New S10 machine, replaced DS1 ABIPAP

[Phaleronic]

    One of your fine moderators requested I create a thread, and I appreciate that very much.

I have a new S10 for her machine and used it last night.  I changed the defaults to try to match my DS1 as the S10 will move into bipap on EPR 3.  This is the data, and any insight I would greatly appreciate.

[Phaleronic]

Mask type and model: Airfit F20 full face

[SarcasticDave94]

OK let's see... Flow Limits are quite high. The tool to combat this will be the following 2 items, EPR and more minimum pressure.

Your median EPAP was about 10, and that's probably close to where you'll need to be. This is if EPR 3 is already on, turn that 6.2 to 8. You can take it up in steps if you prefer.

Note that you do have some CA which is Central Apnea. I suspect this is a version of treatment emergent, as in using the PAP. That is unless you had CA show on a diagnostic study. Since you will be increasing pressure, which may increase CA, keep an eye on the stats. CA and flow limits are treated in opposing fashion, which is why I mention it.

Last, show OSCAR in this setup, events, flow rate, pressure, leak, flow limit on your next post update.

[Phaleronic]

OK let's see... Flow Limits are quite high. The tool to combat this will be the following 2 items, EPR and more minimum pressure.

Your median EPAP was about 10, and that's probably close to where you'll need to be. This is if EPR 3 is already on, turn that 6.2 to 8. You can take it up in steps if you prefer.

Note that you do have some CA which is Central Apnea. I suspect this is a version of treatment emergent, as in using the PAP. That is unless you had CA show on a diagnostic study. Since you will be increasing pressure, which may increase CA, keep an eye on the stats. CA and flow limits are treated in opposing fashion, which is why I mention it.

Last, show OSCAR in this setup, events, flow rate, pressure, leak, flow limit on your next post update.

Yep, I did bump min up to 8 after seeing this data.  CA was minimal (as it's probably false positives) in both of the Phillips machines.  There was no CA in the sleep study at the time (4 years ago).  I'm sure that CA in RP machines can also have false positives.. 

I also raised the max pressure.  

My initial impression with this machine is that I wanted to sleep more than I've slept on my phillips machine, which is odd, since I would wake up refreshed and full of energy.  

When looking at the data this resmed machine is minimizing most of the events, but I feel like crap.

Regards,

P

[Sleeprider]

It would be interesting to see the flow rate graph at a resolution of about 3 minutes. Your flow limits are impressive! By zooming in on the graph you will see a very flattened inspiratory wave-form. I can't say what causes it, but rarely do we see someone at nearly 0.5 flow limit with EPR at 2. I think your solution is probably to find a narrow pressure range that feels good and stick with it. Your graphs do not include the pressure chart, so it's impossible to correlate the times with better results with a pressure. I actually think your flow limits are caused by chin-tucking, rather than any anatomical issues. Some people have obstructive apnea or increased incidence of hypopnea from chin-tucking, but you and some others we have see, can continue to breathe through the positional obstruction.

[Phaleronic]

It would be interesting to see the flow rate graph at a resolution of about 3 minutes. Your flow limits are impressive! By zooming in on the graph you will see a very flattened inspiratory wave-form.  I can't say what causes it, but rarely do we see someone at nearly 0.5 flow limit with EPR at 2.  I think your solution is probably to find a narrow pressure range that feels good and stick with it.  Your graphs do not include the pressure chart, so it's impossible to correlate the times with better results with a pressure. I actually think your flow limits are caused by chin-tucking, rather than any anatomical issues. Some people have obstructive apnea or increased incidence of hypopnea from chin-tucking, but you and some others we have see, can continue to breathe through the positional obstruction.

Thank you for the evaluation, it's at EPR 3 in that dump.  I've had flow limits in all the data (on phillip's apap and bipap).  I can add pressure and zoom in on whatever event needed.

Regards,

P

[Phaleronic]

OK let's see... Flow Limits are quite high. The tool to combat this will be the following 2 items, EPR and more minimum pressure.

Your median EPAP was about 10, and that's probably close to where you'll need to be. This is if EPR 3 is already on, turn that 6.2 to 8. You can take it up in steps if you prefer.

Note that you do have some CA which is Central Apnea. I suspect this is a version of treatment emergent, as in using the PAP. That is unless you had CA show on a diagnostic study. Since you will be increasing pressure, which may increase CA, keep an eye on the stats. CA and flow limits are treated in opposing fashion, which is why I mention it.

Last, show OSCAR in this setup, events, flow rate, pressure, leak, flow limit on your next post update.

Thank you Dave, I'll do that shortly 

Regards,

P

[Gideon]

Why were you on a BiPap?

I too suspect a positional cause to your flow Limits.

Post a set of charts with your current settings, you have been changing them.

An experiment, make your pillow flatter, if you use 2 pillows, use one. If you use a firm foam pillow try a thin non-foam pillow. If Sleeprider and I are right (post the detailed data Sleeprider requested) the common fix is a soft cervical collar, read the links in our signatures for details on this.