New User [need help with my data]

[Recurve]

Thanks again I will run this past my mum and see if she will allow the changes.

1 Quick question and I may have this totally wrong but Sleeprider said " In this case EPAP min is at 8.0, but cannot exceed 12-cm in order to protect the 10 cm PS max and the IPAP max of 20 cm. EPAP and PS could only rise if the machine allowed an IPAP max of 25.0."

So would I have to also change IPAP to 25.0." for any of these new setting to take effect?

EDIT she does use a cervical neck collar 95% of the time however the 2 best nights on ASV she forgot to use it. But we have purchased 2 and rotate them to be washed. Summer in Perth can be bad so she has also ordered a chin strap to try as well.

[ajack]

I doubt your max will go over 12 or 13 by your charts. I think the max epep setting is around 15, It is on my S9. You have to have enough epap to fix the oa/h.
The max PS is your min epap and the number to take it to 25. with a min epap 9 that max PS is 16.

The machine will work out what it wants.

It's fine to wait, you move when you are confident it's the right thing, you could change settings 1cm at a time when you do.

for now you might want to work on your positional stuff, like chin tucking, a soft foam cervical collar is a great tool to see of this is the cause. You can also use different pillows, you want to support your neck, but have you head free to drop back on to the pillow. Think chin up head back, like CPR

[ajack]

It may not be chin tucking then, it may be backsleeping without enough min epap? There just seems to be a large move in pressure.
Being an aussie, you are getting a free sleep study, either through ins or the public hospital, or if on a HCC, the doctor pushing one of the private labs to bulk bill. You could leave it to them to titrate.

[Sleeprider]

My initial impression was in line with discussions so far...I thought all of this UA and flow limitation needs a cervical collar. As I read, I see a cervical collar is in use, so that basically leaves other forms of positional apnea and EPAP too low. I think all of this is on the right track, and hopefully some professional observations will help to sort it out. A note on cervical collars, they should not be fitted too tight or to tall. A comfortable, supportive fit is all that should be required. If multiple bed pillows are used, this can prop up the head and cause the positional apnea to persist in spite of the collar.

[DeepBreathing]

Hi Recurve - good to see that things are on track at last.

Summer in Perth can be bad so she has also ordered a chin strap to try as well.

I don't think a chin strap will do much to prevent flow restrictions in the throat. It might help mouth leakage, but I don't think that's a huge problem for your Mum. The main thing is to ensure that her airway is open, which is best served by having the neck supported and the head slightly tilted back. A collar can help. Additionally, some attention to her pillow might be needed. Many pillows are too high and too firm, resulting in the support being at the back of the head and allowing to chin to drop down to the chest (thus restricting the airway). The best pillows are slightly higher at the front, supporting the neck, and lower in the middle to allow the head to fall back slightly.You can get them at Big W or similar - look for "contour pillows". The other alternative is a duck feather pillow (which I have) or one filled with buckwheat (?) hulls. You can push and pull these to get the shape you want.

[Recurve]

Thanks again to all who have helped us get this far. Last night was the best night thus far. We left the settings as is for now, Mum wishes to at least give them the chance of her next hospital stay before we go our own way with minor adjustments. She is open to trying different settings once we have our own machine. Her tech did say he can still get the older model she is currently using for about half the cost of the newer model AVS. He said the main differences are cosmetic and the way the humidifier is. I like the idea of newer tech but if it is just cosmetic would u suggest the S9 or the Aircurve? I am finding it harder to get her to use the neck collar as her best nights are without it. I shall try and look at a newer pillow as suggested. Here is last nights charts apart from a major leak around 7:30am it looks ok to me.

https://imgur.com/a/BarGG

[DeepBreathing]

I think that chart speaks for itself! ASV is the answer.

The pressure is getting up pretty high, which may cause a disturbance, but she'll probably get used to it. I think that's why there are breaks in the therapy - the pressure gets too high, disturbs her sleep and she switches off. There may be some benefit in lowering IPAP max for a while and gradually building it up again, but that's a discussion you should have with the doc / tech.

The S9 VPAP Adapt (which is what I use) is essentially the same machine in an older package. You should carefully check out what they are offering you - is it "new old stock" (ie an unused machine which has been sitting on the shelf), a machine which has been traded in or used for rental, or one which has been used in the clinic. If it's new old stock then that's fine - make sure you get the 2 year warranty and get an extra warranty by joining the Resmed user group at http://www.sleepvantage.com.au/

If it's a used machine, get them to demonstrate the number of hours it's been run and also the manufacture date. Typically these machines are good in excess of five years, but you really don't want one that's 4.5 years old. Also confirm that it's a VPAP Adapt, not a VPAP S or VPAP Auto, which are different machines. Also, get them to demonstrate it has the ASVAuto mode - some of the earlier Adapts didn't have this.

If you're feeling adventurous, you can get a "gently used" VPAP Adapt from Supplier #2 for around US$1000 to $1300, which may be a significant saving on what your clinic is offering. In that case you need to factor in the cost of postage, a customs handling fee ($80 last time I checked), and the fact you won't have a local warranty.

Good luck with your choices - you've done a fantastic job advocating for your mother!

[ajack]

I'd be happy with a new s9. You also want the later s9. model 36037A (is there a higher model?) the 3rd and 4th number of the serial, is the build year. Check the screen for the run hours, to make sure it's a new machine. one hour on it and it's secondhand and a quarter of the price. How many hours are on the one she is using? they might want to quit that, they would also have full warranty on a demo unit.

There is no rush, I initially missed she was going back for a titration. There was only one area where it went a bit wonky. You mum could ring the hire firm and ask them to have a look at the SD card, most will adjust as you go through the month.

[DeepBreathing]

You also want the later s9. model 36037A (is there a higher model?)

That's an American model number - here in Oz you should get the 36377. (Same machine, just a different number to confuse things).

[ajack]

make sure it's the Auto asv, there is a manual s9 model

Thanks for that, even though it has the 22 country code, guess where I got mine from