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03-08-2021, 02:39 PM (This post was last modified: 03-08-2021, 02:43 PM by R Moby.)
faulty data on Resmed S-9 ?
I have had good results with my Resmed S-9 Bipap for several years. Sleep study prior to PAP showed AHI 29 when supine, AHI 9 sleeping on side. The machine maintained average AHI below 5.0 for several years - until six weeks ago. AHI reading now swings in a much wider range, between 1 and 12, sometimes higher. I’m not noticing a significant change in daytime sleepiness. No apparent change in medical status. I’m wondering if the unit has started showing incorrect data. Does that ever happen? During the five years of use, I’ve dropped it on the floor several times. Also, I’m interested in any insights to be gleaned from the Oscar data which I’ll attempt to attach below (haven’t done that before.) Holding my breath at the end of exhalation appears to be a primary issue. BTW I made the unwise decision a few years ago to have LAUP to remove some of the tissue at the back of my throat to treat OSA. (I hope that no one is doing that anymore.) It complicated my ability to use PAP, e.g. if I increase IPAP above 9.8, aerophagia results. I use tape over my mouth to keep PAP from just blowing out of my mouth like a dragon - works well. Great to become reacquainted with the Board – thank you.
You are in fixed pressure mode VPAP S, with a pressure of 9.6/4.6 (PS 5.0). I'd like to get you to Vauto mode with EPAP min 6.0, PS 4.0 and IPAP max 14.0 and see what we get. If you are using extra pillows or something firm that causes chin-tuck, you need to toss it, and you may need the soft cervical collar. http://www.apneaboard.com/wiki/index.php...cal_Collar We can get your AHI to less than 2, but you have some work ahead. We will start with an increase in EPAP pressure and Vauto mode for the obstructive apnea, and reducing pressure support for the centrals.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
[attachment=30679 Wrote:Sleeprider pid='386777' dateline='1615242433']Moby, you need to increase the minimum EPAP pressure due to OA, but you have to deal with the positional apnea.
You are in fixed pressure mode VPAP S, with a pressure of 9.6/4.6 (PS 5.0). I'd like to get you to Vauto mode with EPAP min 6.0, PS 4.0 and IPAP max 14.0 and see what we get. If you are using extra pillows or something firm that causes chin-tuck, you need to toss it, and you may need the soft cervical collar. We can get your AHI to less than 2, but you have some work ahead. We will start with an increase in EPAP pressure and Vauto mode for the obstructive apnea, and reducing pressure support for the centrals.
Thank you for those excellent suggestions. Good results on night one - AHI 1.7. I'll wait a week to see how it plays out.
I changed to Vauto mode, and raised EPAP to 6.0. Had to leave IPAP at 9.8 because higher than that drives the air down my esophagus.
The information on cervical collars was very helpful. I had been using one, but not understanding the chin tuck issue correctly. (Releaf, size large, 3 1/4" wide). It appears I need a wider collar since I have a long neck.
Do you have any guidance on the settings for trigger and cycle on the Resmed S-9? I set them according to what feels most comfortable, but don't know if that impacts AHI.
This is the first time that a knowledgable person has looks that the Oscar data on my machine. When I took it to my sleep clinic provider two years ago, they were dismissive and condescending and appalled that I was changing the settings. So I am grateful for your assistance.
I sometimes have people change trigger or cycle sensitivity or time to address specific issues. None seem applicable here, so you can try alternative settings and see what is most comfortable as you have done. We usually increase trigger sensitivity when centrals are present, There is rarely a need to change cycle sensitivity, We increase Ti Min when a user has very weak or irregular inspiration to encourage the machine to maintain IPAP and not cycle when inspiration is hesitant. Ti Max is frequently moved to between 2 and 3 seconds if a user complains that the machine is "cutting off" inspiration.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Since making the changes you suggested on 3/9, AHI has dropped to average 1.0 (from 30 day average of 5.0). Yay. Recent data attached.
How/where are centrals indicated on a chart?
Although I'm on VPAP Auto, the pressure holds steady at max setting 9.8. Is that because the machine would otherwise increase IPAP?
I think we wil consider that a success, and it reveals a need for higher EPAP pressure. You are using PS 3.8 with EPAP min 6.0 and IPAP max 9.8, so I'll hope to ge thtis math correct. I'd like to see EPAP min 6.6 with PS 3.8 and IPAP 10.4. We could do this with S-mode if you prefer fixed pressure.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
