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What does machine class as apnoea event? [Ockrockets Thread]
#21
RE: What does machine class as apnoea event? [Ockrockets Thread]
Ockrocket, I already saw what I needed to know in your summary data. Your hypopnea event rate is what has increased. Let me start with, I really don't like the Philips Dreamstation for this problem. The Resmed EPR works to control these events easily ad comfortably, but your only choice with Philips is to increase minimum pressure or in your case CPAP pressure. Your mask is also giving out and allowing large leaks. Since those were not always present, I think a new cushion or mask may be in your future.

Are you certain that compliance for RMS includes pressure or mode settings? Most are only concerned with hours of use and sometimes AHI. You need higher pressure with the Philips machine, or a change to Resmed would be the better choice if you really want some sleep bliss. One way or the other, we can't resolve this problem with our hands tied behind our back.
Sleeprider
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#22
RE: What does machine class as apnoea event? [Ockrockets Thread]
(05-21-2020, 07:15 AM)bonjour Wrote: With OSCAR 1.1.x go to view/reset charts /standard.  
Events
Flow rate
Flow Limits (ResMed only)
Pressure
Leaks
Snore

F12  removes calendar, removes pie chart and right sidbar, takes screenshot, then restores

Thanks Fred,
I will try to reorganise my charts and do more screenshots if necessary.
The help is appreciated.


(05-21-2020, 08:41 AM)Sleeprider Wrote: Ockrocket, I already saw what I needed to know in your summary data.  Your hypopnea event rate is what has increased.  Let me start with, I really don't like the Philips Dreamstation for this problem.  The Resmed EPR works to control these events easily ad comfortably, but your only choice with Philips is to increase minimum pressure or in your case CPAP pressure.  Your mask is also giving out and allowing large leaks. Since those were not always present, I think a new cushion or mask may be in your future.

Are you certain that compliance for RMS includes pressure or mode settings?  Most are only concerned with hours of use and sometimes AHI.  You need higher pressure with the Philips machine, or a change to Resmed would be the better choice if you really want some sleep bliss. One way or the other, we can't resolve this problem with our hands tied behind our back.

Sleeprider,

RMS [Roads and Maritime Services] compliance is AHI 4 or below, minimum 4 hours per night, compliance for minimum 80% of nights.. and a respiratory specialist must sign off that you have been fully compliant in the 30 days preceding the annual check up and report that is required to maintain professional driver endorsements.
The specialist is required to check you physically, and to also check machine data to confirm your numbers are within the specified parameters.  

When it comes to machine setting changes my specialist is the problem, he and I have not always seen eye to eye because he is not used to having patients who have sought knowledge outside of his counsel to give input on their own condition.
I have had disagreements with him in the past over my treatment management.

I have a spare mask on hand, the current one has been in use for the full period since I started using this particular CPAP machine back in August 2016.  Rolleyes ( I'm very good at maintaining things so they keep working by treating them with care )

In this screenshot attached you can see the setting changes I made [the early changes on the first machine were done by the clinic while I was being assessed for the best setting options].

I was doing well with a fixed pressure of 8.0 but then my numbers started to creep up, so I switched to APAP to try to do a bit of a self assessment to see if I could find a better setting.. hence the couple of changes to the minimum pressure.
Not having made a significant improvement I then switched back to fixed at 8.0 and started looking for other causes of the increased AHI.
Not being able to single out a particular trigger for the variation in AHI I decided it was time to ask on here.

I will firstly tighten my mask a little more as the straps do tend to loosen over time, but I think I will switch over to the new one as of next week.
My steps would be the new mask for a couple of weeks, then if no improvement I will look at either upping the fixed pressure or going to APAP with an even higher minimum pressure than I set it to recently.

Ideally I don't want to be making multiple changes together or in short succession, it needs time between any alterations to get a proper idea if anything has changed as a result.

Thank you for the input.
Stephen [aka Ock.]


Attached Files Thumbnail(s)
   
- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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#23
RE: What does machine class as apnoea event? [Ockrockets Thread]
Just saying, this as the rebel you know me to be...If it was up to me, you'd have an average AHI less than 1 and would sleep like a baby. I detest the idea that any individual would impose his ego over my choice in anything. I have no more right to telll you how to best conduct our therapy than your ASSigned specialist. You however are knowledgeable ad motivated to do the right thing, and that's what I want to set free.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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Organize your OSCAR Charts
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: What does machine class as apnoea event? [Ockrockets Thread]
Two sample nights for comparison.
As you can see my AHI varies widely, this is the sort of nightly results I've been getting for some time now.
There is no stability or consistency of treatment any longer, each night is a total unknown for what the numbers will show in the morning.

I will start with the mask change as mentioned by Sleeprider, but if there is anything else that stands out to anyone I would appreciate the feedback.

Thanks

       
- They are not spelling/grammar errors.. I live in Australia, we do it differently Down Under  Big Grin -
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#25
RE: What does machine class as apnoea event? [Ockrockets Thread]
On the nights when hypopnea is present, there are two likely solutions for that. Either some pressure support which your machine cannot provide, or increases in pressure to relieve upper airway restriction. Using the auto-pressure feature of your CPAP might help. We should take a close look at the root cause leading to those reductions in flow rate, so you can reasonably discuss a plan of action with your RMS master. A strategy that might be useful is to involve a medical doctor or RT in your CPAP therapy that can provide therapy recommendations the RMS cannot over-ride. It may also be worthwhile to request a different RMS specialist be assigned to your case. I really think your RMS specialist is over-reaching his authority in dictating how you pursue therapy, rather than keeping focused on the fact you comply with the standards for hours and effectiveness of your therapy.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#26
RE: What does machine class as apnoea event? [Ockrockets Thread]
What I'm seeing tells me the Respironics ScreamStation isn't capable of giving proper therapy. ResMed's EPR would likely help quite a bit. It also sounds like the RMS joker has either gone deaf and blind or doesn't care about good therapy and just likes the control over patient aspect. Replace the joker and ScreamStation, and I think you'd be doing many times better than you're ever going to get as is.

Insanity is doing the same thing over and over but expecting different results. Changes are needed or the results remain the same.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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