New to the forum with a new machine

[WhoKnew]

Thanks again Sleeprider. I think that I want to get a cervical collar ordered and try it. I don’t feel any better or worse than before using my new machine so I’m going to my original pressures and get serious about weight loss.

It was too tempting with the auto set to see what it could do, but there seems to be no rhyme nor reason. I think this time of year is not great for experimentation. My hours of sleep are not as consistent and then there is the attendant holiday stress. I believe it all has some bearing.

I’d like to stay at one level of parameters for a week and then post the results if that’s okay.

Lynda

[ajack]

Given there is still significant obstructive flow limits, with the OA and H. I would think following the auto titration procedure of just below median pressure or 2cm below 95% pressure, would be the right procedure. I wouldn't call this being "tempted into dial-winging by forum comments"

[Sleeprider]

Ajack, I am somewhat conflicted in this view as the normal course of action for obstructive events, including flow limitation is to increase pressure. I have also seen where these pressure increases, do not resolve the flow limits all the way to 20 cm, while comfort is diminished and events increase. So there is anecdotal evidence that flow limits do not always respond to pressure logically. In a new user with low event rates (<1.4 at 12 cm), there is no compelling reason to change while that person adapts to the new use of CPAP and works out the other issues such as leaks and positional apnea. In time, there is probably a good argument to be made for trying higher pressure to see if flow limitation resolves, however, it's one of those things that is low priority compared to being comfortable and adapted to the therapy.

I respect the knowledge you bring to titration and optimizing results on CPAP and other machines. I also think you tend to move too fast sometimes to increase pressure or point out a possible pulmonary issue based on tidal volume, resp rate and other machine data. You may be on the correct side of at least half of those suggestions, but I'm personally going to err or advocate on the side of caution.

[WhoKnew]

Here is the latest result.  I am feeling fine.  I have some reluctance to change my settings, and there are two schools of thought being proposed.  My AHI results are definitely lower than with my ResMed S8 Elite II machine which is a good thing.  There is more information from the new machine as well, and I know knowledge is power, but I need to read more to understand about the RERA numbers and some of the other information SleepyHead provides.

I am still awaiting the delivery of my cervical collar.  Christmas is no time for all of this apparently.

If I'm comfortable, and feeling good, then I think things will stay as they are for a while.  I'm getting somewhat stressed trying to decide whether to adjust the pressures, or not, so I'll do what I normally do which is "if in doubt, don't".  Maybe not the brightest mantra, but it's gotten me this far in life.

Thanks everyone.


Lynda







  
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[Sleeprider]

With regard to changing pressure you just have to go with your best instinct. If you are comfortable, sleeping well, then these results are great. I am really reluctant to ask anyone to chase flow limitations as part of their therapy because I have seen too many people just raise the pressure and either not realize any benefit, or actually see events rise. I don't know why women are particularly afflicted with the flow limitation thing, but it seems to be the case, and the best approach seems to be, if it works, just let it be. You are not apparently having any ill effect from this, so there is no need to make changes that may make you less comfortable. Give yourself plenty of time and if you choose to try some higher maximum pressures, do it at your convenience, and plan to stick with it for a week. There is no pressure to do anything as you're quire well treated.

[WhoKnew]

Thanks Sleeprider. I’m sticking with the current settings for now. If things change I’ll ask for help again. 

Lynda

[ajack]

Now that whoknew new is happy with her results and they are good. I'll expand on why I said what I said.

I think we are going to have to agree to disagree on this one.
OP is moving from a elite fixed pressure cpap of 10 or 11,
auto started at 6cm. median pressure was 12.14 and 95% was 13.96
Going by the chart the pressure quickly rises and events keep it high, it doesn't fall back below 9. I would increase the min to be closer to the median or 95%. 11 for one below median and 12 for 2 below 95%. The max was ok at 15, I would have lifted it a bit more in case of a bad night.

given the op 95% was 13.9 I'm at a loss why you think a max of 12 is right. It goes against basic auto titration

This manufacture, explains it like this for home titration and the option to move to fixed pressure. The algorithms are pretty good. They give us the median,Pmean and 95%/P95 data, we might as well use it, unless contraindicated

https://www.multidoctorshop.com//image/d...nual-2.pdf

The APAP combines the Titrate Mode with new Auto Mode to effectively adjust the
pressure for maximum comfort, with the premise of effective treatment.

To get a accurate P95 pressure, Titrate Mode is applicable for the first 1-2 weeks during the use.
Based on the P95 pressure, MAX APAP is determined.

It is suggested to set the MAX APAP little higher(1or 2 cm H2O) than P95 pressure. And based on the Pmean pressure, Treat P is determined. It is suggested to set the Treat P little lower(1or 2 cm H2O) than Pmean pressure. It can improve patient’s compliance with more accurate and humane pressure
range.

[Sleeprider]

I have no argument against raising minimum pressure. She experiences it for a very short period of time, and in this case the maximum pressure is the control. Minimum pressure is virtually a ramp setting since she is at the maximum within a half-hour.