Suggestions for new settings

[Cliffh]

Good day All,

I have been using Resmed CPAP equipment for the last 8 months with not much success.
What I have been using is the following:
Resmed S9 Autoset with Humidifier
Min Pressure settings 13cm H2O
Max Pressure settings 20cm H2O
EPR Level 3.0cm H2O constant
Full face Resmed Mirage Quattro mask
I have basically been trying to make the mask work for me but have had no success as there is just way too much leakage.
All results were very bad.

A week ago, I received a new nasal mask from Resmed. Model Swift FX
The leakage has basically dropped to zero, however I am struggling to breathe out when connected.
My logic tells me that the pressure settings are way too high for this new mask as I have not changed anything.

Can someone please suggest what I could start with in terms of pressure settings so as to aleviate the problem.

[Walla Walla]

I would drop the minimum pressure down to 12cm for a start and see how that goes. Than continue to adjust the minimum as needed. Make sure you also set the mask setting on the machine for pillows.

[mesenteria]

It might sound counterintuitive at first, but if you suspect one of the settings is too high, lowering it slowly until you find 'the zone' is the right way to go, not reducing pressures wholesale, say five or six cm of H2O immediately.  So, walla walla's advice is probably quite sound.

In the military, though, we have a logic that works when attempting to find the right lay of artillery pieces to get the fall of shot we intend so that we can keep the enemy's head down.  We make more drastic corrections, usually 800 meters plus or minus initially, and we ask for another round.  When that round explodes upon impact, we'll know if we need another bold 800 meters to get a high probability that we'll find the latest round exploding in front of the target area and not behind it again.

From there, smaller corrections are made, and yet smaller after that until we know the rounds are landing on target.  This is known as 'bracketing'. So, 'drop 800', then 'add 400', then, 'drop 200', and when that round comes essentially onto target, "fire for effect!".  Then all guns open up, knowing the correct lie, and they pound the enemy into submission.   This is how I would approach my own therapy adjustments if the results had been terrible to this point...BUT ONLY IF THE RESULTS WERE AWFUL...OBVIOUSLY BADLY WRONG.  I would make 5 cm adjustments initially, see if AHI got markedly better, and then halve the last adjustment in the SAME direction. If that made things worse, I'd know to add it back, and add another half in the same reversing direction for the bracketing effect.


At some point you'll only be adding or subtracting, in succession, one cm at a time, or even half because I believe the machines can raise pressures about 0.2 cm or so if the owner wishes.

[Walla Walla]

It might sound counterintuitive at first, but if you suspect one of the settings is too high, lowering it slowly until you find 'the zone' is the right way to go, not reducing pressures wholesale, say five or six cm of H2O immediately.  So, walla walla's advice is probably quite sound.

In the military, though, we have a logic that works when attempting to find the right lay of artillery pieces to get the fall of shot we intend so that we can keep the enemy's head down.  We make more drastic corrections, usually 800 meters plus or minus initially, and we ask for another round.  When that round explodes upon impact, we'll know if we need another bold 800 meters to get a high probability that we'll find the latest round exploding in front of the target area and not behind it again.

From there, smaller corrections are made, and yet smaller after that until we know the rounds are landing on target.  This is known as 'bracketing'. So, 'drop 800', then 'add 400', then, 'drop 200', and when that round comes essentially onto target, "fire for effect!".  Then all guns open up, knowing the correct lie, and they pound the enemy into submission.   This is how I would approach my own therapy adjustments if the results had been terrible to this point...BUT ONLY IF THE RESULTS WERE AWFUL...OBVIOUSLY BADLY WRONG.  I would make 5 cm adjustments initially, see if AHI got markedly better, and then halve the last adjustment in the SAME direction. If that made things worse, I'd know to add it back, and add another half in the same reversing direction for the bracketing effect.


At some point you'll only be adding or subtracting, in succession, one cm at a time, or even half because I believe the machines can raise pressures about 0.2 cm or so if the owner wishes.

No need to drop a nuke when a fly swatter will do. Usually when going from a full face mask to a pillow mask there's a 1cm to 2cm correction needed to account for the smaller mask volume. If everything else is the same avoid over correcting and use the fly swatter (1cm).

[Cliffh]

[attachment=9010][attachment=9011][attachment=9012][attachment=9013]Hi Guys,

Thanks for the missile/fly swatter answers.
Knowing that I had MAJOR leaks from my previous full face mask, I decided to drop the Min Pressure to 10,
and the Max to 17. I also changed to the "pillow" mask.....thanks I had forgotten about that setting.
Even though I was only on for approx 2 hrs, I did not wake up with a dry mouth.
I include results for your perusal.
Once again, thanks so much.
If you think I could tweak anything else, I would be pleased to hear from you.

Regards
Cliffh

[Cliffh]

Hi Walla Walla,

Thanks for your advice so far.
I dropped the lower setting to 10 and the upper to 17.
Problems so far, even though I now have zero leakage.

I get a maximum of 2hrs sleep and then wake up feeling that I have to disconnect due to discomfort.
It feels as though I can't breathe quick enough and therefore am not getting enough oxygen.
When breathing in, it seems fine however when breathing out I seem to have a lot of resistance and don't expel air quick enough.
It actually exhausts me.

Any suggestions?

Cliffh

[Walla Walla]

If you can download sleepyhead and post some charts we can see what's going on. It's pretty hard to give advice without seeing all the data. The links for sleepyhead are below. Also you'll need to insert an SD card into your machine overnight to record the detailed data.

[Cliffh]

            Herewith the last 3 days of what I could bare

[Walla Walla]

Do you have all your events flags on green at the bottom of the sleepyhead chart? If so than it's time to start dropping your pressure more. I would drop your maximum pressure to 9cm and the minimum to 6cm to start. It appears flow limitations are pushing the pressure higher. Lowering the maximum pressure should help keep the pressure from running away. Eventually you want to slowly keep dropping each pressure until events start showing. Than you can move it up to were you need it.

[Gideon]

Hi Walla Walla,

Thanks for your advice so far.
I dropped the lower setting to 10 and the upper to 17.
Problems so far, even though I now have zero leakage.

I get a maximum of 2hrs sleep and then wake up feeling that I have to disconnect due to discomfort.
It feels as though I can't breathe quick enough and therefore am not getting enough oxygen.
When breathing in, it seems fine however when breathing out I seem to have a lot of resistance and don't expel air quick enough.
It actually exhausts me.

Any suggestions?

Cliffh

First your numbers are awesome.  We can further limit your high (to 11 cmw) because you are not having events, obviously, bump the high up should that happen.  This does 2 things, first it lowers your expiration pressure to a max of 8 because of EPR, hopefully correcting the exhalation issue, secondly it's a lower higher pressure to help with your past leaks.

Let's also drop your minimum to 8 which corresponds with the max of 11 and an EPR of 3.  We want to drop the min to reduce exhalation effort for comfort.

Do note your current settings as they are obviously working for you and as such are a safe place.

This is a big change for me since your numbers are solid, but I would like to drop your min even a bit further but let's see what happens with this.

Fred