[Equipment] trouble moving from RemStar Auto to AirSense 10

[jim.evo]

Jim, I think I'd turn EPR back on since that is going to help with hypopnea and RERA, but you need to increase minimum pressure to compensate and hopefully tighten things up.  

I kind of kind of like 9-14 with EPR at 2 for you.  I can go into a rationale, but that's where I'm at.

Thanks! Sleeprrider. I would ask for your rationale as I'm trying to understand how all this works in addition to getting good settings. 

Thanks again,

Jim

[Sleeprider]

I was just finishing up a rare work project...I'm mostly retired, so I kinda rushed your response.

In reviewing your recent results from two different machines we see hypopnea, a bit of flow limitation, RERA and CA.  It is all within acceptable limits and your treatment is pretty good.  The Resmed machine is pretty aggressive and moves around a lot more than the Philips, but gets good results, although your leak rate is taking a hit there.  Anyway, it appears your OA is resolved at a pressure around 7 cm, so that works for EPAP minimum pressure in the bilevel world. What we want to do is add just a bit of pressure support and take out the hypopnea and flow limitation.  Hopefully RERA takes care of itself with that. 

A minimum pressure of 9 delivers that EPAP min of 7.0 consistently and gives you the equivalent of pressure support, resulting in a final pressure of 9/7.  The machine automatically increases pressure if needed and could go to 14/12.  On second thought that is too high, but it will only go as high as needed, so you could set the maximum at 12 and it should make no difference.  That's the rationale, and it is consistent with bilevel titration protocol methods, except that the VPAP/BiPAP has higher pressure support capability. https://www.resmed.com/us/dam/documents/...lo_eng.pdf

[jim.evo]

I was just finishing up a rare work project...I'm mostly retired, so I kinda rushed your response.

In reviewing your recent results from two different machines we see hypopnea, a bit of flow limitation, RERA and CA.  It is all within acceptable limits and your treatment is pretty good.  The Resmed machine is pretty aggressive and moves around a lot more than the Philips, but gets good results, although your leak rate is taking a hit there.  Anyway, it appears your OA is resolved at a pressure around 7 cm, so that works for EPAP minimum pressure in the bilevel world. What we want to do is add just a bit of pressure support and take out the hypopnea and flow limitation.  Hopefully RERA takes care of itself with that. 

A minimum pressure of 9 delivers that EPAP min of 7.0 consistently and gives you the equivalent of pressure support, resulting in a final pressure of 9/7.  The machine automatically increases pressure if needed and could go to 14/12.  On second thought that is too high, but it will only go as high as needed, so you could set the maximum at 12 and it should make no difference.  That's the rationale, and it is consistent with bilevel titration protocol methods, except that the VPAP/BiPAP has higher pressure support capability. https://www.resmed.com/us/dam/documents/...lo_eng.pdf

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thanks again Sleeprider... I'll set ERP @ 2 and levels 9-12. Will post back in a couple of days.

Thanks again to everyone here, this is a great resource.

Jim
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[jim.evo]

Last 2 nights w/ the new settings (9-14 & EPR 2) seemed to work well (log's attached) except for what now appears to be a leak. My mouth was opening at least once last night. What puzzles me is that this has not been an issue for me for years with the RemStar. 

I do have some old chin straps and will try them but would not like to have to use them... seems my mouth breathing is related to the AirSense unit somehow. BTW, the new settings have done away with the pulsing.

Thanks in advance!

Jim