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New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy - Printable Version

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New in this forum. [Snowy2020] Need help to understand the graphs and adjust therapy - Snowy2020 - 09-06-2020

Hi,

As a newbie this weekend, I  too need someone to take a look at the attached profile. Any helpful comments would be sincerely appreciated.


thanks,

PC


[attachment=26307]


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - bonjour - 09-06-2020

Welcome to the forum

You have a lot of RERAs, on average they are 'waking' you every 15 minutes through the night.  We have to get those managed and it will be somewhat difficult in that you need higher pressure.

First, in File / Preferences / CPAP change the Preferred Major event index from AHI to RDI


this will add your RERA to your AHI to give you RDI which for you is the number that you need to be targeting.

I would like to see redacted copies of both your Diagnostic and Titration Sleep Studies, full copies please, not just the summaries.
Your RERAs are fairly high, I'd like to see if they were higher in your studies because a high RERA index with a fairly low AHI tends to indicate UARS, Upper Airway Resistance Syndrome. (you have the wrong machine to treat this so we need to know)

Is there a specific reason you are using CPAP mode at 14 cmw?  If it is only because that's what they gave you I'd like you to try 

Suggestions
Auto mode (it is easier to optimize in auto mode where we can see what your APAP wants to do, We may suggest to return you to a fixed pressure later.
Min pressure = 12 (2 less than current CPAP pressure per standard titration protocol)
Max Press=re = 20 (machine Max because the 'titrated you to a high pressure)

Expect these settings to change.


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - Snowy2020 - 09-07-2020

Hi,

thank you so much for getting back to me so quickly. I changed the preferences to rdi, and I will try to use APAP tonight. my rdi was 7.76 last night

I have attached sleep study reports . These Sleep studies have recommended pressures 11 to 14 cm over the last 9 years. By experimenting, I think 13-14 is the correct range.

I did notice my RERA index increased recently, possibly because I changed from the resmed swift nano to the p10 ...the index last year was 1.62, last 6 months 1.43, last 30 days 2.77 and last week 6.43. I changed because the swift nano stretched too easily, and had no adjustment. I'm still experimenting with the size between medium and large for the resmed p10 but after these poor results I may have to go back to the nano.

Thanks again for your help


Paul[attachment=26326][attachment=26325][attachment=26324]


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - Sleeprider - 09-07-2020

Snowy, we have 3 sleep studies, two titration and one diagnostic. You never achieved REM sleep in any evaluation and you are surely feeling the effects of that sleep disorder that has NEVER been solved with CPAP. The 2011 study was a titration study that showed significant periodic leg movement, and abundant arousals, no REM with the best RDI of 10.4 events per hour at 8-cm CPAP pressure. Well, that sucks! In January 2017 you had a diagnostic study that showed severe sleep disorders, but failed to exceed 30 AHI so you did not proceed to titration. In this study, no PLM was noted, but you got down to SpO2 of 83% and while your AHI was over 19 events per hour, the RDI was much higher and not tabulated. This sucks too. In March 2017 you had another titration study on CPAP, and oddly, you achieved 0.0 AHI at all pressures from 4.0/4.0 to 11.0/11.0 but showed some improvement of SpO2 at higher pressure. RDI was not measured.

Your clinical studies bring to mind a saying "The definition of insanity is doing the same thing over and over again and expecting a different result". You need to sleep well and achieve REM sleep, something that has never been accomplished by any technician or doctor. I'm going to tell you how it is possible....bilevel. You need to overcome airway resistance that persistently awakens you, even with your high pressure today. I could put you on a Resmed Aircurve 10 Vauto with a minimum EPAP pressure of 9.0 and maximum pressure of 18 and pressure support of 4.0 cm (pressure range 13.0/9.0 to 18.0/14.0) and you would wonder why you suddenly feel like a normal human being. You need bilevel pressure support. Buy one and you will almost immediately get your money's worth, or go through the doctors, and continue to be frustrated. Your solution is obvious, you just haven't complained enough to get what you need. Ask for bilevel based on your long history of unsatisfactory sleep and even the test results that never achieved REM.

If you will zoom into some random segments of your chart 2-3 minutes in length where we can see the flow rate wave-form, I think we can probably identify the problem very precisely. I'm specifically looking for flattened peaks of inspiratory flow.


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - sheepless - 09-07-2020

be aware that resmed machines will ineffectivelly & disturbingly raise pressure against plm induced flow limitations. if you run into this, it's important to cap max ipap. I run my vauto at fixed pressures to avoid this problem (currently ps 4.8 over 7.2 to 12 cmw). otherwise the machine raises pressures against plm flow limitations, sometimes as high as they go, disturbing sleep & causing leaks & aerophagia.


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - Snowy2020 - 09-08-2020

Good Morning,

I set the machine to APAP last night and had what I felt was one of my best nights, despite ahi being above just above 5. I don't remember waking up, or tossing or turning.

The 95% pressure was 12.5 so I feel that the set pressure is in the right ball park. See screen shot. Do I need a BIPAP machine? Should I keep trying APAP this week?



[attachment=26346]


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - Sleeprider - 09-08-2020

Your obstructive events are clustered together and I'm sure they are chin-tucking. I think you would benefit from a soft cervical collar (see link in my signature). You have quite a bit of variable breathing being flagged, and bilevel might help to level that out. I would like to get some zoomed images to see what your respiratory flow looks like in 2-3 minute segments. That might answer the question about the need for bilevel or what is causing such variation in breathing flow rate.


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - Snowy2020 - 09-08-2020

Hi,

thanks for all your help. The collar sounds like  a good idea and I will order one today. I will also assemble some 3 minute segments and send them to you later today. I am already excited at being able to do more things to alleviate this condition which ahs cost me so much good sleep.


Paul


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - Snowy2020 - 09-08-2020

Hi,

here are some segments of flow rate as requested

many thanks,

Paul

[attachment=26364]
[attachment=26366]
[attachment=26367]


RE: New in this forum. [pchalmers] Need help to understand the graphs and adjust therapy - bonjour - 09-08-2020

I see a lot of flow limitation on all of your zoomed views. My recommendation would be to get a BiLevel, Preferably the ResMed VAuto if you are not getting good comfortable results with your Dreamstation Auto.