal settings
Just to keep life complicated: sometimes there are no FLs for a given period because you are awake and your airway muscles haven’t yet relaxed. So when you are waiting to fall asleep, or when you are awake during the night you might see a lack in FLs.
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#18
RE: Trying to narrow in on optimal settings
Yes, that's it. It just makes more sense than swapping back and forwards from cpap to apap. Your chart on page 1 had fixed 10.
keeping the epr 3. Try apap mode, min pressure 10 max 20 and see the results.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#19
RE: Trying to narrow in on optimal settings
so everyone always says to increase pressure in small increments for multiple days before increasing again.

Why?

if a person can tolerate greater/more frequent increases, why not?

worried about centrals? swallowing air? other?

what should one look for when increasing pressure?
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#20
RE: Trying to narrow in on optimal settings
You can, and we frequently do increase by larger amounts, but it depends on how close you are to being optimized. The same goes for the interval between changes. No two nights are the same and we don't want to adjust on the basis of a bad night as we get into the final stages of optimizing.

Titration protocols are to raise pressure 1 cmw at a time, and they do this several times an hour. We can't, simply because we are not monitoring you live.
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