Problems with machine change (CA's)
Hello!
Current settings: EPAP 10.4 Support 1.6 max IPAP 13.2 Ti max 2.5 Trigger V high Cycle V high.
Since switching from a Respironics System One 60 series a few months ago to a ResMed 10 V-auto I'm getting too many centrals and poor sleep. After doing some serious lurking here on the site for a month or two and reading lots of good threads, I have come to the conclusion that I could use some help beyond what has already been done/tried.
I have a Bi-PAP because a botched in-lab observed sleep study was run and my now-former provider chose to go that route. Since the machine can be set up to function like an APAP it doesn't really matter except for providing some extra treatment options that I would not have otherwise.
The other difference is between PR and RM algos. That may be some or most of the problem in my case since the pressure settings are now essentially identical to what was working okay-ish with my old machine. I also endured significant over-titration for a number of weeks and have been periodically stepping down pressure since then to get to the current settings.
Briefly, I'm getting CA clusters plus additional random CA's to the tune of of a CA index around 6. The clusters can show up anytime but are often in a period after starting therapy or restarting therapy during the night.
Leaks show up mostly after an initial disturbance. That disturbance may be a positional change where as a side sleeper the mask and pillow interact.
Hypopneas are fine at around an index of 0.5, OA's are almost non-existant with an EPAP of 10+. Flow limitations are still okay with 95% rate at <.05 nightly with IPAP capped first at 14 for a few weeks and now at 13.2 for a week. FL's are almost non-existent at higher IPAP (eg 16). Old PR machine showed consistent FL index in the low to mid teens over the years FWIW.
I changed the sensitivity on both Trigger and Cycle to high a couple weeks ago and to very high a couple nights ago. So far no change in anything but more perceived comfort. Somewhere around the high to very high is what I recall the PR feeling like. Also I increased Ti max which had only affected my wakeful breathing.
Another difference between machines is the 'rise time.' I am working under the assumption that the RM is using the 'easy breathe' and if not then the rise time is not as aggressive as the PR. Or I have forgotten how I breathed on the PR. In any case I am considering going to S mode to be able to set Rise Time. But it would be nice to get to the best pressure first since FL and CA won't be monitored in S?
Thinking of dropping support by 0.2 increments on a periodic basis. How often? How soon? Also the EPAP was raised in steps from 10.0 to 10.4 solely to help compensate for 'lack of air' when support was dropped from 3 to 2 to current.
Someone will want to see OSCAR charts or more data. I don't have the sleep study charts from 2013 and whatever passed for a sleep study this year is IMHO useless for several reasons that include EPAP never being lower than 12. Initial observation study 2013 showed mild bordering on moderate OA with no CA.
Thanks.
Current settings: EPAP 10.4 Support 1.6 max IPAP 13.2 Ti max 2.5 Trigger V high Cycle V high.
Since switching from a Respironics System One 60 series a few months ago to a ResMed 10 V-auto I'm getting too many centrals and poor sleep. After doing some serious lurking here on the site for a month or two and reading lots of good threads, I have come to the conclusion that I could use some help beyond what has already been done/tried.
I have a Bi-PAP because a botched in-lab observed sleep study was run and my now-former provider chose to go that route. Since the machine can be set up to function like an APAP it doesn't really matter except for providing some extra treatment options that I would not have otherwise.
The other difference is between PR and RM algos. That may be some or most of the problem in my case since the pressure settings are now essentially identical to what was working okay-ish with my old machine. I also endured significant over-titration for a number of weeks and have been periodically stepping down pressure since then to get to the current settings.
Briefly, I'm getting CA clusters plus additional random CA's to the tune of of a CA index around 6. The clusters can show up anytime but are often in a period after starting therapy or restarting therapy during the night.
Leaks show up mostly after an initial disturbance. That disturbance may be a positional change where as a side sleeper the mask and pillow interact.
Hypopneas are fine at around an index of 0.5, OA's are almost non-existant with an EPAP of 10+. Flow limitations are still okay with 95% rate at <.05 nightly with IPAP capped first at 14 for a few weeks and now at 13.2 for a week. FL's are almost non-existent at higher IPAP (eg 16). Old PR machine showed consistent FL index in the low to mid teens over the years FWIW.
I changed the sensitivity on both Trigger and Cycle to high a couple weeks ago and to very high a couple nights ago. So far no change in anything but more perceived comfort. Somewhere around the high to very high is what I recall the PR feeling like. Also I increased Ti max which had only affected my wakeful breathing.
Another difference between machines is the 'rise time.' I am working under the assumption that the RM is using the 'easy breathe' and if not then the rise time is not as aggressive as the PR. Or I have forgotten how I breathed on the PR. In any case I am considering going to S mode to be able to set Rise Time. But it would be nice to get to the best pressure first since FL and CA won't be monitored in S?
Thinking of dropping support by 0.2 increments on a periodic basis. How often? How soon? Also the EPAP was raised in steps from 10.0 to 10.4 solely to help compensate for 'lack of air' when support was dropped from 3 to 2 to current.
Someone will want to see OSCAR charts or more data. I don't have the sleep study charts from 2013 and whatever passed for a sleep study this year is IMHO useless for several reasons that include EPAP never being lower than 12. Initial observation study 2013 showed mild bordering on moderate OA with no CA.
Thanks.
