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RE: Please help with treatment review - DaveL - 11-30-2021
sheepless
I have 2 where max=19.0 Here's screenshot for 6 Sept 2020
Counting roughly I have 5 where max pressure is in the 18's
Perhaps 10 where max pressure is in the 17's
Same day min=15.0
Shall I keep max at 19? Increase min to 15.0? Keep EPR at 2?
Dave
RE: Please help with treatment review - sheepless - 12-01-2021
Dave, I really don't know what to tell you.
the last screenshot was from a year ago so things might have changed since then. I'm surprised to see such good results with higher min pressure. not much in the way of leaks and ca. you might as well try min 15 epr 2 again to see if you can re-create those results.
the one thing that looks to be consistent is that you had and still have persistent low level flow limitations. eyeballing your 11/26/21 and 9/6/20 charts, there isn't the clear relationship between pressure and flow limitations I thought we might see but there does appear to be a correlation between flow limitations and leaks. the best apap tool for flow limitations is epr. do you usually have more ca at epr 3? you could try epr 3 with a lower max pressure hoping to see a reduction in flow limitations without much increase in ca. if you try this, you should also try raising your min to correspond to increased epr. if ca gets too high, you might have to accept these mild but persistent flow limitations and keep epr at 2. some folks bothered by flow limitations have moved to vauto, usually self-funded I think, for sufficient pressure support to better treat them out.
5 years in, I've made great progress but I can't declare success. more knowledgeable members can probably guide you better.
meanwhile, if it was me, I'd start over by going to cpap mode, epr off. you can start as low as you think you can go and work your way up until oa are as low as you can get them or start high at, say, 15 or 16 cmw and work your way down until you see a lot of oa, then go back up until they get to an acceptable level. monitor what happens to flow limitations, leaks, ca and how you feel at each stage.
once you find your best fixed setting for oa, reevaluate based on what happened to flow limitations, leaks and ca. your best fixed setting will be, or will be close to, what you want to maintain for epap to control oa. if exhaling and/or flow limitations bother you, introduce epr at 1, bumping to 2 then 3. for every epr increment, increase your fixed pressure by the same. choose what feels best. we can decide later what to do if ca increases depending on what your obstructive apnea/hypopnea and flow limitations look like and how you feel. depending on how things look, you can reintroduce and experiment with min/max ranges.
leaks seem to be a current, maybe recurring problem for you and may be a cause of arousals. fragmentation is a big, big issue for me. after plm, I think leaks are the main cause of my awakenings. a while back I had an inexplicable and unacceptable rise in lip leaks. the only thing that works at all for me is a collar and that wasn't enough so I reduced pressure until my leaks returned to a more acceptable level, accepting higher ahi for the time being, then slowly worked my pressure back up. idk if that strategy worked or other unknown factors changed over time that helped, but either way, it worked. titrating as described above might tell us something about your leaks as well.
it would be useful to note when you wake up. masking off for at least a minute is one way. spiking a significantly larger breath than usual, speaking to a voice activated audio recorder and video are other options. then you can review in oscar the minutes preceding awakenings looking for clues to what's waking you. if no clues, you'll have to look for other causes. sleep hygiene stuff, environmental factors like temp, noise, etc., other health issues, meds/food/drink/stress, etc.
I've tried a huge range of settings on apap, vauto and asv. I've noticed that I can get similar results, give or take, good and bad, at both lower and higher pressures. I've never understood that. but the best settings are the lowest that achieve the results we want. raising pressure isn't always the best strategy. you've been doing this a long time so you may already know what your pressure tolerances and results are but I mention this hoping you can get reasonable results at lower pressure that should ease your leaks and ca and possibly allow you to tolerate epr 3.
as you know, titration is trial and error. it's probably second nature for you as an engineer: if you choose to tinker, do it systematically and keep notes relating your observations and impressions to results.
RE: Please help with treatment review - SarcasticDave94 - 12-01-2021
If things have stayed the same from September 2020, I'd rather think you'd do better on the BPAP ResMed VAuto with the flow limits as they are and with high PAP therapy pressures. With higher range to be had on PS than the 3 in EPR, it may get you better therapy results and be more comfortable too.
RE: Please help with treatment review - DaveL - 12-02-2021
Thanks sheepless. Thanks Dave.
I reviewed pressure for every day since I got the apap and set it up.
My sleep study prescription was 13 with a comment. I had been 11 for years (Dr Inyoue prescribed that.)
Dr, Awad said that 11 would be sufficient. However, he prescribed 13 saying that my sleep quality would improve. He wrote the Rx for the CPAP unit, and I specified the S10 *for her* as suggested here. He approved that writing an RX for CPAP, 13 cm H two O
The DME objected and said they would rather sell a cpap; I refused. They said it would be delivered setup as a cpap. So I got my S10 *for her*. I used it as a cpap until I got the clinician's manual.
Summary of Max Pressures on APAP.
Only 2 occasions where P=19 (trivial.)
I only had two occurrences where P(max) = 19 as shown on daily report
Approximately 80 % of the days had P(max) 15.5 or less
Approximately 20 % of the days had P(max) between 15.5 and 17
Increase P(min) from 13.4 up to 15 and watch what happens....
Question:
As a first trial--I would like to adjust P(max) down from 19 to 17 and watch what happens...for several weeks. (See if I bounce the needle off the peg...)
I would like to adjust p(min) up from 13.4 to 15 and watch what happens. During that period I would like to Leave EPR=2 then increase to 3....
Does this make sense?
Finally, Dave if I see my Sleep Doc He'll require a sleep study. Two things will happen.
1. He will prescribe a full face mask; I can't wear that.
2. He will prescribe a CPAP only. In Ontario Canada I've been told for over 30 years that my condition requires a CPAP; not any other machine.
Thanks for your suggestions.
DaveL
RE: Please help with treatment review - Gideon - 12-02-2021
DaveL, you are in luck. Ontario Med has (mis)declared the ResMed AirSense 10 AutoSet for Her ans a CPAP, not an APAP. INSIST on THIS machine.
RE: Please help with treatment review - DaveL - 12-02-2021
I've reviewed my pressures during the time I've used my machine. It's an S10 *for her* that's about 1-1/2 years old.
MY pressures are 19 (max) and 13.4 (min) with EPR=2.
Leakage is an issue.
I use a pad I made myself, that fits under my jaw.
Or I use a Knightsbridge Dual Band. I have a love/hate relationship with that.
I wake up at least 3 times during the night. I sleep very poorly. I get up once a night for a short walk.
I'm tired as a son of a gun. I fall asleep at the drop of a hat at home. Not when I'm driving. Brain Fog.
I want to improve sleep quality and well-being.
Would it help to reduce max pressure? Increase Min Pressure? Change EPR?
Here's what I posted before....
Summary of Max Pressures on APAP.
Only 2 occasions where P=19 (trivial.)
I only had two occurrences where P(max) = 19 as shown on daily report
Approximately 80 % of the days had P(max) 15.5 or less
Approximately 20 % of the days had P(max) between 15.5 and 17
Increase P(min) from 13.4 up to 15 and watch what happens....
Question:
As a first trial--I would like to adjust P(max) down from 19 to 17 and watch what happens...for several weeks. (See if I bounce the needle off the peg...)
I would like to adjust p(min) up from 13.4 to 15 and watch what happens. During that period I would like to Leave EPR=2 then increase to 3....
RE: Please help with treatment review - sheepless - 12-02-2021
"I've been told for over 30 years that my condition requires a CPAP"
that may be incompetence or you may actually do better with fixed pressure. your recent charts suggest you've had some ca, not high, like above 5/hr, but fixed pressure might keep those down. another reason to try re-titrating as I described above. meanwhile:
"Does this make sense?"
sure. good place to start. learn from trial and error. it's the only way.
while good idea to give each setting change some time, several weeks is probably longer than necessary. it's my understanding they adjust pressure in the sleep lab within 5 to 20 minutes! sometimes you can tell right off if something's working or not. if not, a couple days to a week should be more than enough. whatever you're comfortable with.
keep us posted.
RE: Please help with treatment review - DaveL - 12-02-2021
Thanks Dave, Gideon & Sheepless.
I'll go adjust my P(max) to 17 (from 19)
I'll go adjust my P(min) to 15 from 13.4)
I'll keep EPR at 2 for a couple of days then increase to 3...
And see what happens.
Dave
I woke up feeling rested! - DaveL - 12-03-2021
That's happened about 10 times in almost 35 years of treatment!
What a wonderful feeling!
I downloaded my S10 *for her* SD card at home. I had huge problems with leakage. I need to solve that.
I checked my sleep report--AutoSleep--on my iWatch 6. Wow. I usually wake up a minimum of 3 times a night. Last night I woke up once. Same mask (ResMed N20). Same machine, but with different settings. And used my home-made pad under my chin. (that's the problem. It's not working as it should.)
Tonight I shall use tape. Let's see if I do it right and stop lip leakage. I really need new tape....
DaveL
RE: Please help with treatment review - sheepless - 12-03-2021
great news! fingers crossed it continues. show us your oscar chart when you get a chance.