Respiratory Rate

[Melman]

I was surprised to see the variation in my respiratory rate. Is this normal or indicative of a problem? Going from 13-15 breaths a minute for extended periods to up to 50 breaths a minute at others while lying in bed  seems very strange. I am new to this and only have four sets of data. I have posted the two most extreme. I moved the pressure graph. My machine is set at a constant pressure of 10 and that is what the graphs show. I realize I had a lot of leakage on Feb 11 but it doesn't appear to correlate with the respiratory rate,

[justMongo]

On average, a resting respiratory rate is about 15 BPM.
I cannot zoom in on your flow rate graph; a zero crossing on the flow rate is a start or end of a breath as the machine sees it.
Likely the higher respiratory rates are artifacts of how the machine scores a breath.

You need to control your leaks better. Are you adjusting the straps at pressure? Best to be at pressure.

[Sleeprider]

I would suggest zooming in on the flow rate chart during those higher respiration rate episodes to see if it really is a faster rate of respiration, or if perhaps the breaths are being improperly counted by the machine.  It looks like higher respiration rate correlates with higher volume, which is a bit counter-intuitive.  You have really serious flow limitations going on...I strongly recommend you enter the clinical menu, and change the settings to Autoset Standard at 9 minimum and 15 maximum and see if you can level things out.  I can see you have episodes of flow limit and respiratory rate change, that would likely respond better to auto-cpap.  Most clinics titrate you to a single pressure, but in your case, either sleep stage or sleep position is causing changes in your respiratory needs.  To be blunt, they got it wrong in your case.  The simple fact you don't have apnea events does not mean you are treated ideally, although as far as a clinic is concerned you are.

[car54]

I too have wild respiratory charts and I have brought this up myself. I am using the highest level of respiratory relief on my exhale (EPR). I believe that I read somewhere because of this there might be an overlap between inhaling and exhaling and because of my high EPR I might be getting some false graphs. I do not know this for sure.

car54

[Melman]

  You have really serious flow limitations going on...I strongly recommend you enter the clinical menu, and change the settings to Autoset Standard at 9 minimum and 15 maximum and see if you can level things out.  I can see you have episodes of flow limit and respiratory rate change, that would likely respond better to auto-cpap.  Most clinics titrate you to a single pressure, but in your case, either sleep stage or sleep position is causing changes in your respiratory needs.  To be blunt, they got it wrong in your case.  The simple fact you don't have apnea events does not mean you are treated ideally, although as far as a clinic is concerned you are.

After looking at the graphs again I see your point. I didn't realize before that 1 was severe. I am convinced that I should change to auto-cpap but am concerned with possible compliance issues. My Dr. prescribed CPAP at 10. I just got the machine two weeks ago and since it is a one year lease to own, am I free to make the change on my own? I need to see my Dr. to confirm compliance after 31 days but could not get an appointment until mid-April. I'm hesitant to proceed without an order to make the change from my Dr. since it may constitute non-compliance and my insurance would not pay for the machine. Do you know if this is a legitimate concern? I don't know what data my DME and insurance company see. Perhaps they would not even know I made the change,; but better safe than sorry.

[OpalRose]

Melman,
Insurance looks at hours of use, they don't normally care about pressure settings.  

Although, I don't know what sort of relationship you have with your Doctor, you can bring this up at your appointment and print out some stats for him to look at.  Tell him you are taking more of an interest in your therapy, and would like to switch to Auto Mode.  Tell him even though your AHI is low, you are experiencing Flow Limitations and Rera's and that you feel it can be resolved by switching to APAP.  

You probably will sound more informed that he is.  

[Melman]

To be honest, I have very little confidence in my Doctor's expertise with respect to CPAP. Unfortunately, I live in a small city and need to travel for 1.5hrs to see anyone with real expertise.
I do think I can persuade him if I present the data. I just don't like the idea of waiting until mid-April. On the other hand, I don't want to risk upsetting him by changing the prescribed setting; I need him for future prescriptions.

[Cranberry Ray]

As OpalRose stated, insurance companies are only worried about one thing, compliance. That is defined by the number of hours each night (normally look for at least 4 hours use) and how often you use your machine (most look for 70% usage which means 21 out of a 30 day period). If you are meeting compliance most doctors really don't care what the machine is set at as long as your AHI is less than 5.0 which is what insurance companies consider effective treatment. If it were me I would make the changes suggested by Sleeprider. He is always spot on with his assessment.

Good luck and continued success with your treatment!

[Sleeprider]

I would estimate most of the people on this forum have managed their own pressure settings at one point of another. The good news is, it's easy to return to another setting if things are not working out. It may help to realize that a CPAP titration study is really just a methodical approach to trial and error. During titration the technician starts at a low pressure like 4-5 cm and observes breathing. Pressure is increased until obstructive events are no longer present, and this is usually monitored during REM sleep and in a supine position. This becomes the CPAP pressure on your prescription. These procedures recommended by Resmed and Philips are linked below. This is not rocket science. Note the second link also discusses titraion using Auto CPAP. Since you have a titrated pressure of 10, and have residual flow limitations, you would use the higher option: Set CPAP pressure at 8 in Auto mode and adjust A-Flex to patient comfort.

https://www.resmed.com/us/dam/documents/...lo_eng.pdf
http://incenter.medical.philips.com/docl...%3d9792335

The Philips machine is not particularly fast to change pressure in auto mode and using the higher recommended pressure as the minimum will work best. The suggestions you are receiving on this forum are not pulled out of thin air, but are techniques and strategies that have worked for a lot of people, and the best part is, If it doesnt work, you can just return to fixed pressure at 10. On the other hand, your event rate is low, and most people just adapt to the CPAP and eventually have lower event rates. If you do nothing, it's probably okay too.

Compliance will not be affected by your settings. Compliance means usage. Worry less, sleep better.

Tom

[chigirl]

If it helps any, I was nervous switching mine as well because I was afraid of my doctor's reaction.  Because they are definitely going to know (doc says she's like Santa, she sees everything.)

When I went to my follow-up appointment she said to me, "I see you've been changing your settings.  It's not what I would have picked, but it's working for you, so that's great."  We talked a little bit about where I found out how to change the settings, and why I changed them and so on.  Then she explained why she would have set them differently. 

It was a very collaberative conversation and went well.  I started our conversation by saying, "I really want this to work for me, so I needed to figure out how to do that."  I think that set the tone for the rest of our discussion.

I wouldn't worry too much about changing the settings.  Hopefully your doctor will react the same way as mine.