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User new to changing settings
#1
User new to changing settings
I've been a lurker here for some time, and have used a Resmed S9 Autosense, and now using an Airsense 10 Autoset. This week, I rediscovered this forum and resolved to understand my machine settings to a greater degree. I'm using Sleepyhead, and have screenshots for the past 5 nights, and would be interested in observations along with reasoning for any advice or conclusions.

The images didn't appear in the chronological order I wanted; I promise to try harder and get the hang of this for next time.

Some explanations:

The 29th April image just happened to show up before I was going to see my doc. It was an exceptionally good AHI for me, and I was hopeful it would repeat the next night. It didn't.

The 30th April through 2nd May images are typical of what I've seen for a couple of years. The therapy shows some promise, but better results don't seem repeatable. Time for me to get more personally involved. When I say typical, all that should be read into that is that the AHI is too high. The reason I say that is because all I have monitored up to now is AHI. I've had a data card in my S9 for ages, but didn't realized that it was discarding data.

On 3rd May, I was frustrated, and slipped from good experimental practice, and made 4 changes at one time. Looking at the 2nd May chart, it seemed to me that as the pressure decayed after a series of events, when the pressure got down towards minimum, events started off again. So with that in mind, I raised the Min Pressure from 8.6 to 12.0. At the same time, I changed the EPR to 1 and the Start Pressure to 8.0. (You may notice that the summary of settings does not reflect these 3 changes, but the machine still shows them, and I believe the data shows it also. I have a post on this issue in the Software Support Section)

The 4th change was that on the same night, I also got a Walgreens Cervical collar and wore it, as some had said that it helped some people, and I thought it couldn't hurt me. That wasn't strictly true; I mismanaged the velcro attachment and woke upwith a raw patch on the back of my neck.

I'm happy enough with the result, and I intend keeping the same settings for a while to see if the good results persist. I've also recently replaced the strap on my Quattro Air mask; some leaks are visible on the 29th April image.

After that, I may either revert the 4 changes I made to see which made the biggest gains, and in the longer term I'd like to see if similar settins but lower overall pressures would work.

Observations?
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#2
RE: User new to changing settings
mjphyi
Welcome to the forum. We will get to the bottom of the problem with your cooperation and determination. I sense the determination so I think you will acheive the results you want.

If you don't have the clinicians manual go here to get it https://www.apneaboard.com/adjust-cpap-p...tup-manual 

Gerry
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#3
RE: User new to changing settings
(05-04-2018, 04:21 PM)mjphyi Wrote: On 3rd May, I was frustrated, and slipped from good experimental practice, and made 4 changes at one time. Looking at the 2nd May chart, it seemed to me that as the pressure decayed after a series of events, when the pressure got down towards minimum, events started off again. So with that in mind, I raised the Min Pressure from 8.6 to 12.0. At the same time, I changed the EPR to 1 and the Start Pressure to 8.0. (You may notice that the summary of settings does not reflect these 3 changes, but the machine still shows them, and I believe the data shows it also. I have a post on this issue in the Software Support Section)

The 4th change was that on the same night, I also got a Walgreens Cervical collar and wore it, as some had said that it helped some people, and I thought it couldn't hurt me. That wasn't strictly true; I mismanaged the velcro attachment and woke upwith a raw patch on the back of my neck.

Observations?

I think all the changes you made were for the better. Your most obvious remaining issue is that your maximum pressure setting is still limiting what the machine can do for you. If you want more AND can handle the pressure I would set it at 20 cm to find out where the machine wants to take the pressure to. After that you may want to choose to limit the machine pressure and sacrifice some AHI for comfort. I am also of the view that EPR is not a free lunch. It increases your maximum pressure. And in your case maximum pressure is becoming an issue. I would set the Ramp to Auto, leave the Ramp Start pressure at 8 cm if you find that comfortable, and set EPR to Ramp Only at a level of 3. That will give you some comfort while awake, and potentially reduce maximum pressure while you are asleep. Minimum pressure at 12 is fine for now, but it might have to be adjusted a touch after you see what you get.
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#4
RE: User new to changing settings
It looks like you have a combination of positional issues and high flow limitations going on. I'd try a soft cervical collar and see if that helps with the positional problems. The flow limitations aren't included on the charts displayed but I'm betting that they're pushing your pressures higher also. No point in raising the maximum in that case.
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#5
RE: User new to changing settings
(05-04-2018, 06:04 PM)Ron AKA Wrote: I think all the changes you made were for the better. Your most obvious remaining issue is that your maximum pressure setting is still limiting what the machine can do for you. If you want more AND can handle the pressure I would set it at 20 cm to find out where the machine wants to take the pressure to. After that you may want to choose to limit the machine pressure and sacrifice some AHI for comfort. I am also of the view that EPR is not a free lunch. It increases your maximum pressure. And in your case maximum pressure is becoming an issue. I would set the Ramp to Auto, leave the Ramp Start pressure at 8 cm if you find that comfortable, and set EPR to Ramp Only at a level of 3. That will give you some comfort while awake, and potentially reduce maximum pressure while you are asleep. Minimum pressure at 12 is fine for now, but it might have to be adjusted a touch after you see what you get.
When I first got the 10, I wasn't gong to use it until I had set it up, but one night I decided to just try it with the defaults. Woke up at 4am with bloating, which slowly went away over 8 hours or so. That was with the defauly Max of 20.

Earlier in my usage with the S9, I'd felt that higher pressures would be better, but I found that I couldn't go over 16cm with the mask I was using then, a Mirage Quattro. It's quite a lot bigger in area than the Quattro Air I'm using now, and it would just start leaking and waking me up. I'd assumed the big area was lifting it off my face, and even tightening straps just made grooves in my face. Back then I'd also tried  Quattro FX with similar results.

With the Quattro Air, I briefly tried 18cm, but although the leaks weren't bad, but the AHI would still typically be in the twenties. AND AHI was all I was looking at back then.

I currently have EPR on Full Time at Level one, because I wanted to keep the (much higher than before) minimum pressure. I had no problems with that setting, albeit over only 1 night.

First I'm going to see if I get a similar result tonight, and then I'll be back to see where we might go from there. I'm not hopeful of going much higher on the max pressure due to bloating. I also haven't got the mask fit correct yet, after replacing the elastic straps.

Thanks for the response so far.
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#6
RE: User new to changing settings
(05-04-2018, 06:53 PM)Walla Walla Wrote: It looks like you have a combination of positional issues and high flow limitations going on. I'd try a soft cervical collar and see if that helps with the positional problems. The flow limitations aren't included on the charts displayed but I'm betting that they're pushing your pressures higher also. No point in raising the maximum in that case.
So in my post, I said that my 4th change was the wearing of a cervical collar.  I did that because it had been suggested in other posts, and I was sufficiently irritated by recent regressions to not care about changing more tahn 1 thing at a time.

So can you tell me what leads you to say I may have positional issues?

Let me make it clear that I'm not challenging your advice, I just want to understand your reasoning.

Also are you suggesting I wear a different kind of collar, given that the most recent image I posted, for 3rd May, I am wearing a collar. Or ar eyou suggesting it was insufficiently effective?

Regarding flow rate, that was recorded, but I followed the advice on posting images, and with the high aspect screen I have, I can't display all the graphs. This might be because Sleepyhead was started in the era of 4:3 screens, but I'm on a 16:9, reduced vertical space. Or is there another Sleepyhead method of saving images, apart from screenshots?
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#7
RE: User new to changing settings
Reducing the EPR to zero will gain you about 1 cm on treatment pressure without increasing your maximum mask pressure, but I am not sure what it will do for bloating.
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#8
RE: User new to changing settings
Actually it was the earlier charts for the reason I mentioned the collar. May 3rd shows no clusters which shows the collar is working for you. It also pretty much confirms that your flow limitations are driving up your pressure. You can narrow the charts by putting your cursor on the bottom and moving each one up a little. That allows you to narrow each chart so you can put more into the screen shot. Also I would increase your EPR for comfort to at least 2cm and probably 3cm.
Download SleepyHead
Organize your Sleepyhead Charts
Posting Charts
Beginner's Guide to SleepyHead
Mask Primer
5
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#9
RE: User new to changing settings
Your situation gets worse with higher pressure. Flow limitations are driving pressure on your auto machine. I agree with Walla, that you need to treat the obstructive positional apnea with a soft cervical collar first. It would really help if the flow limitation graph was included in your charts.

I suspect that in the end we will find your apnea is treated a lower pressures with the positional therapy (soft cervical collar). I would really like to get a close-up of your flow rate chart, no more than a 2-minute segment. I think flow limits may be significant here.
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#10
RE: User new to changing settings
(05-04-2018, 08:49 PM)Walla Walla Wrote: Actually it was the earlier charts for the reason I mentioned the collar. May 3rd shows no clusters which shows the collar is working for you. It also pretty much confirms that your flow limitations are driving up your pressure. You can narrow the charts by putting your cursor on the bottom and moving each one up a little. That allows you to narrow each chart so you can put more into the screen shot. Also I would increase your EPR for comfort to at least 2cm and probably 3cm.
So what is the relationship between clusters and the need for a collar. I that's already been explained elsewhere, then please point me there, and I'll probably be happy. (Unless I don't understand it I suppose).

I've tried EPR at 2 and 3, just because it seemed like a good idea to be using EPR. However, albeit with only 1 night at EPR of 1, no discomfort.

So are flow limitations the same as leaks? But a leak would be flow out of the machine that didn't make it to me. So that doesn't sound like it. So what is or what can limit the flow? Presumably an obstructed airway, and I suppose I'd expect that would raise pressure due to the obstruction, and the machine algorithm might well raise it some more. So what is the reasoning beween limitation of flow, and the wearing of a collar?
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