Need some help and advice for my wife

[Ghost1958]

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

I've never seen it fail on me my wife, and several friends I've helped.
On myself the airflow is all behind my tongue uvula etc with a nasal interface. It takes less pressure to prevent my tongue , throat tissue etc from slamming up and shuttng off my exhale as soon as it starts.
FFM the pressure is coming in equally in from the front of my tongue and throat tissue and nose.
It takes setting the min pressure up 3 to 5 cmh20 to do the same thing as the nasal interface.

Studies have been done ffm vs nasal that show the same thing.
I can't really say exactly the mechanism that causes it but it just does.

[Ghost1958]

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!!

I personally would suffocate at 5 min.
I'd bump her up to 8 or 8.5.
She should be a lot more comfortable, that's about where the machine is staying most of the time , and she will have less pressure fluctuations which should lessen the RERAS. Also understand pap machines are just taking a best guess at RERAS .
Her results look great though.

[doncaruana]

Day 2 with the P10 and still good. No major complaints about leakage and such and numbers still good.

http://imgur.com/a/aTdaG

I have no idea what the heck happened at the beginning because I turned the ramp function off. She said something about it showed on for 45 minutes so I'm just going to ignore that initial flatline and the spike to 15. The rest of the time, the pressure stayed between just under 8 and just under 12.

Looks like the comfort setting did help the RERAs (just one) although we ended up with a few more hypopnea and OA. I know it's not an exact science and they're never going to be completely eliminated, so I'm pretty happy with it. It does look to me like bumping up the minimum would work better for her, but I'm going to let her get used to the P10 a little more before any more changes I think.

[Sleeprider]

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.

Going back to what was said earlier, using a higher minimum pressure prevents higher maximum pressures. By getting rid of that 5 starting pressure, you can prevent that spike to 15. I would think just starting at 8 would be better all around. I think you can set a maximum of 12, and avoid that machine over-shoot.

My wife is brand new at this, and has a pressure of 8. What I've done is to set Ramp at minimum 6.0 on auto, and that seems to work fine.

[doncaruana]

Wife took a nap this morning after I went to work. Before I left, I set her minimum up to 8.4. This two hour nap is a thing of beauty! Said she felt rested afterward too!

http://imgur.com/a/dzWqH

[Sleeprider]

Looks like you're about there.