RE: Help needed with change from APAP to CPAP
Your experienced sleep specialist is right that some machines require some apnea to increase pressure, and this is one of my main gripes with the Philips Respironics auto CPAPs. The Resmed Airsense 10 uses a very different algorithm that actually detects flow limitation and will increase pressure until that is resolved, generally before any apnea occur. Most sleep specialists will look at a user's CPAP data and choose the 90th percentile pressure as a fixed pressure. This is the pressure that is exceeded 10% of the time. Usually that is a pretty good setting, but it means the user is near their highest pressure all the time. If that works for you, then find, however the auto algorithm with Resmed tends to be responsive enough to reach therapeutically effective pressure quickly when needed.
My own approach to CPAP pressure is to look at the data and notice where the median and 95% pressures are, and set the CPAP in that range. This usually keeps the pressure from swinging widely through the night, and allows the user to have the lower pressure that works most of the time, while enabling pressure to rise to levels needed to avoid events. There are exceptions to this approach, especially where chronic flow limitation is present in a way that elevates pressures, beyond the level needed to treat apnea and hypopnea, in an individual that does not respond to pressure to improve flow limitation. This pretty common in people with upper airway restriction syndrome (UARS). Without getting into it too deeply, I prefer a limited auto-pressure range to fixed pressure, but also rely on the data to tell me why the machine is responding in the way it is.
Your therapist recommended a pressure of 14, so I inferred that is near the 90th percentile of your current range of 7 to 14. In most cases a range of 10 or 11 cm minimum and 15 maximum will easily cover that. So I'm not by any means dismissing the suggestion of your therapist, but would have a better idea of your needs if we could look at your OSCAR charts. Without seeing the data, we are all just trying to guess. Can we do something about that?
ATTN :Sleep Rider - From APAP to CPAP
Hi Sleep Rider :
I hope it is Ok - that i have started a new thread from discussion yesterday .
To recap my sleep doc yesterday directed to go from pressure 7 -17 to fixed at 10 . On most recent 25 nights have had 14 AHI in the high 4 's and 11 AHI between 5 and 10 - average about 7.5 . Over all average about 6.6 for 25 nights . And had a stretch of 5 of those in a row under 5 AHI and was feeling reasonable rested when the 5 ran together . Eyes were no longer 1000 pounds to lift .
Followed your suggestion low and high at 10 and EPR off . Still seeking to send Oscar data but having problems as very tech compromised - now turning age 70 and not good with tech .
Results last night - mask on 7.7 hrs - AHI 4.3 - lowest in 2 weeks .
Also have some RESMED data as have figured out some of Oscar ;
CSR 0.00
LL 22.20%
CA 3.17
Obst 0.00
Unclass 0.25
Hypop 0.89
RERA 0.00
Last night sleep seemed shallow and I did not wake rested nor energized as I have had some mornings in the last month when 7- 17 pressure used . AHI seems quite good last night - but sleep doc advised that is not always determinative . The goal - he suggested - is the refreshed and energizing sleep . Last night CPAP seems good all along and there was never any change of pressure nor leakage that I could sense and no sudden changes in pressure - of course . That part was indeed beneficial I think . But last night I was also anxious as to the changes made in pressure - that could also have affected my sleep as I seemed awake a lot . But Fitbit say 1.5 hrs awake - deep 1 hr , light 5.31 hrs - rem 1 .03 hr .
Do you have any thoughts on this or suggestions ? Should I go back to 7- 17 and seek those same good low AHI sleeps or stick with this fixed rate of pressure for some period . Or do you have any other suggestions generally . Without all the data I do appreciate that you have limited info. Im going to work on that when I can get up energy again to try that road .
Thx a lot for any response - all very helpful.
pk
RE: ATTN :Sleep Rider - From APAP to CPAP
It appears that your events are predominately CA, so higher pressure is not going to be a good solution. With 0.0 OA evens, we can actually lower pressure. It is so much better if you just post a chart so instead of guessing, I can give you a very reasoned and precise answer.
My suggestion is to do the same thing again to night with minimum and maximum pressure at 9.0, EPR off. This may further reduce the number of CA events. I have no problems keeping the doctor prescribed pressure of 10.0 and trying to get additional information at the fixed pressure of 10. The 22% large leak rate can increase the flagging of CA events, and it's pretty clear that you need to work on those leaks. If your mouth opens at night and air escapes, you will feel uncomfortable and unrested. Resolving the leak problem is at least as important as calibrating pressure. It appears your doctor's suggestion of a fixed pressure of 10 was beneficial, and the only modification we made was to use the autoset mode with equal minimum and maximum to provide that.
RE: ATTN :Sleep Rider - From APAP to CPAP
It seems you are having issues figuring out how to post charts.
First you want to organize your charts.
Step 1: Open OSCAR and click on the file tab, then preferences then the far right tab (Appearance) and on the right hand side 3 check boxes down you will see "Show event breakdown pie chart", make sure that box is not checked and then click ok.
Step 2: On the daily tab organize the charts so that they show Event Flags, Flow Rate, Pressure, Leak Rate, Flow Limit., you do this by going to the name of the chart (Pressure for example) and clicking and holding mouse on the name then dragging it into the location you want. Can see my following example for order.
Step 3: Click on the view tab and then take screenshot. See attached example.
[attachment=19580]
Step 4: When creating your post go to the area underneath where you type and click Choose File where is says new attachment. The screenshot you just took should be in the folder structure under Documents\OSCAR_Data\Screenshots.
[attachment=19579]
Hopefully that helps, if there is a certain step you are getting stuck on let us know.
RE: ATTN :Sleep Rider - From APAP to CPAP
Thanks a lot Sleep Rider :
I will try it at 9.0 tonight and with EPR off .
I wear a chin strap so loss of air through mouth not likely so great as without strap . Initially when I went to nasal mask from full mask I had huge dry moth issues , But chin strap has prevent most all of that . But there may still be some level of leakage through mouth . I'm working next on charts to send with aid from Geer 1 . Tremendous and very valuable service being provided by you several Forum sleep expert . The Big time commitment required is very much appreciated !
pk
Thanks a lot also Geer 1 - Ill try to follow exactly what you have provided , Thanks a lot for the time spent doing this .
pk
RE: Help-needed-with-change-from-APAP-to-CPAP
Moderator's note
I have merged both threads into one.
Please keep your stuff together.
It is not OK to keep starting new threads on the same topic. Keep your stuff together - it will help those who are trying to help you.
RE: Help-needed-with-change-from-APAP-to-CPAP
Understood - will not do again .
pk
RE: Help-needed-with-change-from-APAP-to-CPAP
Pat, do you have a relative or friend that can help you with posting a chart? Even a high school kid?? They are often more computer savvy than most of us.
The links in my signature line below are step by step instructions on how to Organize a chart, take a Screenshot of chart, and then use the attachment feature to post it here.
RE: Help-needed-with-change-from-APAP-to-CPAP
Thanks a lot Opal Rose .
And yes - no doubt most 10 year olds are capable of managing this . And this is a good idea and will try . It seems that on first try I ran into the Old Sleepy head files and that then a block . Also I have an Apple computer and most of Apnea Board seems non - apple users and apps . Ill try again with your signature line advice . Sooner or later will get this done !
Muck Obliged
RE: Help-needed-with-change-from-APAP-to-CPAP
Pat,
When to start a new thread. When it is, for example, about your wife, someone other than you, to prevent your data from being mixed up.
It is not uncommon for someone to either
1. spend 20-30 minutes looking for your history (different threads) to give you solid advice. or
2. assume ALL pertinent history is in the current thread and provide bad advice because history was not in the thread.
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