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Completely agree with UnicornRider. When finding the sweet spot having a range the machine can use to adjust is important. Once things have settled into a range, some of us set it to a more “fixed” mode with that range.
For example, as I fine-tuned my settings I went from a range of 4-20 PS 3, to 7-20 PS 3, to 7-15 PS 4, to 8-15 PS 4, then finally settled on 8-12 with a PS of 4. That means my EPAP will always be 8 as my IPAP is always at 12, and the PS of 4 holds it there (8+4=12). The mixture of finding the correct range and proper pressure support, allowed me to end up with a fixed setting that helped get rid of most of the micro-arousals as I get many of them from the pressure adjustments.
YMMV of course, but it is one approach to consider.
(11-21-2023, 10:54 AM)PeaceLoveAndPizza Wrote: Completely agree with UnicornRider. When finding the sweet spot having a range the machine can use to adjust is important. Once things have settled into a range, some of us set it to a more “fixed” mode with that range.
For example, as I fine-tuned my settings I went from a range of 4-20 PS 3, to 7-20 PS 3, to 7-15 PS 4, to 8-15 PS 4, then finally settled on 8-12 with a PS of 4. That means my EPAP will always be 8 as my IPAP is always at 12, and the PS of 4 holds it there (8+4=12). The mixture of finding the correct range and proper pressure support, allowed me to end up with a fixed setting that helped get rid of most of the micro-arousals as I get many of them from the pressure adjustments.
YMMV of course, but it is one approach to consider.
I just changed back to Resmed s10, and change the setting according to suggestions, result as attached
Thank You for providing the current, as well as the earlier OSCAR Reports. They are very helpful.
We need to know how you felt.
Did you have any problems with the pressure on either inhalation or exhalation? Or both?
How refreshed/restored did your body feel after waking up?
Are you still using the pillows? How did they handle the pressure.
I had to incrementally increase my pressure to gradually get up to 18 to 22 cmH2O, PS 4 cmH2O. I had to give up pillows somewhere in the 11 to 15 cmH2O range, I had to try several mask as pressure increased. But I am now at a sweet spot for me. I expect to do some more fine adjustment come spring time as we get into my allergy season.
CPAP/BiPAP Therapy for me is like using a pair of glasses to see. Every so often I have to adjust my prescription to see correctly. Sometimes I do not realize I can benefit from a prescription change until I try something different. Other times Headaches, fatigue or just an irritated or depressed mood are indicators I need to change my prescription, Sometimes I need both my BiPAP therapy and my eyeglasses checked and updated.
On your OSCAR Report, just above the Orange colored bar that has your AHI score, are some tabs labeled, "Details", "Events", "Notes" and "Bookmarks" I keep daily notes in the notes section, things like allergies, illness (especially Respiratory), a self check on my moods. Definitely, if I jump out of bed and feel like the Energizer Bunny, it gets noted.
I also wear a Pulse/Oximeter/Motion on my wrist, that information gets logged. I am able to utilize the "Overview" and "Statistics" views of OSCAR and track how well I have been able to control my response to therapy.
So before I suggest you increase your EPAP, I want to know how this feels for you and if you need another couple of days to get used to the pressure.
I feel not comfortable when using epap, it just like braking and feels like apnea, so that's why I'm asking why I need to increase pmax to 15 as my previous setting pmax 10.5 already achieve AHI around 1.5
Yes, I'm still using nasal pillow, my overall feel almost the same except epap braking feel makes me a little bit difficult to fall asleep
The way your OA’s cluster makes me think there is something positional going on. Have you considered a lower pillow if using a higher one and possibly a soft cervical collar? That will help with the chin-tucking and smooth things out a bit with pressure by reducing flow limitations. Once the flow limitations are handled you may find that lower pressure works for you.
Also consider turning off ramp as you have quite a few apnoea’s that happen as it transitions to normal operations from ramp. May help with the comfort.
(11-22-2023, 08:42 AM)PeaceLoveAndPizza Wrote: The way your OA’s cluster makes me think there is something positional going on. Have you considered a lower pillow if using a higher one and possibly a soft cervical collar? That will help with the chin-tucking and smooth things out a bit with pressure by reducing flow limitations. Once the flow limitations are handled you may find that lower pressure works for you.
Also consider turning off ramp as you have quite a few apnoea’s that happen as it transitions to normal operations from ramp. May help with the comfort.
(11-22-2023, 10:21 AM)aslotaru Wrote: Will try turning off ramp tonight, thanks
Last night results not good AHI 7.2, should I keep using 8-15 or I just go back to 8-10.2? I found not so comfortable on using EPR3, before I never use EPR, also high pressure 15 makes me woke up after one and half hours.
(11-23-2023, 09:08 AM)aslotaru Wrote: Last night results not good AHI 7.2, should I keep using 8-15 or I just go back to 8-10.2? I found not so comfortable on using EPR3, before I never use EPR, also high pressure 15 makes me woke up after one and half hours.
It does not seem to matter which machine you use as your charts are almost identical. For the moment let’s stick with the ResMed AS10.
You are sensitive to EPR changes as we have used it to handle flow limitations. When we increased EPR your CA’s increased, which leads me to think they are treatment emergent.
You have a number of leaks which may or may not be mouth leaks. The bursty leaks look like mouth to me, but if someone else has an idea please chime in.
There are still clusters of events that look like chin-tucking, but could be related to the EPR TECSA (Treatment Emergent Central Sleep Apnoea).
Your pressure seems to be consistent in a 9 or 10 cmH2O baseline, so you should adjust accordingly.
One more thing to consider is setting your range at 10-15 and set EPR to 1 or 2. We have to find the right balance of pressure, EPR, position, low pillow, etc, to manage things as best we can.
I still think a soft cervical collar would help, but be sure to size it correctly if going that route. Here is a chart to size it appropriately.
