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+--- Thread: Room for improvement? (/Thread-Room-for-improvement)
Room for improvement? - rabidhamster - 11-12-2022
Hey all, first time poster, so I hope I've remembered the forum rules. I got diagnosed back in June, picked up a used S9 in July, and finally got my first DME provided machine, an S11 AutoSet about a month ago. First of all, I am feeling a *lot* better!
But as I'd imagine a fair few people here have experienced, most of the coaching I've gotten about this condition has centered around compliance with insurance and the DME, with very little about actually improving my quality of life. I was wondering if anyone here could give me a sanity-check? I've attached the OSCAR screenshot below, and also can provide a sleepHQ share link if it would help to look more closely at the data.
They have me set at 5-15cm. I'm using a heated tube, and humidity set at 5, because any higher causes fluid buildup in the tube. I wouldn't mind more humidity, but this seems to be the highest I can go without problems.
RE: Room for improvement? - Gogirl - 11-13-2022
You can always raise the humidity and get a tube hanger. That will take care of the hose rainout. Worked for me. Lots to choose from online.
RE: Room for improvement? - Sleeprider - 11-13-2022
Hey Hampster, your pressure is all over the place, and it's because your machine is detecting flow limits. Let me know if you need more details, but flow limitation is basically the result of inspiratory flow obstruction that is not quite obstructive apnea or hypopnea, but it frankly sucks for sleep integrity because it leads to persistent arousals. Let's do this...minimum pressure 8.0, Maximum pressure 12.0 and EPR full-time setting 3. Try it and you will wonder why therapy suddenly works so well and is more comfortable. You may even drop the "rabid" from your user name.
RE: Room for improvement? - rabidhamster - 11-13-2022
Oh man, thank you so much for taking a look and giving advice! This is literally more personalized advice than I've been given by my doctors, DME, and insurance combined.
I've already punched the settings in, and will let you know how it went!
RE: Room for improvement? - Sleeprider - 11-14-2022
Looking forward to hearing about your results with the revised settings.
RE: Room for improvement? - rabidhamster - 11-14-2022
Sorry for the late reply! The results are a bit mixed, as you can see from the graph. Interesting to me is that I woke up at one point with no preceding apneas, which is new! Still slightly elevated AHI, but still just glad to be trying something new.
RE: Room for improvement? - Sleeprider - 11-15-2022
Apnea are clustered which strongly suggests positional apnea, or chin-tucking. This is very common and can often be addressed by using fewer pillows or adjusting sleep to avoid chin-tucking. Here are a couple wikis that talk about it and show examples of how this problem can be addressed.
Positional Apnea http://www.apneaboard.com/wiki/index.php/Optimizing_therapy#Positional_Apnea
Soft Cervical Collar. http://www.apneaboard.com/wiki/index.php?title=Soft_Cervical_Collar
You are not using EPR! Please revise settings to turn EPR on, full-time at 3.
RE: Room for improvement? - rabidhamster - 11-15-2022
Oh man, thanks for taking another look! And yes, I did recently change my pillow situation to be a bit higher, and I *think* I woke up today with my chin tucked in, so I'll lower the position again, and see if that works.
And oh my god, I totally missed the EPR setting. I'll give it a go, and report back!
Thank you again for your time and help.
RE: Room for improvement? - rabidhamster - 11-21-2022
So I've been experimenting a bit. Not sure I have the head positioning/pillow down, but I *have* seen a marked improvement in AHIs, and have even been able to get out of bed almost an hour earlier than usual this whole week! So DEFINITELY heading in the right direction!
I've got a few more days worth of graphs. Still seeing flow restrictions. Still head tucking, you think?
RE: Room for improvement? - Sleeprider - 11-22-2022
Looks like really good improvements. You may want to try increasing minimum pressure to 9.0 to see if it can stabilize your pressure and apnea. That will start therapy at 9.0/6.0 pressure which is certainly reasonable.