[Treatment] Anyone want to try helping with luna G3 graphs

[Chrisr]

I've been on cpap for about 11 months. The first six months was great, I left the settings on apap 4-20 pressure, my reslex set to highest setting. I started with the airfit f30 mask then in my first supply shipment that included the full headgear, my dme switched me to the arifit f30i because, who knows. I seem to do fine with both and I don't have a preference. 

At some point in the last five months treatment started getting less effective. Now its to the point where some days I have brain fog and don't want to do anything. One or maybe two days a week I'm good. I upped my minimum pressure to 6, thought it helped but it didn't last. Tried 8, same thing. I have not tried changing the reslex setting, just learned that it could help earlier today.

I know this information is incomplete compared to resmed machines but it's what I have. So here's a graph from two nights ago with the minimum pressure set to 7. Felt like crap yesterday.

   

Here's a graph from last night with minimum set to 8.5. I feel like crap today too.

   

I'll gladly take any suggestions, tips, insults, whatever you've got if it might help me out. I may not be able to reply over the weekend.

Thanks
Chris

[PeaceLoveAndPizza]

I think there is enough there to take an initial pass at settings.

Try the following:

Min pressure 8
Max pressure 12
Reslex 2
Ramp off

That will limit the range to 8-12 and provide 2 cmH2O pressure support on exhale. Hopefully it should be more comfortable.

Keep an eye on the leaks as well. There are a few spots where it looks like there is a mark burp likely from pushing your head into the pillow. Nothing to worry about now, but something to keep in mind.

[Chrisr]

Thank you for the response Peace. I will try those settings. I have a couple of questions though. 

First, should I change everything at the same time? I have tried a minimum pressure of 8 already so that wouldn't be the first time for that.

I've seen the recommendation to lower the max pressure before and wondered what that did if that pressure was never reached anyway. So if the max pressure is set to 10 but it never auto adjusted to more than 9 is that actually changing anything?

It seems that there are some nights where I have no leaks at all and some where the mask just doesn't like what I'm doing.

That reminds me of something else on my mind. The more I've raised the pressure the more the mask leaks obviously, so the more I've tightened the straps. This causes my chin to be pulled back towards my airway, causing more leaks and closing down my airway a little bit. Is this everyone else's experience too or am I doing something wrong? 

Something else I forgot that may not matter. I am a mouth breather, which you probably knew already. I did use mouth tape the other night but it was uncomfortable and I have a really hard time getting a deep breath with it on.

Thanks again

[PeaceLoveAndPizza]

No reason not to make these changes all at once. The only real change is the addition of pressure support (resflex).

In this case as we are adding a bit more pressure and pressure support, I want to be sure there is enough headroom for any eventuality. Bumping it up does not hurt. I imagine we may need to increase the pressure higher than 8, so the new range is a step in that direction.

Masks are finicky beasties. Some nights they work fine, others not quite so well. Your leaks are not that bad, just something to watch. 

Regarding mask fitting, watch some YouTube videos by LankyLefty27. He does a good job explaining how to properly fit a mask. In a nutshell, the mask should just sit on your face and not be overly tightened. When you apply CPAP pressure, the silicone will expand sealing against your face. The difficult thing is not jostling it when you lay down as you turn your head into the pillow. I use a CPAP specific pillow, which has a divot for the mask to fit so it does not get moved around. Others just keep their head towards the side of the pillow and have the mask off the edge. Use whatever works for you.

With full-face or hybrid masks, mouth tape is not necessary nor typically suggested. I use an F&P Evora hybrid (similar to your F30 but with a more rigid area for the nose), so that if I open my mouth it is still inside the mask. I also use a soft cervical collar which helps keep my mouth closed and my neck in a better position to keep the airway open. It works for me. You may want to give it a try as it is an inexpensive experiment. If you were using nasal pillows or mask I would ask one of the folks to help with the mouth tape option as I have no experience with it.

[Chrisr]

Thank you. That is very helpful. I will try the changes tonight.

[Psychotech]

I think there is enough there to take an initial pass at settings.

Try the following:

Min pressure 8
Max pressure 12
Reslex 2
Ramp off

That will limit the range to 8-12 and provide 2 cmH2O pressure support on exhale. Hopefully it should be more comfortable.

Keep an eye on the leaks as well. There are a few spots where it looks like there is a mark burp likely from pushing your head into the pillow. Nothing to worry about now, but something to keep in mind.

i want to add to the above said settings, keep sensitivity to 4-5 the machine will response quickly when their is an apnea event

[Chrisr]

I wanted to check back in so everyone knows I didn't just wander off.  I've slept four nights now with the new settings. I haven't remembered to get the data card out and take it to work with me yet but I will soon. One thing I was wrong about, the reslex setting. It was set for almost no relief(I think 3). I changed it to 2 which made it easier for me to exhale. Oddly, I didn't like it and it took some getting used to but its normal for me now.

I had an odd weekend and got to bed late last night so I really can't tell if I'm sleeping better yet.

I was looking at some old data and came across something that I'm not sure about so I wanted to get some opinions here. If it would be better to start a new thread I can do that too, just let me know. These are in order and should overlap some.

           

I'm curios about the wavy pattern that starts in the first shot.

[Chrisr]

I don't think my new settings are helping, I've been very tired and not interested in life the last few days. I think I'll try a minimum pressure of 9 tonight and see if I can tolerate the mask being tight enough to seal it.  

Here are some more graphs I got with the min pressure set to 8.  I wonder what the long period of shallow breathing is in the first screenshot.  The second shot is where it transitions from normal(maybe) breathing to the shallower breaths. The last shot is just some weird patterns. 

Can anyone help?  What would it take to get a developer to write the code for Oscar to read data from the luna machines? Money? Machine? Data?

           

Thank you

[PeaceLoveAndPizza]

The latest charts shows a good amount of flow limitations restricting the airflow. I think adding some pressure and pressure support are needed. The first and third charts show the restricted airway in the flow rate reductions, and the second shows it in the peak of the wave being flattened by the exhale flow limitations.

Rather than jumping up to a new range all at once, consider increasing pressure by 0.2 or 0.4 every few nights whilst also increasing the pressure support with ResFlex=3 (which as I recall is the limit on the Luna G3). 

If you want to try it all-in, something like the following may help:

Min pressure 10
Max pressure 15
ResFlex 3

If that is too uncomfortable, go back to the slight increase every few nights scenario.

[Chrisr]

Thank you, you've been very helpful.

I'm pretty sure the Luna G3 only adjusts pressure in .5 increments but I may try the all at once first and see if I can fall asleep. I have never had the pressure that high before. I'll try for a few days and see what happens.