How to adjust the full mask usage

[Ron AKA]

Please see last few days data after change pressure to 5-10

My opinion is that the maximum pressure is definitely too low at 10 cm. I would set it at 20 and then see where the machine wants to go. 

The minimum pressure should be increased as well. These would be my suggested settings:

Ramp: Auto
Ramp Start (pressure): 6 cm
Max Pressure: 20 cm
Min Pressure: 8 cm

It is normal to start a new user with a wide range between max and min so you can see where events are occuring and what the machine is doing automatically to address them. The large majority of the events in the three detail pages are with the pressure pinned at the 10 cm maximum.

[Ron AKA]

Please see last few days data after change pressure to 5-10

I went back and looked at some of the older charts you posted. I will revise my suggestion on setting slightly. 

Ramp: Auto
Ramp Start (pressure): 6 cm
Max Pressure: 15 cm
Min Pressure: 8 cm

I would also make a couple of suggestions. One of your earlier chart from March 28 showed a huge amount of Cheyne-Stokes Respiration. That is serious at her age, and you should discuss it with her doctor. And the one from April 7 with the 10 cm maximum is really bad and a risk to her well being. 

Are you setting the machine? Or is somebody else. I would be happy to help you, and I am sure others here would too, if you are having trouble.

[Ron AKA]

The other thing to consider once you have the pressures and ramp fixed is the mode the machine is operating in. It looks like it is in the "For Her" mode. That has some advantages and limitations. A quote from ResMed:

"AutoSet for Her mode

AutoSet for Her mode is based on key aspects of ResMed’s AutoSet algorithm and delivers therapeutic responses tailored to the characteristics of female OSA patients. The AutoSet for Her is similar to ResMed’s AutoSet algorithm with the following modifications:

 Reduced rate of pressure increments designed to help prevent arousals.
 Slower pressure decays.
 Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to
20 cm H2O.
 Minimum pressure (Min. Pressure) that adjusts according to the frequency of apneas:
If two apneas occur within a minute, the pressure reached in response to the second apnea will
become the new minimum treatment pressure until the next treatment session."

It is possible that the machine is not responding fast enough with increased pressures to prevent excessive apnea events. It also appears to not respond to apneas which occur above 12 cm, which could limit effectiveness.

One could research your detailed data and determine what impact this may be having. However it is probably easier and more practical, once you have the pressures and the initial ramp setup fixed, to just switch the machine from the "For Her" mode to the standard mode. I don't have this machine, but I understand the two modes are selectable. Perhaps someone with the For Her machine could comment...

[luckydxx]

The other thing to consider once you have the pressures and ramp fixed is the mode the machine is operating in. It looks like it is in the "For Her" mode. That has some advantages and limitations. A quote from ResMed:

"AutoSet for Her mode

AutoSet for Her mode is based on key aspects of ResMed’s AutoSet algorithm and delivers therapeutic responses tailored to the characteristics of female OSA patients. The AutoSet for Her is similar to ResMed’s AutoSet algorithm with the following modifications:

 Reduced rate of pressure increments designed to help prevent arousals.
 Slower pressure decays.
 Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to
20 cm H2O.
 Minimum pressure (Min. Pressure) that adjusts according to the frequency of apneas:
If two apneas occur within a minute, the pressure reached in response to the second apnea will
become the new minimum treatment pressure until the next treatment session."

It is possible that the machine is not responding fast enough with increased pressures to prevent excessive apnea events. It also appears to not respond to apneas which occur above 12 cm, which could limit effectiveness.

One could research your detailed data and determine what impact this may be having. However it is probably easier and more practical, once you have the pressures and the initial ramp setup fixed, to just switch the machine from the "For Her" mode to the standard mode. I don't have this machine, but I understand the two modes are selectable. Perhaps someone with the For Her machine could comment...

Thanks for looking up this detail for me.

Yes i can do the setting change.  but if "Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to 20 cm H2O." Why i see the previous stat can reach max pressure above 14. that i don't understand. 

please see some of the stat when she started use last year at Apr. All seems good, though she said same insomnia problem, then stopped at Aug.  But last month she started again, don't know what happen, high AHI.

[Ron AKA]

Yes i can do the setting change.  but if "Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to 20 cm H2O." Why i see the previous stat can reach max pressure above 14. that i don't understand. 

It will still go above 12 cm in "For Her" mode, but not due to obstructive apneas, only due to flow limitation and snore. If she is having apneas above 12 cm pressure it will not respond.


You may also want to check to see if it is in the Standard, or "For Her" mode.

[luckydxx]

Yes i can do the setting change.  but if "Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to 20 cm H2O." Why i see the previous stat can reach max pressure above 14. that i don't understand. 

It will still go above 12 cm in "For Her" mode, but not due to obstructive apneas, only due to flow limitation and snore. If she is having apneas above 12 cm pressure it will not respond.


You may also want to check to see if it is in the Standard, or "For Her" mode.

it is "auto for her" mode now

[luckydxx]

Yes i can do the setting change.  but if "Treats apneas up to 12 cm H2O and continues to respond to flow limitation and snore up to 20 cm H2O." Why i see the previous stat can reach max pressure above 14. that i don't understand. 

It will still go above 12 cm in "For Her" mode, but not due to obstructive apneas, only due to flow limitation and snore. If she is having apneas above 12 cm pressure it will not respond.


You may also want to check to see if it is in the Standard, or "For Her" mode.

can you tell me difference of mask pressure and pressure on the chart? thanks

[Ron AKA]

can you tell me difference of mask pressure and pressure on the chart? thanks

I have not see it written anywhere, but here is what I have concluded from looking at the data on the SleepyHead charts. I believe the Pressure chart with the red and green lines are the pressures the machine is setting as a target at the time you select on the graph. The red line is the basic pressure, and the green line is the basic pressure less the EPR value. You will note that these values change very slowly and if you expand the time scale they become almost straight lines.

The mask pressure is the measured actual pressure and compensated to reflect estimated actual pressure in the mask. If you expand out the time scale you will see the pressure fluctuate up and down with every breath. The top of the pressure peaks is what the mask is delivering in response to the target pressure of the red line. The bottom of the peaks is what the pressure is being reduced to on every breath due to the EPR setting. On the ResMed machines this is almost a match to the EPR setting. 1 reduces pressure by 1 cm, 2 by 2 cm, and 3 by 3 cm.

I like to look at he mask pressure along with the flow graph in the expanded scale because you can see at what pressure in the cycle that the breathing response fails.