User new to changing settings

[mjphyi]

Thanks Sleeprider. Here's a few recent screenshots.

Michael

   
   
   

[Sleeprider]

Increasing pressure resulted in decreasing obstructive events, and at 15 cm fixed with EPR 3, you had a near perfect night according to AHI. If you feel good, that that may be the end of the story, but I doubt that's the case give your flow limitations have not budged or gotten worse. I'm seeing more mouth leaks below large leak threshold as well. The cursory results look great, how do you feel? Ready for some pressure support?

[mjphyi]

Increasing pressure resulted in decreasing obstructive events, and at 15 cm fixed with EPR 3, you had a near perfect night according to AHI.  If  you feel good, that that may be the end of the story, but I doubt that's the case give your flow limitations have not budged or gotten worse. I'm seeing more mouth leaks below large leak threshold as well.  The cursory results look great, how do you feel?  Ready for some pressure support?

So I had forgotten about the limit of 3 chart postings, and I'd selected 7 more varied results to post, but couldn't. So I'm not sure if the 3 I did post are typical.

Feeling good or bad really doesn't happen for me. I think maybe once in 700 or so nights of use have I felt that I got a much better sleep. I've had some nights that I have had trouble getting to sleep, but that didn't make me feel especially bad in the morning. So I think that how I feel isn't a reliable indicator of anything.

I do see many more leaks than seems desirable, but they don't seem to affect the numbers much at all, now that I'm on the nasal mask. Sometime, I'll set off a discussion on what triggers ResMed's pressure raising algorithm, because I suspect it's a little bit off when one has leaks and a full face mask.

Currently, I believe that most of my leaks are from the mask slipping around my head as I move my head while "asleep". I used to worry that I had not properly converted from mouth breathing (and I know of 2 instances where a mouth breathing leak woke me up), but I taped my mouth closed for 2 nights, and I could tell no difference in the charts. Sometime in the next month, I will rig up the IR camera and get a more definitive answer.

In a few days, I'll be away on a trip using my old S9 and I'll set it to my current CPAP settings of 15cm and EPR=3.

However last night I tried the VAuto for the first time, on the same CPAP settings, just to see if it gave similar results, and it did. So I don't mind doing a couple of nights in S or VAuto mode to see if I notice any difference. However I think I'll remind you why I believe I need the settings I'm using, which is:

1   I'm only a nose breather at 12cm. I usually take a half dose of Fluticasone before going to bed, and starting at 10.6 to 11.0 has worked, but where I really need 12 is if I've got up for a bathroom break, I'm OK when vertical, but when I put the mask back on and am horizontal, I do need 12 to start to nose breathe properly and get back to sleep.

2   I'm fairly consistent at getting aerophagia over 17cm, and that definitely makes me feel worse, albeit only for a couple of hours after it's woken me up.

3 I haven't seen any consistent results that tell me more EPR is better.

That all being said, what settings would you suggest on the VAuto?

Michael

[Sleeprider]

We're going to go pretty conservative with the Vauto on PS 4 for now. I'm open to you setting up as you think is best, and will give you some ideas to guide you in that. If you set to Vauto mode with EPAP min 9.0, PS 4 and IPAP max 17, that will sttart you in auto pressure at 13/9, and allow you to go to 17/13. That is probably my "go-to" suggestion for your start. You are welcome to take EPAP min higher or lower, but those settings should avoid the congestion issues, aerophagia, and will let us see what a bit more pressure support does.

[mjphyi]

We're going to go pretty conservative with the Vauto on PS 4 for now.  I'm open to you setting up as you think is best, and will give you some ideas to guide you in that.  If you set to Vauto mode with EPAP min 9.0, PS 4 and IPAP max 17, that will sttart you in auto pressure at 13/9, and allow you to go to 17/13.  That is probably my "go-to" suggestion for your start.  You are welcome to take EPAP min higher or lower, but those settings should avoid the congestion issues, aerophagia, and will let us see what a bit more pressure support does.

I've made those changes for tonight.

The defaults for the settings I've never played with before seem to be
TiMax=1.0s
TiMin=0.7s
Trigger=Med
Cycle=Low

Should I leave those as they are?

[mjphyi]

   
   
   

Well that was interesting. The 3 charts above are from the VAuto, the first in CPAP mode, the second in VAuto mode, and the 3rd from the same night, a zoom into one of the OAs, just in case it's interesting.

It's interesting mostly because I didn't know what to expect, and I found the pressure supply pattern surprising. The machine's pressure started me off inspiring, and before I was done doing so, it backed the pressure off, apparently forcing or "suggesting" that I continue to breathe in. If I didn't, the breaths supplied progressively less air, and if I did, I imagined that I could feel the increased pressure on my chest as I breathed in on my own. I was actually up on one elbow twice looking at the screen pressure display, which confirmed what I thought. I wasn't sure the night would go well, or if I would get to sleep.

However, I did, and can't say I feel any different. The results in numbers look good, although not out of the range that I've been getting with fixed 15cm CPAP, but did achieve that with less pressure which I'll count as an advantage.

In a recent post in this thread, I said I didn't want pressures above 17cm to avoid aerophagia. It occurred to me that the last time I got that was with a full face mask, and I suspect that aerophagia won't happen if my nose breathing techniques keep functioning.

[Sleeprider]

With 9-17 at PS 4, look at the 95% flow limitation statistic...0.0 with a max of 0.09. Compare to your previous result of 0.24 and 0.42. Look at the flow rate line and compare the number of "spikes" that may be arousals or deeper breathing. This represents far fewer sleep disruptions with the pressure support. You tolerated the pressure support well and had only 1 CA event. Pressure variation is less than 1-cm, and this suggests you will tolerate a lower minimum EPAP pressure. That is a choice you can make based on comfort. I think this is a good pressure range for you, and will be interested in your impression.

I am going to disregard the CPAP mode because the leak rate is much higher, as well as flow limits and event. I think we can forego CPAP mode for now. Your event closeup shows the event was preceded and followed by an expiratory snore. I don't know the significance, but the flow rate looks good here and the OA may have been an arousal with change in body position. When you have a choice of only one event in a night, that's not too bad.

Change Ti Max to 1.8 to avoid premature loss of PS.
Default Ti Min is 0.3 and Ti Max is 1.8, so someone had adjusted this machine for longer inspiratory support and time of inspiration. That would suggest the last user had COPD.

[mjphyi]

With 9-17 at PS 4, look at the 95% flow limitation statistic...0.0 with a max of 0.09.  Compare to your previous result of 0.24 and 0.42. Look at the flow rate line and compare the number of "spikes" that may be arousals or deeper breathing. This represents far fewer sleep disruptions with the pressure support.  You tolerated the pressure support well and had only 1 CA event.  Pressure variation is less than 1-cm, and this suggests you will tolerate a lower minimum EPAP pressure. That is a choice you can make based on comfort.  I think this is a good pressure range for you, and will be interested in your impression.

I'll get back to this in more detail later in the day. But I am glad and grateful that you have so easily been able to demonstrate a quantifiable improvement in the charts. On CPAP and APAP and especially with a full face mask, I have always been suspicious that there was an interaction (and I don't know which is cause and which is effect) between flow limitations and leaks, and especially the beginning and end of leaks, and that this interaction was making the effects of the leaks bigger.

But these leak effects are reduced when the leaks aren't "large". I think they may still be there, for example, the in VPAPauto mode, FLs at 23:50 and 06:18 I see as "related" in some way to a change in leak rate, while the FL at 01:32 seems less so.

Anyway, enough of the digressions. I agree with you that the results are better on VPAPauto, and I will continue with it for the next 2 nights, and then I'll be away on my trip, and going back to CPAP, although still checking in on the forum.

I am going to disregard the CPAP mode because the leak rate is much higher, as well as flow limits and event. I think we can forego CPAP mode for now.  Your event closeup shows the event was preceded and followed by an expiratory snore. I don't know the significance, but the flow rate looks good here and the OA may have been an arousal with change in body position.  When you have a choice of only one event in a night, that's not too bad.

I just picked this event at random because I could post another chart. With less "noise" in the results, I'm hoping to be able to get more out of the charts than before.

Change Ti Max to 1.8 to avoid premature loss of PS.
Default Ti Min is 0.3 and Ti Max is 1.8, so someone had adjusted this machine for longer inspiratory support and time of inspiration. That would suggest the last user had COPD.

I was not expecting that because I believed I had cleared all previous settings and data, and was using a new SD card. The last user was using it in S mode however.
I will make those changes for tonight.

Thanks again,

Michael

[mjphyi]

Only settings change is TiMax from 1.0 to 1.8

   

I was probably awake for the 2 CAs at the end.

[mjphyi]

   

Went to bed late and tired, was awake by about 0650 on chart

Settings
TiMax=1.8s
TiMin=0.7s
Trigger=Med
Cycle=Med

Changed Cycle from Low to Med from last night.

Back to CPAP for a while.