Question Pugsy

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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fdw
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Re: Question Pugsy

Post by fdw » Fri Aug 29, 2014 3:32 pm

Agreed, it would be to my advantage......however Im in a routine as to where I lye down on the coach to watch some TV and end up falling asleep. Sometimes it's 15 minutes and others an hour, when I do go to bed Im really relaxed and fall asleep almost right away. The problem is after around 6 hours in bed I wake and 95% of the time stay awake.

Im checking something right now about EPR and min/max pressure settings in AutoSet.

My prescription for CPAP is 13.0, and my current setup for the S9 AutoSet is: Start 6.0----Min 8.2---Max 15.0--- EPR 3.
Shouldn't my settings be more like: Start 6.0----Min 10.0---Max 15.0---EPR 2 ??????


The machine replace was a S8 Vantage (7.5 yrs old), the S9 AutoSet has only been in use for a short time <1 week.
ResMed AirSense S10 Autoset (Ins. Pur. 3/16/2016)
AutoCPAP 10-15 EPR 1.0 (Latest Sleep Study 3-7-16)
Started CPAP March 1995 with a pressure of 11.0

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archangle
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Re: Question Pugsy

Post by archangle » Fri Aug 29, 2014 4:06 pm

It's funny. My blurry eyes and blurred mind read this as "Operation Pugsy." An interesting concept. Maybe we should rename the board.

Let me once again applaud Pugsy for her help and patience.

fdw, I'll agree that your numbers do look good.

However, if you feel like tinkering, you might want to start increasing your minimum pressure and see how you feel. You can always drop it back later.

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palerider
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Re: Question Pugsy

Post by palerider » Fri Aug 29, 2014 4:13 pm

fdw wrote: Im checking something right now about EPR and min/max pressure settings in AutoSet.

My prescription for CPAP is 13.0, and my current setup for the S9 AutoSet is: Start 6.0----Min 8.2---Max 15.0--- EPR 3.
Shouldn't my settings be more like: Start 6.0----Min 10.0---Max 15.0---EPR 2 ??????
epr reduces the baseline pressure by that much, so your start is really 4, min 5.2, max 12 with up to 3cm boost on inhale.

raising your min would likely be good, and the idea of lowering your epr is good, if it's comfortable for you. (some people like it, some don't, some like it at first and decide they don't need it so much later.)

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Pugsy
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Re: Question Pugsy

Post by Pugsy » Fri Aug 29, 2014 4:26 pm

fdw wrote:My prescription for CPAP is 13.0, and my current setup for the S9 AutoSet is: Start 6.0----Min 8.2---Max 15.0--- EPR 3.
Shouldn't my settings be more like: Start 6.0----Min 10.0---Max 15.0---EPR 2 ??????
I don't understand Start 6.0 and then Min 8.2 unless you are talking about ramp starting at 6 and working up to 8.2.
Ramp doesn't count as the real minimum. I don't count ramp pressures when I consider pressure needs.

When you say minimum of 6 I assume that is the minimum for the entire night. I see you are using ramp and that's not a problem but once it goes to the minimum pressure that's the main pressure.

If you want to change from 8.2 to 10.0 minimum I would leave EPR at 3....I don't recommend 2 changes at one time.
Or leave it at 8.2 and change EPR 2.
fdw wrote:Im hoping once the MAGIC number is achieved in APAP and I could get 7-8 hours of sleep I would feel much better, I think Im close.....I've only been on APAP for a week with the S9 AutoSet.
You know there's a lot of truth to "give it time". Those people that have the overnight miracle are in a small minority.

Oh...there's no magic number. that works all the time. We don't sleep the same each night. Too many other things mess with our sleep and the machine is limited as to what it can fix. Best we can hope for is to come up with a number that gets us close most of the time.
fdw wrote:How long does it take the body/mind to get use to the APAP over CPAP (once the settings are spot on or near)?
not sure I understand the question. Someone that used cpap mode for many years at 13...heck even if you just went to cpap mode at 8 right now it would be a big change. Some people might not ever get adjusted to having the variable pressures. Your pressure needs aren't all over the place though.
Are you uncomfortable when you turn the machine on? Is that what your question is? Maybe it's the starting pressure difference that seems to need some adjustment to.

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fdw
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Re: Question Pugsy

Post by fdw » Sat Aug 30, 2014 6:11 am

I don't understand Start 6.0 and then Min 8.2 unless you are talking about ramp starting at 6 and working up to 8.2.
Ramp doesn't count as the real minimum. I don't count ramp pressures when I consider pressure needs.
In the settings of the Machine there is a START pressure, MINIMUM Pressure, and MAX pressure settings
When you say minimum of 6 I assume that is the minimum for the entire night. I see you are using ramp and that's not a problem but once it goes to the minimum pressure that's the main pressure.
No, I mean that's what the Machine starts out at.
If you want to change from 8.2 to 10.0 minimum I would leave EPR at 3....I don't recommend 2 changes at one time.
Or leave it at 8.2 and change EPR 2.
I understand what your saying here...now
You know there's a lot of truth to "give it time". Those people that have the overnight miracle are in a small minority.
I really hope Im one of those....but know I'd be in the minority. I've been screwed up for so long I just need support from this forum to get as close as possible. I have talked to my physician (8-27-14) and he's having a re-titration scheduled. In years PASSED my insurance did NOT cover any CPAP/RE-Titration until this plan year. So I've purchased my own supplies and equipment on my own including my NEW S9 AutoSet
Oh...there's no magic number. that works all the time. We don't sleep the same each night. Too many other things mess with our sleep and the machine is limited as to what it can fix. Best we can hope for is to come up with a number that gets us close most of the time.


Yes, I realize. I should re-frase to as close to therapy as possible
not sure I understand the question. Someone that used cpap mode for many years at 13...heck even if you just went to cpap mode at 8 right now it would be a big change. Some people might not ever get adjusted to having the variable pressures. Your pressure needs aren't all over the place though.
Are you uncomfortable when you turn the machine on? Is that what your question is? Maybe it's the starting pressure difference that seems to need some adjustment to
I had the understanding the starting pressure was the pressure the machine actually started out at, and the MINIMUM pressure was once RAMP time was fulfilled then the Machine would not go below that MINMUM pressure and in my case Start pressure is set to 6.0, Minimum pressure is set to 9.2, and the Maximin pressure is set to 15.0

Here is a picture of las nights graph. I know you don't really look at AHI but last night the AHI was 0.82. That's down nearly 50% from the previous nights of 1.68
The Flow Limits are a little higher last night though, and not sure how that's interrupted.
Anyway I really, really appreciate your comments and suggestions.

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ResMed AirSense S10 Autoset (Ins. Pur. 3/16/2016)
AutoCPAP 10-15 EPR 1.0 (Latest Sleep Study 3-7-16)
Started CPAP March 1995 with a pressure of 11.0

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Pugsy
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Re: Question Pugsy

Post by Pugsy » Sat Aug 30, 2014 8:35 am

The flow limitation graph isn't horribly horrible by any means. It's hard to determine just how much of a factor in good sleep quality that flow limitation graph is. It's more of a go by how you feel thing than go by what you see thing but here's and example of my Flow limitation graph from back when I was using the S9 VPAP.
Image

Image

I understand now what you mean about the 2 minimum pressures thing. You are counting the minimum pressure that the ramp is set to start with.

Regarding the drop in AHI....you know there are some people who are able to tell a significant difference in how they feel with drops like you have had. Statistically there really isn't all that much difference between AHI of 1.4 vs 0.7 but it isn't impossible for someone to feel markedly better with the lower AHI.

I don't know if your Flow limitations are a factor in how you feel or not. Again it wouldn't be impossible. If you want to consider trying to reduce the FLs a little more....a small increase in the minimum pressure is what would be done. This would be the minimum pressure after ramp is finished and not the 6 cm starting ramp pressure. Just a little more base pressure for the bulk of the night.

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fdw
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Re: Question Pugsy

Post by fdw » Sat Aug 30, 2014 9:05 am

Extremely valuable information and guidance. I think for tonight I'll raise the MINIMUM from 9.2 to 9.6 and leave it there for several nights to see how I feel.

Would you think a 0.4 increase in the MINIMUM to aggressive?

BTW, today is the best I've felt in many weeks.....so I think Im really almost there.


Pugsy you are a true gem.....really!
ResMed AirSense S10 Autoset (Ins. Pur. 3/16/2016)
AutoCPAP 10-15 EPR 1.0 (Latest Sleep Study 3-7-16)
Started CPAP March 1995 with a pressure of 11.0

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Pugsy
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Re: Question Pugsy

Post by Pugsy » Sat Aug 30, 2014 9:11 am

fdw wrote:Would you think a 0.4 increase in the MINIMUM to aggressive?
No, not at all. Your machine will do 0.2 cm increments but did you know that the Respironics machines don't offer anything less than 0.5 cm?

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fdw
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Re: Question Pugsy

Post by fdw » Sun Aug 31, 2014 7:02 am

Pugsy wrote:
fdw wrote:Would you think a 0.4 increase in the MINIMUM to aggressive?
No, not at all. Your machine will do 0.2 cm increments but did you know that the Respironics machines don't offer anything less than 0.5 cm?
Looks like my AHI increased slightly nothing to complain about.....don't want to tinker much more. My OA's increased but zero's on everything else, and I feel just as good this morning as yesterday. Anyway have a look at lasts nights results and tell me what you think.

BTW, there's a pattern Im starting to see that around the 3.5-4.5 sleep Im having 2 OA's really close together.....Any ideas why???????

Thanks

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ResMed AirSense S10 Autoset (Ins. Pur. 3/16/2016)
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Started CPAP March 1995 with a pressure of 11.0

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Pugsy
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Re: Question Pugsy

Post by Pugsy » Sun Aug 31, 2014 7:30 am

fdw wrote:BTW, there's a pattern Im starting to see that around the 3.5-4.5 sleep Im having 2 OA's really close together.....Any ideas why???????
Either supine sleeping or REM stage sleep.
Good chance it is REM stage sleep because it's common for our OSA to be worse during REM sleep.
During those wee hours of the morning is when we have more REM sleep so the chances to have the airway tend to collapse a little more will increase
See the hypnogram here
http://en.wikipedia.org/wiki/Sleep

Don't be alarmed when your AHI varies from night to night. We don't sleep the same each night.
Such a small difference that you had last night is statistically irrelevant.

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fdw
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Re: Question Pugsy

Post by fdw » Mon Sep 01, 2014 8:23 am

Pugsy,

I want to again express my extreme gratitude for your valuable input.

I did change my EPR last night from 2 to 1 and everything still looks good to me....filling (starting too) good.

Only question is the leak rate is higher, would that be from lowering the EPR?

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AutoCPAP 10-15 EPR 1.0 (Latest Sleep Study 3-7-16)
Started CPAP March 1995 with a pressure of 11.0

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Pugsy
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Re: Question Pugsy

Post by Pugsy » Mon Sep 01, 2014 8:27 am

That leak line looks very suspicious for mouth breathing. Is your mouth uncovered? Still using the nasal cushion mask? It's low level though. Still within the machine's ability to compensate. I see similar plateaus when I mouth breathe.

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fdw
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Re: Question Pugsy

Post by fdw » Mon Sep 01, 2014 9:17 am

Pugsy wrote:That leak line looks very suspicious for mouth breathing. Is your mouth uncovered? Still using the nasal cushion mask? It's low level though. Still within the machine's ability to compensate. I see similar plateaus when I mouth breathe.
I wear a chin strap plus I use a soft pillow to tuck under my chin to help keep my mouth closed. Yes, I still use the same mask. 99% of the time I wake in the same position I fall asleep in, sometimes I wake with a dry mouth, this morning I did not.

The reason I ask is last night the over RED line was 3.10% with a EPR setting of 1. The last 5 nights the over RED line was <0.03% and the EPR range 2-3.
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Re: Question Pugsy

Post by Pugsy » Mon Sep 01, 2014 9:54 am

I wouldn't worry about that tiny amount of leak over the red line.
Not quite 15 minutes total over 7 1/2 hours. I have ignored more and bigger:lol: As long as the leaks don't wake me up and they don't last long in large leak territory I don't really care.

A chin strap or pillow or whatever isn't going to totally prevent mouth opening.
They will help major mouth/jaw drop but you can still open your lips and breathe in and out even if your jaws are clenched together.

No matter what the cause...it's not prolonged and while not the prettiest of leak graphs...still within acceptable limits for the most part as long as it doesn't disturb sleep IMHO.

When I get leak lines like the above...I suspect mouth breathing but I also suspect that perhaps the mask is getting tired and leaking.
That's when I give the nasal pillows a really good washing. So far it has fixed it every time. I don't know for sure if it was mouth breathing or just tired nasal pillows. Coincidence? Possibly. I had 14 % over red line the other day for 2 days in a row. Pretty ugly leak line all the way around so I decided to wash the nasal pillows just in case. The next night was below 1% time over red line.

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Re: Question Pugsy

Post by fdw » Mon Sep 01, 2014 3:01 pm

I wash my mask every day with soap and water and replace the mask every 2 months. The one Im on now is right at 6 weeks old.

I've tried full face mask and can't handle the dry mouth at ALL. In the very early years (late 90's) I used duct tape a few times until I found out it wasn't very healthy.
ResMed AirSense S10 Autoset (Ins. Pur. 3/16/2016)
AutoCPAP 10-15 EPR 1.0 (Latest Sleep Study 3-7-16)
Started CPAP March 1995 with a pressure of 11.0