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First Night - ResMed AirSense 10 AutoSet
#11
RE: First Night - ResMed AirSense 10 AutoSet
(04-06-2018, 12:54 PM)sonicboom Wrote: The problem with racing to conclusions based on one or two nights is the inability to duplicate pre sleep conditions from one night to the next.  Did you eat exactly the same foods? Did you last drink at the same time?  Did you last eat food at the same time?  Were food or drink too close to sleep onset?  Did you take meds?  Did you take them at the same time?  Did you drink alcohol?  How many?  etc...  I notice all of these things effect my AHI.  So I would leave things be for another few nights.  To ease your mind an AHI under 5 is considered treated and in time you will figure out whether you can improve AHI on this machine or whether you might be a candidate for BiPap - a question well down the road. 

You make some very good points, and I know night to night variations in AHI are par for the course. I was just a little disappointed in the direction things headed. And, I am now thinking that making small changes perhaps is the not the best strategy to determine the direction I need to go to make improvements. The factors you listed are good ones, and I think another one that should at least be considered is weather. No not directly if it is raining, or sunny or snowing, but the barometric pressure. It is changing all the time. In general as it goes low the weather gets worse, and as it goes higher the weather gets better, but the point is that it is changing, and could have an effect on apnea. To determine how significant the effect could be I did a little research to see how much atmospheric pressure actually changes in normal variations from day to day. From having a low pressure to a high pressure the difference is about 1 inch of mercury or perhaps a bit more. When you convert that to cm of water that is used for units of pressure with CPAPs it is about 35 cm. Pretty significant if you think pressure really does effect the incidence of central apneas, and consider that a 5 cm treatment change is a big change. My conclusion in this is that perhaps we give too much weighting to the absolute pressure in our lungs and on how much it can affect central apnea incidence.

So my new line of thinking is that unless I want to proceed down the road of death by 1000 cuts, perhaps I need to make some big changes in treatment to see what they do, or at least see what direction they take me. I'm considering trying two options to see what they do:

#1 Minimize EPR
Max Pressure - 11 cm
Min Pressure - 8 cm
EPR - Off

#2 Maximize EPR
Max Pressure - 11 cm
Min Pressure - 10.5 cm
EPR - 3 cm

Both should have a benefit in reducing OA's by increasing EPAP about the same, and about equal in comfort based on exhale pressure. I'm hoping that one or the other will be significantly better than the other in reducing total apneas, and give me some clear direction in which way to go...
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#12
RE: First Night - ResMed AirSense 10 AutoSet
Tried setup #2 last night, and it was a fail. I suspect I am opening at least my lips and letting air out especially at the higher pressures. That is being scored as a large leak, and I suspect also causing some of the apnea events. Will put the optimization project on hold until I sort out the leak issue.
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#13
RE: First Night - ResMed AirSense 10 AutoSet
For mouth leaks chin straps and soft cervical collars help along with taping your mouth closed with a strip of medical paper tape.

I would still reduce the EPR to 1 or turn it off all together. FWIW
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#14
RE: First Night - ResMed AirSense 10 AutoSet
Make one change and run it for a week if at all possible (unless it causes a significant health issue) IMO.
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#15
RE: First Night - ResMed AirSense 10 AutoSet
(04-07-2018, 12:18 PM)Walla Walla Wrote: For mouth leaks chin straps and soft cervical collars help along with taping your mouth closed with a strip of medical paper tape.

Will try my homemade Tensor bandage chin strap and some medical paper tape tonight to see what it does.
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#16
RE: First Night - ResMed AirSense 10 AutoSet
(04-07-2018, 12:18 PM)Walla Walla Wrote: For mouth leaks chin straps and soft cervical collars help along with taping your mouth closed with a strip of medical paper tape.

I would still reduce the EPR to 1 or turn it off all together. FWIW

I agree with Walla2
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#17
RE: First Night - ResMed AirSense 10 AutoSet
OK, so last night is showing some hope for improvement. I used a home made Tensor bandage chin strap and some Paper Medical tape on my mouth to eliminate loss of air through an open mouth. Large leaks were eliminated, and I think leakage rate is now acceptable, although I was fighting an issue with one nostril of the P10 not sealing well for the first half of the night. Not a lot of fun wearing all of this stuff and if that is what it takes I see a full face mask in my future.

As for results I got up in the night as the setup was not comfortable and I was going to abandon the tape on the mouth at minimum so I could get a better sleep. But the A10 told me the AHI was 0.7 so I put it all back on and tried a gain for the second half of the night. It was much worse with many of the events occurring in the last hour of sleep. 

I think I will leave everything the same for tonight except for the max pressure. Especially in the second half of the night the demand for pressure was bumping into the 11 cm limit. This seems to be new as I was not needing that much pressure before. In any case it seems worthwhile to just put it at 15 cm and get it out of the way for now. 

In general OA events are down, and CA events are up. In looking at the mask pressure detail I think the underlying issue is a waxing and waning of the breathing effort. Sometimes the cycle ends with an obstruction event and other times it ends with an open airway event. I suspect increasing the max pressure limit will probably prevent some of the OA events, but they will end with a CA event flag instead. So total events probably won't go down, just the ratio of the OA to CA. 

If these OA events don't self correct over the next couple of months, I think I will also have to start checking out the AirCurve 10 options if I want to get AHI under 5 consistently.
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#18
RE: First Night - ResMed AirSense 10 AutoSet
(04-08-2018, 05:18 AM)Apnea Infant Wrote:
(04-07-2018, 12:18 PM)Walla Walla Wrote: For mouth leaks chin straps and soft cervical collars help along with taping your mouth closed with a strip of medical paper tape.

I would still reduce the EPR to 1 or turn it off all together. FWIW

I agree with Walla2


Agree, I prefer “soft” cervical collars, but tape if you must. EPR 1 or off.

You should be giving the changes you make more than a day before making more changes.
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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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#19
RE: First Night - ResMed AirSense 10 AutoSet
Quote:Agree, I prefer “soft” cervical collars, but tape if you must. EPR 1 or off.
You should be giving the changes you make more than a day before making more changes.

I agree that I should be waiting for more nights before making more changes. Increasing max pressure to get it out of the way is going to be my only change for tonight -- I promise!

Am I correct in assuming a cervical collar would only reduce obstructive apneas due to body/neck position? And if OA's are minimal then the benefit of using one would be minimal? I use a fairly aggressively shaped therapeutic memory foam pillow now and I would think it would support the head and neck somewhat like a cervical collar???
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#20
RE: First Night - ResMed AirSense 10 AutoSet
The Cervical collar also helps prevent mouth leaks by gently nudging the jaw closed.
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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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