Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Understanding My Current State and How To Improve
#1
Understanding My Current State and How To Improve
Hello All,

I am amazed at the wealth of information on this forum. I started on CPAP therapy about 3 months ago and have had little to no useful help from my Doc or DME after diagnosis and machine delivery. I was using the Dreamstation 1 and got things to a level where it was tolerable to sleep with for 6+ hours a night and then the recall happened. 

After almost a month of not using the CPAP while I tried to figure out a solution I finally gave up with Phillips and my DME and purchased a ResMed AirSense 10 AutoSet. Last night was the first night on the machine and first time uploading my data to OSCAR. I currently where a Dreamwear Nasal mask with an additional chinstrap as my mouth would tend to open occasionally during the night. I tried to provide the relevant information I have seen on other threads throughout the forum put please let me know if there is anything I have missed that may be more helpful.

Ideally, I was looking to get some feedback and understanding of where I should proceed to fine tune the therapy as I see the bulk of the AHI is Clear Airway apneas and I awake briefly multiple times during the night. I do wake up feel better with the CPAP than without but I would say at this point it doesn't feel like a life changing improvement. 

Thanks!


Attached Files Thumbnail(s)
   
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: Understanding My Current State and How To Improve
From what I see, you have some problems with Centrals that should go away with use as your body becomes accustomed to the therapy.  You could drop the EPR to 1 and that might help but it could give you more flow limits and H events.  I think I would just give it a couple days and post again....
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
Post Reply Post Reply
#3
RE: Understanding My Current State and How To Improve
I doubt you will be having a light switch moment with an instant change, but a gradual change over time is reasonable.

Your obstructive events are in awesome territory, so we are going to sacrifice some of that in favor of reducing your CA events.

Actions that reduce obstructive events are the same actions that increase CA events in those sensitive to having centrals, this is not everyone. Thus we have a balancing act between obstructive and Central events with a subjective opinion on comfort being the deciding factor.

a simple change, reduce EPR by 1.

Then post your chart again with a critical report of how you feel and why.

It is possible that we may try turning EPR off.

As your body adjusts to PAP and the resulting lower levels of CO2 over the next 2-3 months we may be able to increase EPR and other settings as the balance gradually shifts back toward favoring the obstructive treatment.
Post Reply Post Reply
#4
RE: Understanding My Current State and How To Improve
Thanks stacyburke and Gideon for the quick replies! I went ahead and reduced the EPR to 1 and although it wasn't as comfortable on exhale, as expected, I do feel better today and noticed I did not wake up in the night as often. Would you recommend that I turn EPR off all together for now or is it ok to continue on with a setting of 1 (based on the latest screenshot) and collect some more data for a bit?

Thanks again for the help!


Attached Files Thumbnail(s)
   
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: Understanding My Current State and How To Improve
Trout
I am dropping in to just encourage you. I want you to know others are like you and we are here with you. You are doing good by taking control of your health. Looks like the changes are helping it cut the treated AHI in half. This is so awesome. Keep listening and sleep well.
Thank you,
Brent aka Factor

Just a Regular guy.
My untreated AHI was 87.  You can do it hang in there.
"You can if you will"   Jerry Kramer

Got OSCAR?
Organize Charts
Optimizing Therapy

My Story
Post Reply Post Reply
#6
RE: Understanding My Current State and How To Improve
So it has been 10 days since I started using my new ResMed machine and I must say it seems to work much better for me than the Dreamstation I had previously. I had a couple of questions for the folks here that I was hoping to get some opinions on.

Here is my journey over the last 10 days:
  • Started the first night with a pressure range of 8-10 and EPR setting of 2 which resulted in an AHI of just below 5
  • Per the suggestions above I reduced the EPR setting to 1 and consistently saw a drop in AHI to 3 or less
  • Since then I have seen the pressure riding fairly low with my Mid being typically 0.5 above my min pressure, because of this I started to adjust my min pressure down. I stopped at min pressure setting of 6 as I haven't seen mention of many settings below this. With the pressure reduction, comfort has gone up and I was able to turn off EPR and have seen no significant increase in AHI.
  • After the small gains and better understanding of the machine, last night I decided to make a couple changes at once that caused a decent shift  
Last night I did the following
  • I saw that I had the Response setting at Soft, so I switched that to Standard.
  • I also switched from the Dreamwear Nasal Mask to Dreamwear FFM for two reasons, I had some minor large leak issues with mouth breath and also comfort issues with the Nasal mask pressing just below my nose and making my front teeth sensitive, both resolved with this change
  • I did forget to switch Mask Type from Nasal to Full Face on the machine. 
  • My AHI had its first significant drop, to less than 0.5 AHI, since first reducing EPR to 1 on night 
So now to my questions....  Smile

  1. I was wondering the impact of Soft vs Standard on the ResMed machine?
  2. With regards to my changes last night, my guess is that change was a result in the shift from a Nasal to FF mask and not the change from Soft Response to Standard. Would I be correct in that assumption based on what others have seen? 
  3. What changes when I switch the setting the mask type setting from Nasal to Full face on the Resmed machine?
  4. I continue to spend the majority of the night at or near my min pressure. Is it ok to test reducing this further? I will continue watching how it impacts my number of events but is there any other concerns I should be aware of?
I attached some images of Last Night (7/15), a typical night (7/12).

Thanks!
Trout


Attached Files Thumbnail(s)
       
Post Reply Post Reply
#7
RE: Understanding My Current State and How To Improve
Trout the view is the Resmed 10 does respond very quick at least compared my previous machine Remstar onesystem, the quest could be have the untreated 2 O & H , but the question is are they due to supine and even higher pressure may not treat any way ? and the trial dropping pressure lower may possibly assist with comfort and also CA's but without testing may not find out the answer ?  so I would say it's " Your Call" ? and then take it from there, but other more in the know's may chime in the right direction. Smile
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: Understanding My Current State and How To Improve
Your principles are sound, well done.
At this stage do not chase numbers, change for comfort.
1. You can think of soft as a slower response, a lesson response to an event which includes flow Limits.
2. Either one or both could have effected the change.
3. The circuit volume, mask, hose, plus lungs increased and the intentional leak increased to vent the additional volume of the mask. Additionally the pump must move additional air because of this increased volume.
4. It is ok to test further.

.Keep the following in mind.
Min pressure should not be over than 4 + EPR to give EPR room to work.
Watch for headaches as that can be a sign of oxygen levels being a little low, or the weather changed. Typically try a min of 7 or 8. If it persists try +2 cmw.

BiLevel 101
Exhale pressure or EPAP is what treats or prevents OA events.
Pressure Support (PS) the difference between inhale and exhale pressure (that is all it is) or EPR is what treats hypopnoea, flow Limits, etc.
Increased PS is also a major driver in flushing out CO2 and thus increasing CA events in susceptible individuals.
Post Reply Post Reply
#9
RE: Understanding My Current State and How To Improve
So it has been a month on the new ResMed machine and I was looking to get some feedback on the CA events that I have. I have tested lower pressures down to 5 to see if that helped but anything lower than 5.8 and I feel like I am not getting enough air. 

Attached is my data from last night which is very representative of a typical night. I am exclusively a stomach sleeper, usually have very few H/OA events now but the CA events always hover around 1 AHI since I have turned off EPR (which helped reduce CAs from around 2 AHI). I will say that over the past month I now wake more rested but the only complaint would be arousals throughout the night that result in some brief tossing and turning.

I guess my question is, is it worth pursuing the CA events and/or arousals in more detail? Or is it best I just focus on accumulating more time and data on the machine as it has only been a month?

Thanks!


Attached Files Thumbnail(s)
   
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  Forum has helped...but now next step to improve nightgagger 60 2,558 09-18-2021, 10:02 AM
Last Post: nightgagger
  Is this Periodic Breathing & How can I Improve AHI (Centrals & Hypopneas)? R3LOADED94 10 409 09-16-2021, 04:25 PM
Last Post: staceyburke
  Understanding sinus issues and change in flow rates?? mruwu69 4 258 09-11-2021, 10:08 PM
Last Post: LordEthan2
  Need help with flow limits/understanding waveforms blancobonzo 4 234 09-06-2021, 07:17 PM
Last Post: 2SleepBetta
Brick [Treatment] What can help improve inspiratory flow shape? rfburns 4 221 09-03-2021, 02:42 AM
Last Post: kappa
  [Equipment] Current ResMed models Choke43 6 246 08-29-2021, 09:25 PM
Last Post: Choke43
Smile long time user need help understanding stats 17blue17 5 177 08-26-2021, 05:13 AM
Last Post: 17blue17


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.