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[Diagnosis] Finetuning settings to prevent CA
#1
Finetuning settings to prevent CA
This is my first posting and I hope I can get back on track with some help!

My AHI index has steadily gone up over the years to the point that I need help!!!

It was doing great (AHI <1) but now I am back to where I was (exhausted after sleeping)...

I went to my doctor but since AHI is still under 5 he thinks all settings are fine. He proposed to prescribe some meds saying it may help a bit??? 

Can someone knowledgeable give me feedback what to do? I have a hard time to do my job and being a good father and husband.

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*** Moderator Note: Corrupted image removed. ***
Please see the OP's following post for the correct images.
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#2
RE: Finetuning settings to prevent CA
Here the images,...

And machine setting:

ModeCPAP Mode APAP
Pressure MinMinimum Therapy Pressure 6.00 cmH2O
Pressure MaxMaximum Therapy Pressure 8.60 cmH2O
Antibacterial FilterAntibacterial Filter No
Climate ControlClimate Control Manual
EPRResMed Exhale Pressure Relief Full Time
EPR LevelExhale Pressure Relief Level 2cmH2O
Humidifier StatusHumidifier Enabled Status On
Humidity LevelHumidity Level 4
MaskResMed Mask Setting Pillows
Patient AccessPatient Access No
RampRamp Enable Off
Smart StartMachine auto starts by breathing On
TemperatureClimateLine Temperature 27 ºC
Temperature EnableClimateLine Temperature Enable 2


Attached Files Thumbnail(s)
           
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#3
Gross 
RE: Finetuning settings to prevent CA
I have experimented with reducing the EPAP from 3 to 2 to 1 to 0 and 1 seems to be the best. Any suggestions as to what pressures to use to minimize my events? Any other settings I should try differently? I used to be under 1 so I am wondering if I can get back to that level as it gave me lots of energy to get things done. See also screen shots I attached.

Please help me.

Many thanks!

settings: 

Statistics
Channel                                                                                                            Min   Med     95%    Max
PressureTherapy Pressure (cmH2O) W-Avg: 7.24                                                   6.00  7.12    8.48    8.60
EPAPExpiratory Pressure (cmH2O) W-Avg: 6.24                                                     5.00  6.12    7.48    7.60
Minute Vent.Amount of air displaced per minute (L/min) W-Avg: 6.46                      0.00  6.25    9.62    17.62
Resp. RateRate of breaths per minute (Breaths/min) W-Avg: 15.23                         0.00  14.80  20.40    39.40
Flow Limit.Graph showing severity of flow limitations (Severity (0-1)) W-Avg: 0.01   0.00  0.00     0.05     0.49
Leak RateRate of detected mask leakage (L/min) W-Avg: 5.13                               0.00  1.20     24.00   28.80
SnoreGraph displaying snore volume (?) W-Avg: 0.00                                            0.00  0.00    0.00      0.00
Insp. TimeTime taken to breathe in (Seconds) W-Avg: 2.13                                   0.56  2.06     3.04     5.00
Exp. TimeTime taken to breathe out (Seconds) W-Avg: 1.89                                  0.12  1.92     2.44     9.60
Tidal VolumeAmount of air displaced per breath (ml) W-Avg: 429.94                      0.00  420.0  640.0    1400.0
 
Total time in apnea 00:01:56
Time over leak redline 4.545%
Machine Settings
 
ModeCPAP
Minimum Therapy Pressure 6.20 cmH2O
Maximum Therapy Pressure 8.60 cmH2O
Antibacterial Filter No
Climate Control Manual
EPR ResMed Exhale Pressure Relief Full Time
Exhale Pressure Relief Level 1cmH2O
Status Humidifier Enabled Status On
Level Humidity Level 4
Mask Setting Pillows
Patient Access No
Ramp Enable Off
Machine auto starts by breathing On
Line Temperature 27 ºC
Line Temperature Enable 2


Attached Files Thumbnail(s)
           
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#4
RE: Finetuning settings to prevent CA
A few things to address your question, it looks like Ramp is off and EPR has been reduced to 1. While it's possible to minimize pressure range even more, it really is not needed. The recent chart I saw had 4 CA flags in 8 or so hours, so there's not much of anything there that needs addressed on the Centrals.

I think there's some leak control work to be done if you must fine tune something. We'd need a standard screenshot no zoom to see leak patterns.

Unless there's some computer issue blocking use of OSCAR, I'd go for the upgrade from Sleepyhead. Sleepyhead has not been updated for several years, and there's quite a few upgrades the programmers have gained with OSCAR. It's far less buggy and more accurate.
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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#5
RE: Finetuning settings to prevent CA
Dave, 

Thank you for your time looking at the images, I upgraded to Oscar and have attached a few images for you to look at. I also added an image with EPR at 2 cmH2O showing many more CA's. 

I do wake up with a very dry moth recently. Maybe I need to tape my mouth shut like I read some people do.

Please let me know what I can change to find the best settings.

Thanks again, MD


Attached Files Thumbnail(s)
           
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#6
RE: Finetuning settings to prevent CA
I would like to see a few 3-minute views, Please squeeze the leaks, flow limits and pressure a bit to fit it in. one of the views should be normal breathing.
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#7
RE: Finetuning settings to prevent CA
You mentioned previously using EPR of 3, it would be good to see some examples of that as well. As Gideon noted flow limitations would be of more value than tidal volume.
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#8
RE: Finetuning settings to prevent CA
Here the 3 min views. I hope I got the right panels in for you.

MD


Attached Files Thumbnail(s)
           
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#9
RE: Finetuning settings to prevent CA
here images with EPR set on 3 cmH2O and some details of that night


Attached Files Thumbnail(s)
           
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#10
RE: Finetuning settings to prevent CA
Many thanks for looking at the info. Amazing my doctor is not able (willing) to do what you are doing.
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