Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

New User - Optimization Help Please!
#11
RE: New User - Optimization Help Please!
Thanks for your advice—I changed the Y-axis maximum to 80.

Could you give some feedback on my data from last night?
How detrimental are large leaks? I think my mask fits pretty well, but reading about how it should "hover" over your face influences me to have it very loose. It doesn't feel super uncomfortable if I tighten it more (but I feel like I typically ignore any discomfort...), so should I do that? 

I have recently purchased an SpO2 monitor, so I have included that data. Is there anything abnormal about my levels? I read fairly good reviews on this product, but would any expert say that given my data, it may be inaccurate? Still waiting for the sleep clinic to send my sleep study results, but I recall my at-home sleep study recorded a SpO2 below 90% most of the night (I will confirm this when I receive the results). Just a little skeptical about these Amazon products.

Last Night: [attachment=24685][attachment=24686][attachment=24687]

Zoomed In: [attachment=24688][attachment=24689][attachment=24690]
Post Reply Post Reply
#12
RE: New User - Optimization Help Please!
The night before:[attachment=24691][attachment=24692][attachment=24693]
Post Reply Post Reply
#13
RE: New User - Optimization Help Please!
You have quite a bit of flow limitation, which is the flattened inspiratory flow waves you see, and this leads to the RERA and hypopnea you see. While there is a fair amount of CA present, it's really variable, and not too uncommon with new users. The use of EPR at 1 has not changed your CA event rate substantially, so I think we can observe where things settle out. If needed we can add more EPR and treat the CA with EERS (enhanced expiratory rebreathing space). Let's give this a couple more days, and take another look at how to move forward. Your feedback on comfort will be important.

With regard to mask fit, the cushion should be lightly held in place without compressing or deforming the cushion.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#14
RE: New User - Optimization Help Please!
(07-13-2020, 10:21 AM)bonjour Wrote: Welcome to the forum.

I assume that you are being treated for daytime sleepiness, correct?

Settings.
Ramp off, at these pressures you don't need it
Set min pressure = 6,  It should rarely be set lower than this, and usually higher.  This is IMHO the min adult setting, mos have issues breathing at inhale (IPAP) pressures lower than this
Set EPR = 0 or off.  This is an attempt to reduce your Centrals.  Since you already have a few months on your machine this may not work, but we need to try.

Your history shows consistently "high" Central Apneas.  I would like to see a couple of zoomed 5-minute shots of your central apneas to see the character of them.  I would also like to see a redacted, we don't need your personal info, copy of your full sleep study, including the art tables and charts, not just the summary.

Your Aerophagia, let's see if this helps it before we make more changes.

Hi Bonjour,

I just received my results back. Here they are

https://imgur.com/a/eGMFRO2

I am unsure if submitting images on a 3rd party website are okay. If this is against the rules, I will attach via the forum function.

Most recent nights data:[attachment=24996][attachment=24997][attachment=24998]
Post Reply Post Reply
#15
RE: New User - Optimization Help Please!
On the page with the heading "Risk indicator," we see that about 1/3 of the breaths you took during the study were flow limited, though the discussion of the results doesn't say anything about this. I'll let others give you advice about your settings -- you're balancing the need to address FLs and the need to avoid too many CAs -- but I do want to draw attention to this finding.

If you haven't already, you might want to read the discussion of FLs here:

http://www.apneaboard.com/wiki/index.php...imitations

and follow the additional links.

FLs indicate that you are having to work hard to complete an inhalation. You start breathing in, encounter a limitation, then redouble your effort to overcome it. (The limitations are slight restrictions to your airway, often from relaxation of the tissues lining it.)

When this goes on breath after breath, a couple of things can result. First, you can get tired out just from the effort of breathing. Second, the ongoing disruption caused by the effort can keep you from sustaining a normal sleep architecture (sequence of sleep stages). Third, the FLs can lead to arousals, which may be brief wake-ups or may be a change from deeper to less deep sleep.

So I hope with help you can see your FLs go down. That could be a significant help to you.
Post Reply Post Reply
#16
RE: New User - Optimization Help Please!
Thanks for your response.

I read that increasing the minimum pressure may minimize the number of FLs.

Would this lead to more aerophagia? Does increasing the minimum pressure increase anything else, such as the Clear Airways?
Post Reply Post Reply
#17
RE: New User - Optimization Help Please!
Hi Sam R Squared,

Yes, increasing the pressure should reduce the FL events, but that increase can increase aerophagia/air swallowing. With CA, it's a bit more complex. Mostly they respond to less pressure and less pressure swings, and they typically are consistently inconsistent.

Hopefully some good news for you, I didn't see CA listed on your sleep study data. I am not certain how long you've been on PAP therapy, but you're showing signs of having treatment emergent CA. Basically, since you're fairly new to PAP therapy, you're getting rid of CO2 too efficiently for what your brain is used to being your "normal" breath efficiency. If these prove to be treatment emergent CA, your brain will rewrite itself within 3 months of PAP use and will register a new normal breathing efficiency rating. While this is going on, the CA should diminish and eventually disappear.

Best to you on this therapy and may you succeed at this.
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.
Post Reply Post Reply
#18
RE: New User - Optimization Help Please!
Sam, we have found the best way to address flow limitation is not just an increase in pressure, which is your only choice with CPAP, but an increase in pressure support, which is a bilevel capability. The difference in pressure between IPAP and EPAP is pressure support and you get up to 3-cm with the Airsense 10 CPAP machines in the form of EPR. If flow limitation does not respond to the up to 3-cm of pressure support available with the Airsense 10, we often try to get people over to the Aircurve 10, which is not limited for pressure support. Using pressure support instead of brute pressure, is far better for individuals that suffer from aerophagia. So if you want to address flow limitation with your current machine, we would rather increase EPR instead of pressure. We just want to be sure the minimum pressure is sufficient to allow EPR to work. For example, with a minimum pressure of 7.0 and EPR at 3, the starting pressure is 7.0/3.0 (IPAP/EPAP). That is simply bilevel pressure support, and it means as you inhale, pressure is increased as flow rises to support the inspiration, counter-acting inspiratory flow limitation or resistance. Yet, pressure drops back to low levels during exhale, which has less impact on aerophagia. Okay, that's the basics of pressure.

With minimum pressure 6.0 and maximum pressure 8.0, and EPR 1, your starting pressure is 6.0/5.0 and it can increase to 8.0/7.0. We are seeing your pressure vary in the full-range and your events are mostly CA which CPAP cannot treat. Your CA events have not changed with your original settings with EPR 2 and the current EPR 1, so I want to give you back that pressure relief, but make pressure more steady. If you are game for it, let's go to a constant pressure by setting both minimum and maximum pressure at 7.0 and EPR at 2. This will result in 7.0/5.0 pressure through the night. My hope is that the lack of pressure fluctuation will calm the CA and make you more comfortable.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#19
RE: New User - Optimization Help Please!
Thanks for your input!

I adjusted things as you said, but still feel pretty tired in the mornings. 
 
Do you think I should keep with these settings for some more time?

[attachment=25113][attachment=25114][attachment=25115]
Post Reply Post Reply
#20
RE: New User - Optimization Help Please!
I hope Sleeprider can swing by to answer the question about your settings. You're stuck between the CA rock and the FL hard place.

Some information that might be helpful: do you think you were asleep before your break and again before the end of your night? If you weren't, then the CAs in those spots can be discounted as reflecting awake breathing, which is much less regular than sleep breathing.

I also wonder whether you ever have a chance to sleep longer. Six or seven hours might not be enough for you.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  APAP optimization assistance jayed53 9 434 03-14-2024, 03:13 PM
Last Post: jayed53
  New to CPAP, help with optimization spsalv 5 371 01-23-2024, 02:52 PM
Last Post: spsalv
  [Treatment] First stab at optimization Ferloft 5 606 12-05-2023, 09:14 PM
Last Post: Ferloft
  Therapy optimization help!!! xaid 7 785 06-27-2023, 07:41 AM
Last Post: Sleeprider
  Oxygen concentrator as non-medically indicated optimization? cyrial 3 466 06-05-2023, 10:37 AM
Last Post: cyrial
  [Treatment] Koala1 - Moving to Resmed, aerophagia, please help with optimization koala1 101 7,196 05-27-2023, 03:52 AM
Last Post: koala1
  Fragmented Sleep, FLs, Suspected UARS, REM Related. 5 Months of Optimization + EERS. pineh 10 2,526 08-09-2022, 10:25 AM
Last Post: Silvia10


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.