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Optimizing treatment - sleepingsleepy - 03-12-2023
Hello there!
I have been using CPAP for about 6 years now and even though CPAP treatment
has helped alot I still feel like there is room for improvement regarding fatigue, energy levels and
cognitive symptoms.
I was wondering if anyone with more expertise than my self could evaluate my charts.
I have attached charts from 1 night with a little better than average results.
My average ahi over the last year is 4.58. I guess this would be considered acceptable since it
is below 5 and maybe a further improvement wont be noticable at all but why not optimize if possible.
From what I've read some of the OA's look like they are positional?
Do you see any other possible issues?
Very interested to hear your opinions
RE: Optimizing treatment - Sleeprider - 03-12-2023
The example provided from February 1 shows you're using a Philips Respironics Dreamstation Auto at a wide range of pressure 4.0 to 18.0 at A-Flex level 3. Your median pressure is about 7.5 and 95th percentile pressure is 10.2 cm. Your apnea are expressed as clusters of obstructive events that typically arise with pressure less than 7.5.
These results suggest that there may be some positional issues at play (chin-tucking) due to the clustering of events, but definitely show your minimum pressure is too low. The Philips machines are especially slow to respond to obstructive cues and only rises after snores and obstructive events are already occurring. It's important that the minimum pressure be high enough to avoid this. My personal experience with these machines is that Flex levels of 1 and 2 are better than at 3 where I think they have sync problems. You might get away with these settings on a Resmed, but not this one. Finally, your machine is recalled and should be changed.
My recommendation for changes in settings is to use minimum pressure 8.0, maximum pressure 12.0, A-Flex or C-Flex at 2. Read our wiki about positional apnea in the Optimizing Therapy wiki here: http://www.apneaboard.com/wiki/index.php?title=Optimizing_therapy#Positional_Apnea If higher pressure alone does not cut your AHI in half then we can still look at some aids or mitigation measures for chin-tucking.
RE: Optimizing treatment - sleepingsleepy - 03-14-2023
Thank you for your reply. I really appreciate it.
I reached out to the clinic that issued the machine to get it swapped.
I tried to change settings on the machine but found out that the settings are locked. I wrote the clinic if they would be willing to unlock it.
I will try out your recommandations once they do.
I understand your point about the minimum pressure but wouldnt lowering of the maximum pressure possibly mean that the machine cant deliver the pressure needed? What are the pros of limiting the maximum pressure?
My 95 percentile pressure is on average a little higher than this example should I go with this maximum pressure instead of 12?
RE: Optimizing treatment - Sleeprider - 03-14-2023
Sleepingsleepy, do you have the setup manual, or have you tried this? https://www.apneaboard.com/dreamstation-clinician-setup-instructions
RE: Optimizing treatment - sleepingsleepy - 03-14-2023
Thanks. Now the settings for pressure min 8 - max12 and A-flex 2.
Excited to see how the charts will look now.
RE: Optimizing treatment - pilothaz - 03-14-2023
Good luck and hope you have great results. I have to setup and post my screens for optimization myself.