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Upgraded to Resmed AirSense 10, but ...
#1
Upgraded to Resmed AirSense 10, but ...
My sleep doc upgraded me to a Resmed Airsense 10 last week (and large facemask now instead of a medium). The first night I left the settings as they had it set it at the supplier (min pressure 4 and max pressure 5) and got and AHI of about 20. No good. So I adjusted my settings a little but still around 15. So I looked at what the pressure settings I had on my old Resmed 9 and set the 10 to those old settings. Definite improvement to my AHI but still varying between 4 and 9 AHI).  On my previous setup I was getting AHIs between 1 and 2. What gives?  I decided to use my oximeter again to track what was going on.  The screen shot from last night is below.  Anybody see anything obviously wrong in my settings that I'm missing?
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#2
RE: Upgraded to Resmed AirSense 10, but ...
We’re you using EPR on the S9 ? A good chunk of your AHI is CA’s were you seeing those previously ? Maybe post a typical night from the S9 so we can see what was happening with that, but it looks like the EPR may be causing CA’s
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#3
RE: Upgraded to Resmed AirSense 10, but ...
You are running a max of 20 and you have, at least here, predominately Central Apnea.  The best treatment for CA on a CPAP is generally lower pressure and to minimize pressure variability.  This means a minimum range and reduced or no EPR.

Also, add the Flow Limit chart as flow limits are one of the triggers for increasing pressure.  Flow limits are the smallest of the obstructive events.  You can shrink Pressure and leak rate charts to make room.

I would set the EPR to either 1 or off and consider dropping the max to 15.  Yes the tops will be clipped.

Fred
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#4
RE: Upgraded to Resmed AirSense 10, but ...
I agree bonjour about reducing the EPR down to 1cm. I try that first before changing the pressure.
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#5
RE: Upgraded to Resmed AirSense 10, but ...
The DME had it set to WHAT?? 4 to 5??? They were drunk, right?
PaulaO

Take a deep breath and count to zen.




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#6
RE: Upgraded to Resmed AirSense 10, but ...
[attachment=9576 Wrote:bonjour pid='281109' dateline='1545950097'][attachment=9577]You are running a max of 20 and you have, at least here, predominately Central Apnea.  The best treatment for CA on a CPAP is generally lower pressure and to minimize pressure variability.  This means a minimum range and reduced or no EPR.

Also, add the Flow Limit chart as flow limits are one of the triggers for increasing pressure.  Flow limits are the smallest of the obstructive events.  You can shrink Pressure and leak rate charts to make room.

I would set the EPR to either 1 or off and consider dropping the max to 15.  Yes the tops will be clipped.

Fred

Thanks to all for the replies. I first just adjusted the EPR down to 1, changed no other settings.  Below is what I got.  Less CA but now something new (to me) ...

I've never had a Cheyne Stokes Respiration (CSR) event before, but I do know that I had shifted position in the night and the masked had a very small oscillating leak around part of the seam, it took me a few minutes to get the mask to seal back again.. Hopefully that was it (I'm not at high altitude).  I had my annual in September, my internist said there were no probs. And my SpO2 and pulse rate looks okay during the CSR event.

[attachment=9578] [attachment=9579]
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#7
RE: Upgraded to Resmed AirSense 10, but ...
Thanks for the exploded view, what you have shown is NOT CSR but a series of OA followed by recovery breaths being misinterpreted as CSR.

BUT. . . The densely clustered periods of OA, including your "CSR" is positional Apnea. Look for a loose-fitting soft cervical collar to keep your chin from tucking.
That is the best fix we have seen for positional apnea.

Guests coming so I have to run

Fred
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#8
RE: Upgraded to Resmed AirSense 10, but ...
(12-28-2018, 09:54 AM)bonjour Wrote: Thanks for the exploded view, what you have shown is NOT CSR but a series of OA followed by recovery breaths being misinterpreted as CSR.

BUT. . .   The densely clustered periods of OA, including your "CSR" is positional Apnea.  Look for a loose-fitting soft cervical collar to keep your chin from tucking.
That is the best fix we have seen for positional apnea.

Guests coming so I have to run

Fred

Thanks, Fred. I appreciate all the knowledge being shared here!
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#9
RE: Upgraded to Resmed AirSense 10, but ...
(12-27-2018, 10:46 PM)PaulaO2 Wrote: The DME had it set to WHAT?? 4 to 5??? They were drunk, right?

Yeah, right? What other excuse is there for that??
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#10
RE: Upgraded to Resmed AirSense 10, but ...
(12-28-2018, 12:21 PM)heropass Wrote:
(12-27-2018, 10:46 PM)PaulaO2 Wrote: The DME had it set to WHAT?? 4 to 5??? They were drunk, right?

Yeah, right? What other excuse is there for that??

What were the settings on the Dr.'s prescription?
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