New Member - Hello! [how long before considering adjustments?]

[skiajl6297]

Hello - greetings from a new member.  I was recently given a revised diagnosis of Upper Airway Resistance syndrome.  I was on System One machine for about 5.5 years due to the same diagnosis, eventually lost a bunch of weight, and stopped CPAP after the machine stopped working.  

9 months later, after my wife encouraged me to revisit the doctor due to noisy sleeping, and after a pair of at-home sleep studies, I was diagnosed again as having UARS/OSA (told like a precursor to OSA), given a new Auto Dreamstation, and RX'd a pressure range of 4-17.  My previous diagnosis was a continuous 5 pressure which worked pretty well for me.  I am not certain what my AHI was from my at-home sleep study, nor am I aware of how my night broke down, e.g. centrals versus obstructives.

I am about one week into my new machine, and seeing improvement in my symptoms.  My best night so far has been an AHI of 3.8, last night.  (Every other night has been in the 7.5-9 range.)

I was prescribed a full face mask, but after two nights of misery, realized it wasn't working for me.  I queued up my old ESON nasal mask from my old machine (using unopened replacement masks) and have adjusted quite well.

How long is it reasonable to go before considering any adjustments?  Obviously if all of my nights go well and I feel better, no need to make changes.  But I am always interested in tinkering to make things just right.  I need to schedule my doctor follow up as well, to report back on how I am adjusting.

Thanks in advance for everyone's help!  Looking forward to learning more about this.

[mesenteria]

Welcome!

You have guessed that it is best to give any one adjustment a few nights to settle things down before concluding that the adjustment either isn't necessary or is simply wrong.  A week is too much, in most cases, but three nights would be a good start to see if a computation of an average yields a salutary figure.

Also, you mention how you 'feel' about the therapy, and that is very important.  If you have no confidence in your machine or in its treatment of your condition, you probably won't feel good about using it and relying on it.  Similarly, if you actually feel more alive, energetic, alert, motivated, or just feel more 'well', that's a huge endorsement of the machine and its settings if prior to their use you felt horrible.

Also, the numbers don't tend to lie.  If you feel 'well', or believe that you needn't fiddle with anything, but your AHI averages higher than about 5/hr, you are not deemed to be treated by the people who build systems and protocols for their use in dealing with CPAP and OSA.  Some refinement is in order, and you're not likely to experience a degradation of that 'well' feeling.

Little steps, evaluate, consider a refinement, effect reasonable changes, and then give the machine...AND YOU...some time to settle in together before repeating the process once again.

Please extract some recent OSCAR data and present it for us to consider.

[Sleeprider]

for individuals with UARS and inspiratory flow limitation I really prefer either a bilevel machine or the Resmed Airsense 10 Autoset. The reason is that these machines provide separate inhale and exhale pressure, and the higher inhale pressure really helps with flow limitation. If you zoom in on your graphs with OSCAR, you will probably see flat-tops on the inspiratory flow wave That is flow limitation, and the Dreamstation just doesn't deal with it very well because the Flex pressure relief is not a bilevel pressure and the flow limits mess up its timing. That's why many people with UARS using a Dreamstation will see the inspiration time is longer than the expiration time. That is an error by the Dreamstation which improperly times the transitions in the presence of flow limitation. If you can swap for a Resmed Autoset, do so.

You can adjust pressure anytime, and one of the other faults of the Dreamstation is that is is very very slow to respond to flow limitations and prevent apnea. You certainly need a starting pressure closer to 7 or 8 cm. I know of no one with your condition that does well on a Philips Auto CPAP and a minimum pressure of 4.0. Try it, you'll like it. 4-cm is like starving for air and is why your AHI is still high.

[Dormeo]

Welcome! It’d be great if you could post your Oscar charts. Just follow these links in Sleeprider’s signature:

Download...
Organize...
How to attach...

I’m betting the experts here can guide you through some beneficial fine-tuning.

[skiajl6297]

Thank you all for the warm welcome and information!

I downloaded my data to Oscar, but do not have access to that pc from work, so will upload data this evening. I am definitely curious what folks see, and am interested in learning how best to evaluate my own data.

Last night was a little less good compared to the prior, around a 5.2 AHI, according to the Dreamstation/Dreammapper software. My reported 90% pressure to date is 6.5cm. My Dreamstation continues to report about 30+ hypopneas each night (ranging from low of 17 on my best night, to a high of 48), even though my "Clear Airway Apneas" and "Total Obstructive Apneas" have trended downward.

My mask fit seems to be going well, as the worst night I have had was a 93% mask fit.

Sleeprider - how do you determine inspiratory flow limitation? Is that something you assumed based on my UARS diagnosis, or is it just a piece of being diagnosed with UARS? Asking because I do not understand, and want to. I have my machine set on A Flex, with the flex relief set to 3.

Do any of these Auto machines convert to bi level in settings? Or are there different models of Dreamstation devices? Sleeprider - are there any settings changes in my Dreamstation that might make this more palatable?

And finally - if I were to call my DME supplier and ask whether I could switch this machine for the Resmed Airsense 10 Autoset, what justification would I give? Is this a patient preference decision, or is there some underlying justification I can give? (I suspect they will ask why I want to make a change, and I also suspect that they will bristle at my answer of "Because someone on a forum suggested it").

I will post more data, and await feedback prior to making any adjustments. I appreciate the help everyone - thank you for your time!

Adam

[Sleeprider]

Sleeprider - how do you determine inspiratory flow limitation? Is that something you assumed based on my UARS diagnosis, or is it just a piece of being diagnosed with UARS? Asking because I do not understand, and want to. I have my machine set on A Flex, with the flex relief set to 3.

Do any of these Auto machines convert to bi level in settings? Or are there different models of Dreamstation devices? Sleeprider - are there any settings changes in my Dreamstation that might make this more palatable? 

And finally - if I were to call my DME supplier and ask whether I could switch this machine for the Resmed Airsense 10 Autoset, what justification would I give? Is this a patient preference decision, or is there some underlying justification I can give? (I suspect they will ask why I want to make a change, and I also suspect that they will bristle at my answer of "Because someone on a forum suggested it").

Without seeing your charts, I can only speculate, but your AHI is still a bit high, and I'm certain that if you have UARS, that we will see flow limitation and hypopnea as key elements of your current results.   Aflex is not bilevel, and is a pressure relief of up to 2-cm ahead of expiration, and a predicted return to CPAP pressure ahead of inhale.  A setting of 3 is not usually very comfortable and can result in higher hypopnea events, so I would suggest you limit Flex to 1 or 2. 

The Resmed CPAP machines all provide exhale pressure relief (EPR) which is a true bilevel pressure. EPR is compared to Aflex in this wiki http://www.apneaboard.com/wiki/index.php...herapy#EPR  If your CPAP pressure is at 7, exhale will be 4 cm.  The pressure difference is 1, 2 or 3 cm and so it is not a true bilevel, which can have much higher pressure difference.  In bilevel, we call the difference between inhale and exhale (IPAP/EPAP)  pressure support.  So in bilevel terms, the Resmed CPAPs provide true bilevel pressure that follows respiration and can be 7/4, 8/5, 10/7, 20/17 or whatever is appropriate.  It is the pressure support that really helps to minimize flow limitation and hypopnea.  Again, just betting that with a diagnosis of UARS, those are your main issues.  Here is a Wiki article that describes why bilevel therapy is good for UARS  http://www.apneaboard.com/wiki/index.php...ome_(UARS)   

Your DME supplier will not likely swap the machine unless your doctor writes a prescription specifying the Resmed Airsense 10 Autoset, Aircurve 10 Vauto, or a bilevel machine.  This would be based on your currently marginal efficacy with Philips CPAP.  The biggest advantage of a Resmed Autoset compared to your Philips is that it would increase pressure to prevent all of these events, something the Philips is notoriously bad at.  In all likelihood, the Doctor and DME will tell you to continue to us the machine and your results will probably improve. They will also tell you (like I did), to increase minimum pressure.   In any event, your results will end up being good with a pressure increase, and I probably should have left well-enough alone with your current CPAP. It can be optimized, but I would still move Aflex back to 2 and set minimum pressure at 8.0.

[skiajl6297]

Thank you for your response. I will post my OSCAR charts tonight! I also reached out to my doctor to get his thoughts. More to come...

[skiajl6297]

Trying to post screens!  Fingers crossed...

Please let me know your thoughts.  I am trying my min pressure up to a 6.5, and the flex back to 2.

[ajack]

Hi, I would have min pressure 6.5, 7 or 8, you will see what you need as you go forward. Do a mask fit function setting on the machine, that blows high pressure to help fit your mask. any leaks is good to get fixed and out of the way. Get the manual from the top of this page, it's better than the one with the machine..

[Sleeprider]

I'm totally onboard with Ajack. Minimum pressure at 8.0 is going to help...your charts totally exemplify UARS, and as I predicted, most of your AHI is hypopnea. More importantly, we see a good rise in flow rate when inhale begins, but it stalls and flattens out or drops in rate. THIS is why bilevel pressure works so well. Your description of your condition was perfect, as was your doctor's diagnosis. The problem is, most docs don't know that different CPAPs deliver different therapy, and the Resmed excels at flow limitation, while the Philips falls flat on its face.