RE: Need some help and advice for my wife
No objection here with raising max pressure. Overall she looks pretty good with the exception of two periods where obstruction sets in. Hopefully the EPR is making things otherwise more comfortable.
Check out Supplier #31 for some ways to make mask comfort better.
RE: Need some help and advice for my wife
My two cents.
The closer you out her min pressure to a good working level the lower her max will likely reach.
If she can tolerate 17 20 on max she can easily deal with a min of 12 or 13.
Is raise her to 12 min leave max at 20.
If no or just one or two CAs show up bump her to 13.
At 13 with a Simplus mask to stop the leaks she'll likely not go much over 16.
If she can go to a nasal with chin strap her AHI will be lower at much lower pressures.
01-03-2017, 06:36 AM
(This post was last modified: 01-03-2017, 06:37 AM by doncaruana.)
RE: Need some help and advice for my wife
A little better last night...
http://imgur.com/a/64x5g
The first night with an SD card is the only baseline I really have. The summary info after the fact is either under-reported by the machine (when it wrote it the SD card initially) or under-interpreted by Sleepyhead.
So, that night, with no (5/20/no EPR) adjustments OA/H/RE were .66/1.15/.82
Then we went to 9/17/EPR3 and got 0.29/2.48/1.31
Same settings the next night were 2.09/.86/.74
Last night, after going to 9/19/EPR3 we got .74/.44/.3
However, she had some "leak into the eyes" and other leak issues last night, I'm guessing once the pressure cranked up to 19.
Some questions here...
I don't understand the correlation between higher min and max and the simplus mask. Are you saying that the simplus is better at not leaking, thus she could crank up the minimum and it would stay there and reduce events, thus reduce ramping up to higher pressures?
Can someone explain (it may have already been done here) what the effect of EPR is likely to be? Is it a comfort thing or should we actually expect it to help with hypopnea? And could 3 be too much, and, if so, why?
Lastly, in lieu of jerry-rigging a full face mask, can anyone comment on nasal pillows and a chin strap? Is it possible that could be an alternative and, if not, typically what reasons would it not be?
Again - thanks all for all the help and advice!
RE: Need some help and advice for my wife
I think you have arrived at a solution Don. You can see where the clusters of OA were intercepted and stopped this time. A couple got through at 01:20-01:30 and the machine responded appropriately. With higher minimum pressure, those would not happen, but that is acceptable if she is comfortable and sleeping well. I don't disagree with what Ghost1958 is saying. Setting minimum pressure near the current median is a good strategy if comfort is not an issue.
RE: Need some help and advice for my wife
(01-03-2017, 06:36 AM)doncaruana Wrote: A little better last night...
http://imgur.com/a/64x5g
The first night with an SD card is the only baseline I really have. The summary info after the fact is either under-reported by the machine (when it wrote it the SD card initially) or under-interpreted by Sleepyhead.
So, that night, with no (5/20/no EPR) adjustments OA/H/RE were .66/1.15/.82
Then we went to 9/17/EPR3 and got 0.29/2.48/1.31
Same settings the next night were 2.09/.86/.74
Last night, after going to 9/19/EPR3 we got .74/.44/.3
However, she had some "leak into the eyes" and other leak issues last night, I'm guessing once the pressure cranked up to 19.
Some questions here...
I don't understand the correlation between higher min and max and the simplus mask. Are you saying that the simplus is better at not leaking, thus she could crank up the minimum and it would stay there and reduce events, thus reduce ramping up to higher pressures?
Can someone explain (it may have already been done here) what the effect of EPR is likely to be? Is it a comfort thing or should we actually expect it to help with hypopnea? And could 3 be too much, and, if so, why?
Lastly, in lieu of jerry-rigging a full face mask, can anyone comment on nasal pillows and a chin strap? Is it possible that could be an alternative and, if not, typically what reasons would it not be?
Again - thanks all for all the help and advice!
If the min pressure is set close to her effective pressure it won't be So far behind the curve to get up to effective pressure. And won't go as high on the max side.
The Simplus is just a very comfortable very good sealing frm.
If she can use a nasal mask like an Eson with a.chinstrap
or pillows with a chin strap her pressures would likely be more in the 9 to 15 range.
Just takes less pressure with a nasal interface unless it's some who only needs a max of 7 or something like that.
RE: Need some help and advice for my wife
Well, a new day, a new mask. This time we went with the P10 nasal pillows and a chin strap. Actually, the DME suggested it once my wife described what she's been through so far. He also said, as ghost1958, the pressures likely wouldn't be as high.
So here's a new set of graphs and wow are they encouraging!!
http://imgur.com/a/q7aNW
My wife wanted me to set everything back to the original first, so we did that. But now, of course, I'm looking to tweak things a bit still. 
First, I don't get the ramp function. It doesn't seem to work very well. I looked at last night, where I turned it back on (only for 20 minutes) and the first night we had detailed data, before any changes, and all it does is hold the pressure at the minimum for however long you have it set. And I noticed she had a RERA right at the end of the ramp. Seems pretty pointless to me with her minimum pressure set so low.
For the pressure, it never even got to 13, so ghost1958 you were almost dead on! But does it still make sense to try to bump up the minimum? Mind you, I'm going to let her stay at these settings (might change the ramp).
I'm also noticing that every RERA event she had was right after the pressure raised, so I'm wondering if using the soft setting (raises pressure more gradually, right?) would be better for her.
Lastly, with pressures down in this range now, would the airsense for her make any sense or is the likely minimum still too high to make a difference?
Thanks again everyone!!
RE: Need some help and advice for my wife
Don, can you please reset the scale on the leaks? Right click, select y-axis and be sure it is on Auto-fit. It appears to currently be on a maximum scale of 4 and we are not seeing the extent of leaks.
That aside, these are excellent results. As far as the pressure increases, a lot of that is caused by going back to the 5 minimum. It works, but is causing some unnecessary fluctuation. With the nasal pillows, it looks like she could use a minimum at 8.0 and I would not expect the max to go past 11. I would agree with using the soft setting. Good idea.
RE: Need some help and advice for my wife
Don, can you please reset the scale on the leaks? Right click, select y-axis and be sure it is on Auto-fit. It appears to currently be on a maximum scale of 4 and we are not seeing the extent of leaks.[/quote]
Oops! I forgot I had overriden these when I first started doing the graphs and I don't think I've reset them. I'll get them when I get home from work.
RE: Need some help and advice for my wife
(01-04-2017, 01:48 AM)Ghost1958 Wrote: Just takes less pressure with a nasal interface unless it's some who only needs a max of 7 or something like that.
Ok Why? Really would like to know.
Fred
RE: Need some help and advice for my wife
(01-04-2017, 10:07 AM)doncaruana Wrote: Don, can you please reset the scale on the leaks? Right click, select y-axis and be sure it is on Auto-fit. It appears to currently be on a maximum scale of 4 and we are not seeing the extent of leaks.
Oops! I forgot I had overriden these when I first started doing the graphs and I don't think I've reset them. I'll get them when I get home from work.
[/quote]
Updated with leak graph. I still overrode the limits a little because it was off the charts when she first put it on.
http://imgur.com/a/NBg3x
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