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RE: New to CPAP - Need advice! - avaholic - 09-15-2018

Wow, last night was rough!

I upped the minimum pressure to 13 as suggested. 

Why then did the pressure spike all the way to to the top of the range (18) for so long? I'm pretty sure I wasn't asleep at 11 pm so this happened while I was still trying to fall asleep. It hasn't done that at all since I got the machine 3 weeks ago. I think my max so far was 17.

I was woken up by work at 3 am so I even when I tried to go back to bed a couple of hours later, I couldn't go back to sleep. I just disabled those sessions in the graph.

I also must have swallowed a ton of air. I'm bloated and have been burping ever since I got up.  Huh

Friday
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RE: New to CPAP - Need advice! - jaswilliams - 09-15-2018

Can you zoom in on the flow graph for those clusters of OA’s you may need to consider a cervical collar to stop your chin from tucking we need to see what’s going on


RE: New to CPAP - Need advice! - avaholic - 09-15-2018

I bought a 3 in soft cervical collar yesterday and attempted to use it last night. I took it off about 20 mins after I laid down to sleep. I had an extremely difficult time with it. I tried it tight, tried it loose, tried it not even velcroed around the back of my neck. I just couldn't get comfortable at all.

20 min prior to event cluster @ 23:58
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20 min event cluster
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RE: New to CPAP - Need advice! - Sleeprider - 09-15-2018

We seem to have found the pressure you can't tolerate without ingesting air, and proved that pressure alone is not going to resolve the flow limitations that lead to your obstructive apnea. Once again, the solution to this is bilevel, with a lower EPAP and enough pressure support to ease inspiration without restriction. I continue to believe the Airsense 10 should help here. The suggestion by Jaswilliams to consider a soft cervical collar is a good one, and could significantly reduce the event rate, especially considering the 18 cm pressure did not break these apnea.

Moving pressure back to 12-16, and adding EPR 3 once you get the Autoset will provide a lot of relief.


RE: New to CPAP - Need advice! - Rtype - 09-15-2018

Aerophagia is no fun.  As sleeprider commented, 18 is too high, and your max limit should be set lower to perhaps 17, 16.5 or 16.

Personally, I don't like autoPAP, as the machine controls the pressures that can muck up a night's sleep.  Much prefer CPAP or BiPaP with set pressure limits that you can test and then change with better precision.

As you've mentioned, you are anticipating a different machine in a week, but are still interested in maximizing your use with the current machine. In that context, if this was an off night that you haven't experienced before requiring a high pressure of 18, then ignore it and retest again with minimum limit at 13 and a max limit at 16.5.    

Refit your mask for leak and then adjust just a snug tighter than that.   Testing leak while sitting up is not the same as laying down and moving one's head from side to side on a pillow.


RE: New to CPAP - Need advice! - avaholic - 09-15-2018

Yes, I understand how to check proper mask fit. Thanks.

To clarify though, the pressure on this Philips unit has always been set to 12-18. I had just never seen the pressure go that high (18) until last night. The only variable last night was upping the minimum pressure to 13. How would upping the minimum pressure cause me to hit the max pressure so many times last night?

Everyone keeps telling me I need a bilevel unit. After going through all the hoops to swap DMEs and get this ResMed, I'm kind of worried now that the AutoSet help much at all...


RE: New to CPAP - Need advice! - Rtype - 09-15-2018

(09-15-2018, 03:00 PM)avaholic Wrote: I had just never seen the pressure go that high (18) until last night. The only variable last night was upping the minimum pressure to 13. How would upping the minimum pressure cause me to hit the max pressure so many times last night?

Everyone keeps telling me I need a bilevel unit. After going through all the hoops to swap DMEs and get this ResMed, I'm kind of worried now that the AutoSet help much at all...

Upping the minimum pressure to 13 wouldn't have caused it.  You can see in your charting, the machine figured you were continuing to have events and that you needed higher and higher pressure.   Real events?  Don't know.

I doubt you needed the additional pressure, since this was the first time in 3 weeks it ever did that.  This could be positional.  Why last night, I some how transitioned to my left side, instead of my favored right side.  My AHI goes way up and didn't sleep well.  The best you can, review what might have been different last night than other nights. Sometimes you can identify it; other times not.  But if its an odd night occurrence, don't put too much emphasis on it.  Keep an eye on the main trends you notice.

During the 2nd half of the sleep period, it actually looked really good and the machine was progressively reducing pressures to where I think you probably normally require.  

No need to worry. . . work with what you have and will get in a week.  There is such a diversity of machines, manufacturers and settings. . . the effect one machine/setting has on one person can be totally different for another


RE: New to CPAP - Need advice! - Sleeprider - 09-15-2018

(09-15-2018, 03:00 PM)avaholic Wrote: Yes, I understand how to check proper mask fit. Thanks.

To clarify though, the pressure on this Philips unit has always been set to 12-18. I had just never seen the pressure go that high (18) until last night. The only variable last night was upping the minimum pressure to 13. How would upping the minimum pressure cause me to hit the max pressure so many times last night?

Everyone keeps telling me I need a bilevel unit. After going through all the hoops to swap DMEs and get this ResMed, I'm kind of worried now that the AutoSet help much at all...

I missed that you were on the new machine.  Yes, the Resmed will raise pressure faster and we need to limit the maximum pressure and set you up to take advantage of the pressure support that EPR can provide.  Your image did not include your full machine settings and pressure summary.  Correct me if I'm wrong, but this is a Philips, right?  If you have the Resmed, we can do something different.  When I talk about bilevel, I am including the Autoset in that even though it is limited to 3-cm

[Image: attachment.php?aid=8279]


RE: New to CPAP - Need advice! - avaholic - 09-15-2018

Sleeprider - I'm not but I wish I was. I'm still using the Philips unit. I was just mentioning all the hoops I've gone through to start the process of geting the ResMed. It's supposed to happen sometime next week but nothing is confirmed yet.  Smile

I just don't understand why last night it maxed out for the first time. I thought that the AutoSet was an 'APAP' and the VAUTO was a 'BIPAP.' Is that not right? I'm not sure what 'limited to 3 cm' means. I'm sorry I'm still learning. 

Rtype - Regarding positioning, I sleep on my back; always. I never move. I wake up on my back. This was also noted in my sleep study. I've tried to sleep on my side but my arms and legs both end up 'falling asleep' and really bothering me. I know of nothing else that was different last night other than upping the minimum pressure to 13. That's why I was perplexed. I guess I'll just chalk it up to 'sh*t happens.'

After I turned off FLEX Thursday night, I had the best nights sleep I've gotten in at least 2 weeks. The pressure was set to 12-18 then but it never even hit 17 that night.

How about setting the pressure to 12.5 -17? I think I'm afraid I wont sleep well again with the min set to 13.


RE: New to CPAP - Need advice! - Sleeprider - 09-15-2018

Vauto is VPAP or bilevel, Autoset is CPAP, but has 3-cm EPR to play with that works identically to VPAP. I can prove it with charts. At 3-cm Pressure support or EPR 3, the machines behave identically. Vauto has a few settings that can help with trigger and cycle sensitivity and inspiration time min and max, but really if you can get a CPAP but are thinking a bilevel could be beneficial, the Autoset is not a bad way to go.

Don't be discouraged by the stuff on the Philips, you have a new door opening next week that will surprise you.