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Dugy40 [Doug's Therapy Thread] - Printable Version

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RE: Dugy40 [Doug's Therapy Thread] - Sleeprider - 07-14-2020

There are a couple good wiki articles with a great deal of information. The Optimizing Therapy in my signature links is a good start. A very long wiki with interpretation on how to read charts is the "Beginners Guide to Sleepyhead" which is the software before OSCAR. http://www.apneaboard.com/wiki/index.php/Beginners_guide_to_sleepyhead

On flow rate y-scale I try to select a value that crops only the largest breaths or sighs. It varies from person to person. The auto-scale captures the maximum flow rate which is often the result of a leak or starting or ending therapy. 80 has been a good value for me, but you might try 50 or 60. The correct values are whatever works best for you.


RE: Dugy40 [Doug's Therapy Thread] - Dugy40 - 07-14-2020

(07-14-2020, 12:30 PM)Sleeprider Wrote: There are a couple good wiki articles with a great deal of information. The Optimizing Therapy in my signature links is a good start.  A very long wiki with interpretation on how to read charts is the "Beginners Guide to Sleepyhead" which is the software before OSCAR. http://www.apneaboard.com/wiki/index.php/Beginners_guide_to_sleepyhead

On flow rate y-scale I try to select a value that crops only the largest breaths or sighs.  It varies from person to person.  The auto-scale captures the maximum flow rate which is often the result of a leak or starting or ending therapy.  80 has been a good value for me, but you might try 50 or 60.  The correct values are whatever works best for you.

I’ll leave it where you suggest till I learn better how to interpret data.  
 Tracking says my airsense will be here by Friday.   I think from my experience with mail it’ll be here Thursday.   
 Tracking on Able Tech  ResMed machine says pending.  They claim it mailed last Thursday but I have my doubts.  
   If you don’t mind could you make a list of what I should set every setting at? A lot to ask I know.  Been watching videos and am familiar With the settings it has but will be lost on what to set them at.  I’ll be ordering a climate tube if it doesn’t have one.  
  Thanks Doug.


RE: Dugy40 [Doug's Therapy Thread] - Sleeprider - 07-14-2020

Doug you have really good results with fixed pressure at 9.0 and I expect as you transition to a new machine there will be an increase in events. The main difference with the Resmed is a more natural delivery of pressure between inhale and exhale. With that said the starting settings are easy:
Mode: Autoset Standard
Minimum pressure: 8.0
Maximum pressure 12.0
EPR: on full time
EPRSetting: 3

Humidity is for comfort and manual setting can yield higher humidity than auto climate control.


RE: Dugy40 [Doug's Therapy Thread] - Dugy40 - 07-14-2020

(07-14-2020, 03:29 PM)Sleeprider Wrote: Doug you have really good results with fixed pressure at 9.0 and I expect as you transition to a new machine there will be an increase in events. The main difference with the Resmed is a more natural delivery of pressure between inhale and exhale.  With that said the starting settings are easy:
Mode: Autoset Standard
Minimum pressure: 8.0
Maximum pressure 12.0
EPR: on full time
EPRSetting: 3

Humidity is for comfort and manual setting can yield higher humidity than auto climate control.
I found this article by a sleep tech.  What do you think? Someone asked what to set epr on.   This is the answer given. He’s against epr. I am not posting to dispute your recommendation.  Just wanted your thoughts. 
   I'm glad you asked. This is one of my favourite topics to bend people's ears about. EPR stands for Expiratory Pressure Relief. It is a function that ResMed introduced in their S8 and later models and it is the the same as C-Flex on Respironics machines, which they have had since the M series (although I'm sure both companies would swear blind they're totally different). The idea is to drop the pressure slightly on expiration in order to make the pressure more tolerable. Sounds reasonable but it is, in fact, a huge problem and should be avoided in almost every instance. "Why?", I hear you ask. I'll try not to get into too much detail explaining this.
The first problem is that EPR (and C-FLEX) lower your effective CPAP pressure. For example, if you need a CPAP 12 to breathe properly, but have EPR set on 3, you will only be getting an effective CPAP pressure of somewhere between 9 and 10, and because this is lower than is required you will obstruct. What will often happen next is that the patient will complain of persistent symptoms (because their OSA is not being adequately treated) and their download will show a higher than desirable AHI, so the pressure will be turned up making it less tolerable, increasing leak problems and leading to overall lower compliance with therapy. I have had to deal with this on more than one occasion.
The second problem is that by raising and lowering the pressure as you breathe, EPR actually increases the amount of air that you are breathing. With standard CPAP the pressure is constant, and the movement of air in and out of you lungs is done purely by your own respiratory muscles, so the amount of air you breathe is the normal amount that you should be breathing. All CPAP does is hold your airway open so that you can breathe normally. EPR works like low level BiPAP. As you breathe in the pressure increases and as you breathe out it decreases, which means that more air is moving in and out of your lungs than normal - the EPR is slightly augmenting your respiratory effort. This may sound all well and good, but there is a reason that you breathe the amount you do. Too little is a problem, we all know that, but too much can be a problem too. The extra breathing work done by EPR can be enough to hyperventilate you, sending your CO2 level too low which, in turn, causes central events. Again, I have recorded evidence of this happening.
Where I work, we only ever allow our patients to use EPR or C-Flex if they have had a sleep study with it and we can verify that it is not causing any harm. Otherwise we do not use it at all. I can think of fewer than 5 people who have actually had some benefit from using EPR/C-Flex in all my years of being a sleep tech. The people who sell the machines and the reps for the companies who make them will extol the virtues of EPR/C-Flex and tell you that it is perfectly safe. IT IS NOT. One of the engineers who designed the system admitted as much to another tech I work with.
So, to sum up, do not use EPR/C-Flex unless you have had a sleep study with it to make sure it's OK. It's not worth the risk. On ResMed machines EPR can be set to ramp only which is much less risky. Otherwise, if you think you really need it, get a study done while using it. As always, consult with your doctor, but you will probably find that they know nothing about this, as most of them don't in my experience


RE: Dugy40 [Doug's Therapy Thread] - Sleeprider - 07-14-2020

The person writing the article is clueless


RE: Dugy40 [Doug's Therapy Thread] - sheepless - 07-14-2020

in my experience & after hanging around here for a few years, it's apparent that many sleep techs, RTs, dme providers & doctors know little about their discipline. as a rule I tend to question folks that speak with such authority. also generalizing, I adhere to the notion that those who know, often don't. what we see here every day proves the author mistaken.


RE: Dugy40 [Doug's Therapy Thread] - Dugy40 - 07-14-2020

(07-14-2020, 04:16 PM)Sleeprider Wrote: The person writing the article is clueless

Good to know.  Pretty sure he said he was a registered sleep tech.   Going to see what the others say back to him.  Thank you.


RE: Dugy40 [Doug's Therapy Thread] - SarcasticDave94 - 07-14-2020

There are cases where "experts" know so much they lose common sense and are out of touch. Here's one example. And yes, EPR and Flex are in fact different. We see it here on AB with ResMed's EPR being equal to PS but in reverse. Flex, well in the murky Respironics world, Flex doesn't equate exactly to any known measurable unit of anything. Settings of 1 2 or 3 of something.

Again, EPR isn't just comfort, it's proven to enhance therapy. If Sleep Tech Timmy would get off the couch and breathe through a ResMed, he'd know EPR is a good thing.

It's still true, you can't fix stupid, but Duct Tape makes 'em quieter.


RE: Dugy40 [Doug's Therapy Thread] - Dugy40 - 07-14-2020

(07-14-2020, 04:54 PM)SarcasticDave94 Wrote: There are cases where "experts" know so much they lose common sense and are out of touch. Here's one example. And yes, EPR and Flex are in fact different. We see it here on AB with ResMed's EPR being equal to PS but in reverse. Flex, well in the murky Respironics world, Flex doesn't equate exactly to any known measurable unit of anything. Settings of 1 2 or 3 of something.

Again, EPR isn't just comfort, it's proven to enhance therapy. If Sleep Tech Timmy would get off the couch and breathe through a ResMed, he'd know EPR is a good thing.

It's still true, you can't fix stupid, but Duct Tape makes 'em quieter.

Well I am going to listen to you guys.  Please don’t take offense if I ask you something that says the opposite of what you told me.  I am reading a lot. Trying to learn.  I don’t know much at all yet.  I need all of you alls help.  I appreciate it to. 
   Should I post my screenshot everyday of the night befores sleep? Didn’t post last night.  Bout the same as yesterday but leak rate wasn’t even visible most the night. 6 it got to but I think that’s when I pull my mask outwards and set it back down to make sure it’s adjusted right.


RE: Dugy40 [Doug's Therapy Thread] - SarcasticDave94 - 07-14-2020

AB is here for you to ask questions. You ask what you feel like to be certain for yourself you're getting good PAP therapy. And if the answer doesn't do justice to the need to know, ask again or say it needs more of an explanation. Just remember that questions that don't get asked never have an answer.