Little Olive - Therapy Adventure

[Little Olive]

Thank you Unicornrider,  I will visit all the suggested places and hope I can retain the information.  Years of apnea has wrecked my brain!   

I really agree about the pressure, even with my limited knowledge.   I'm not going to get too excited about last night's great result, I just hope I can maintain it, I know there will be ups and downs, but I just need to know I am making progress, even if it's a little bit at a time over time.
 
I so appreciate the support here, I really needed it, after a rubbish week and feeling terrible.

[UnicornRider]

It takes time to take in all of the information. but you will have this thread to fall back on to review the links and refresh your memory.

Your posted graphs from your sleep study indicated a lot of Desaturations. Did you get a written Sleep Study Review from the sleep study? If so please redact all personally identifying information and post it here. That can give greater insight into your respiratory needs that members here can interpret for you. 

After you review all of the information I sent, post you OSCAR Report, we will be better able to assist you through this.

Mask selection and leaks are a very common issues with new users of CPAP therapy.  The Mask Primer will greatly enhance your chances of success.

https://www.apneaboard.com/wiki/index.ph...ask_Primer

Be sure to read all the way down to Jeffy1958 description on how to get a leak free fit. He put all of the knowledge prior to that, into practical application and made a great difference in me being able to get control of my leaks at the pressures I run on my machine. 

Do not be intimidated by the apparent amount of information, you will quickly pick up on it and the knowledge you gain will give you leverage in dealing with your equipment providers and sleep specialist.

[Little Olive]

Shall I lower the pressure setting?

[jcp519]

There's a few suggestions that I have.

Firstly, the response setting should be changed from soft to standard. This setting will make the algorithm more responsive to detected flow limitation. The soft setting can sometimes cause the machine not to respond correctly. Secondly, I think you should bump up your min pressure to at least 7 cmH2O because you have EPR on 3, I could even see bumping it up to 8 being beneficial because your pressure tends to go up to around 10 or so. Lastly, if you can tolerate it, turn ramp completely off.

Also, could you give us a zoomed view of the flow rate chart so we can see some individual breaths? Pick a couple spots at a resolution of around 3 minute chunks.

[UnicornRider]

Did you wear a SCC collar during this session?
Then reason I ask is that, you have a lot of clustered events, CA events make up the majority of those.
CA events can sometimes be Hypopnea events that are misidentified as CA, especially in a Chin Tuck situation.

True CA events are usually caused by sweeping too much CO2 from the lungs, so the normal response would be to reduce the EPR. ( may have to later)
However we use EPR to minimize Flow Limits,  if we reduce the EPR we would risk increasing true OA and H events.

There is "Therapy Emergent Central Sleep Apnea" events (TECSA), seen in some new patients, which will resolve themselves with use of the machine as the body acclimates or adjusts to therapy. However your bar graphs you provided in post #3, indicate a substantial number of CA events. that is If I read it correctly, there seems tobe 7 categories' listed, but only 6 bar-graphs. I read it as no Unclassified Apnea (UA).

So this refers back to post #31, the links I provided for Positional Apnea and SCC. Everything you can do to reduce events with external environmental changes helps.

With both your Ramp and Pressure Minimum set to 6 cmH2O, You have no ramp only delayed start of APAP, as seen on your Pressure graph.

The ResMed minimum pressure is 4 cmH2O. you only get EPR 3 when pressure rises to or above 7cmH2O, also seen on your Pressure graph.

 So if you have been practicing with the AirSense 10 to acclimate yourself, you may be able to eliminate the Ramp. You receive no therapeutic value during Ramp, we encourage everybody to eliminate ramp ASAP. If it is too uncomfortable to eliminate the ramp, you can raise ramp pressure slightly and/or shorten ramp time. Practice during the daytime to determine this, bedtime is not the time to figure this out.

You have been using Soft Response, Standard Response will be more aggressive with the response to Flow Limitations, hopefully minimizing the pressure increase.

 Your Median pressure from the Statistics of the left hand panel was 9.36 cmH2O, a higher minimum pressure would more closely match this and give a smoother start to APAP pressure control. With Standard Response and SCC I hope this goes down.

Also from the Left Hand Panel Statistics, your 99.5% Pressure is 11.2 cmH2O, we could reduce your pressure maximum, to prevent uncomfortable pressure runaway.

So to wrap this up:  Mode         APAP
                             Press Min     7 cmH2O
                             Press Max   13 cmH2O  
                             EPR   On     Full Time
                             EPR              3 cmH2O
                             Ramp          Off (if possible)
                             Ramp Press   6.4 cmH2O (if needed)
                             Response     Standard
                            
                             Wear the collar


      Let us know how you do, what recommendations you were able to follow. How your body is responding.         

    Review the links in post #39, that will help you organize you charts better, and resize the height of your graphs so the Flow Limits graph will fit on the first screenshot. When providing a second screenshot please include the left hand side bar, you can use the vertical slider of the left hand side bar to bring up information not visible in the first screenshot.

You are doing well, it is a lot to grasp in a very short time.

[Little Olive]

Yes I was wearing the collar last night.   I thought things were improving ??   I'm feeling quite overwhelmed     there is so much to learn and understand.

btw I had heaps of CA events on my original sleep study.  It's hard to answer your post without it being up here to refer to as I write. ,  There was little in the way of written report of my sleep study, but I will post that tomorrow, mosty just graphs and numbers.  I will try to provide the information you suggest.

 I am now heading off to bed, so I will have to come back to this tomorrow. , I think we are on opposide sides of the planet .
It's Monday evening here. Thanks again for your care and interest, I very much appreciate it, thank you.

PS Edited to say yes that is correct re the bar graphs, no unclassifieds lots of CAs. Thats waht I was so depressed about after diagnosis, all those centrals and Cheyne Stokes.

[Little Olive]

Thank you, I have noted those suggestions, and added them to my list of things to try and do.  Well actually, to  find out the detaisl of, what the settings do and why... and then change them. For example, I dont even really know what ramp is...  a gradual rising of the pressure?  So no ramp is the equivalent of fixed pressure?   I feel pretty overwhelmed, and hope I can keep up with my lessons!  Its a long time since I have ahd to learn so much new stuff, its probably good for my brain fog!

Edited to say this post was intended for JCP519, .

[stevew168]

Ramp simply increases the pressure gradually to the minimum pressure, either over a fixed time, or when you are still awake, depending on how you set it. Only when ramp ends does your apap begin to respond to apneas and hypopneas. It does not set your apap to a fixed pressure.

[jcp519]

Sorry for throwing all the info at you! It can be a bit overwhelming at first.

Stevew168's explanation on ramp is pretty much how I would explain it. You generally don't want ramp on because the time ramp is active, your machine is not providing adequate therapy pressure and is not responding to any events.

Standard vs Soft is just the algorithm the machine uses to respond to apnea/hypopnea. Soft is a lot less responsive and is usually not recommended.

And we are raising min pressure because when EPR is on 3 cmH20, every time you exhale, your pressure goes down 3 cmH2O. But the machine has a lowest possible pressure of 4 cmH2O so if your min pressure is set to 6, the EPR only drops the pressure by 2. So setting the min to 7 allows EPR to work at its full potential.

[Little Olive]

Excellent, thanks so much!  im changing all those today -pressure 7 to 13,  eliminate ramp, and soft to standard.  Just looked at last night and  got some problems there.