Fired My Sleep Doctor

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Paper_Nanny
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Re: Fired My Sleep Doctor

Post by Paper_Nanny » Wed Apr 26, 2017 12:15 am

palerider wrote:if you feel like trying it, set the minps to either 2 or 3 tonight, and see if that makes a difference.
Already set that way last night. Current settings, as you suggested in a previous post are:
maxpres 25
epap min 7
epap max 15
ps min 1
ps max 18
please clarify something for me, you felt better before, or after the backup rate was changed to auto? and when it was changed to auto, the number of timed breaths increased greatly?
My surgery was on 12/13. Pre-surgery, backup rate on 5, felt good. Between 12/13 and 3/20, back up rate on 5, felt awful. 3/21 to present, backup rate on auto, still feel awful.

When it was changed to auto, the number of timed breaths shot way, way up.

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Jasba64
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Re: Fired My Sleep Doctor

Post by Jasba64 » Wed Apr 26, 2017 4:21 am

A hypopnea is shallow breathing. I didn't know you can correct it. What do you do to correct that?

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Julie
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Re: Fired My Sleep Doctor

Post by Julie » Wed Apr 26, 2017 5:55 am

Cpap.

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Jasba64
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Re: Fired My Sleep Doctor

Post by Jasba64 » Wed Apr 26, 2017 7:00 am

I use Cpap and never have no SleepyHead findings. I have a few RERA's, OA' and CA's every night. My AHI is always below 5 but does anyone have ZERO events, ever?

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Re: Fired My Sleep Doctor

Post by Guest » Wed Apr 26, 2017 7:19 am

Jasba64 wrote:My AHI is always below 5 but does anyone have ZERO events, ever?
*Waves hands* ... I do, I do

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Re: Fired My Sleep Doctor

Post by DreamStalker » Wed Apr 26, 2017 7:24 am

Jasba64 wrote:I use Cpap and never have no SleepyHead findings. I have a few RERA's, OA' and CA's every night. My AHI is always below 5 but does anyone have ZERO events, ever?
I've been getting an average of about 3 ZERO event nights per week for the last 10 years. I attribute it mostly to having a leak-free fitting mask ... IMO, a leak-free mask fit is the key to finding the optimal CPAP pressure settings and consequently, optimal CPAP therapy.
President-pretender, J. Biden, said "the DNC has built the largest voter fraud organization in US history". Too bad they didn’t build the smartest voter fraud organization and got caught.

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Jasba64
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Re: Fired My Sleep Doctor

Post by Jasba64 » Wed Apr 26, 2017 9:37 am

I use a full face mask and that currently being a Mirage Quattro. I have no leaks from the data SleepyHead shows.

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palerider
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Re: Fired My Sleep Doctor

Post by palerider » Wed Apr 26, 2017 9:42 am

Paper_Nanny wrote:
palerider wrote:if you feel like trying it, set the minps to either 2 or 3 tonight, and see if that makes a difference.
Already set that way last night. Current settings, as you suggested in a previous post are:
maxpres 25
epap min 7
epap max 15
ps min 1
ps max 18
yes, but what I just suggested was raising the ps min to two or three.
Paper_Nanny wrote:
please clarify something for me, you felt better before, or after the backup rate was changed to auto? and when it was changed to auto, the number of timed breaths increased greatly?
My surgery was on 12/13. Pre-surgery, backup rate on 5, felt good. Between 12/13 and 3/20, back up rate on 5, felt awful. 3/21 to present, backup rate on auto, still feel awful.

When it was changed to auto, the number of timed breaths shot way, way up.
so, the number of timed breaths doesn't make any difference. if it had, I'd have suggested going from auto back to something like 8.

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Paper_Nanny
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Re: Fired My Sleep Doctor

Post by Paper_Nanny » Wed Apr 26, 2017 1:06 pm

palerider wrote:yes, but what I just suggested was raising the ps min to two or three.
Ugh!! I'm sorry. I am usually not quite so daft. That wasn't the first time I have replied in a way that makes me cringe when I have read it later. I appreciate your patience.
so, the number of timed breaths doesn't make any difference. if it had, I'd have suggested going from auto back to something like 8.
I don't know... I wouldn't eliminate it as a possibility. The number of patient triggered breaths goes down and in the past, that had mattered. Maybe there is so much other mess in my sleeping right now that the significance of the timed breaths is being obscured by other factors. Maybe once the other things are straightened out, the timed breaths/ patient triggered breaths will turn out to be a factor.

Or maybe I am grasping at straws, because I keep hearing a little voice in my head telling me this is never going to get better and I am destined to live the rest of my life fighting through this fog of exhaustion. I do tell that voice to hush up, but sometimes, I don't. Sometimes I sit and listen and believe that voice and I make myself cry.

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Paper_Nanny
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Re: Fired My Sleep Doctor

Post by Paper_Nanny » Wed Apr 26, 2017 1:48 pm

I am confused by the mask leak information from last night. On the Sleepyhead welcome screen, it says, "You had significant periods of major mask leakage." But on the graphs, it looks like it was under and hour, and on the left side, it says major leaks were at 0%. So, all that seems contradictory. Can someone help me make sense of that?

After about 4:00, the pressure lines on the graph look really flat and I was having one hypopnea after another. I would have expected that the pressure lines would change in order to treat those, but that doesn't seem to be happening. Why? (I think this is similar to the question robysue asked -- Tue Apr 25, 2017 2:02 pm.)

I am posting two different screen shots from last night. The differences are what is showing on the left side and Patient Triggered Breaths vs Leak Rate. Let me know if there is anything else that would be useful to see.

Image


Image

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palerider
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Re: Fired My Sleep Doctor

Post by palerider » Wed Apr 26, 2017 2:02 pm

Paper_Nanny wrote:I am confused by the mask leak information from last night. On the Sleepyhead welcome screen, it says, "You had significant periods of major mask leakage." But on the graphs, it looks like it was under and hour, and on the left side, it says major leaks were at 0%. So, all that seems contradictory. Can someone help me make sense of that
Sleepyhead is wrong, it's making guesses based on resmed parameters. There is a menu option to turn off the ”leak redline”, you should do that.

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raisedfist
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Re: Fired My Sleep Doctor

Post by raisedfist » Wed Apr 26, 2017 7:08 pm

I'm not too familiar with ASV, but it looks that while your obstructive apneas are under control, your hypopneas are not, even with opening up the settings more. Generally, IPAP is usually what is increased for hypopneas and flow limitions (sometimes EPAP can be helpful depending on the situation). For whatever reason it doesn't seem that your machine is responding very well to events when they happen.

If it were me I would trial a higher PS min - say 4cmh2o. According to the link below (pardon my complete lack of knowledge regarding M.S.), some people with M.S. experience weakness with the breathing muscles and need help with ventilation (especially at night). This is largely done by PS (IPAP - EPAP) because the EPAP keeps your airway open and the IPAP helps your muscles rest by assisting with breathing and getting air in for gas exchange.

Note: I may be completely off track with your actual needs/problems, but it could potentially be helpful and I don't claim to be an expert.

http://www.nationalmssociety.org/Sympto ... g-Problems

For Respironics, their titration guide recommends the following starting point for ASV:

EPAP Min: 4
EPAP Max: 15
PS Min: 0
PS Max: 20
Max IPAP: 25
Rate: Auto

If you experience obstructive apneas: increase EPAP
If you experience central apneas: increase PS max

If you experience an inadequate breathing rate on Auto mode: Set fixed rate of 8 - 10bpm, or 2bpm below spontaneous rate. Then set inspiratory time of 1.5 seconds.


https://www.sleepapnea.com/downloads/10 ... fGuide.pdf

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Paper_Nanny
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Re: Fired My Sleep Doctor

Post by Paper_Nanny » Wed Apr 26, 2017 10:54 pm

raisedfist wrote:For whatever reason it doesn't seem that your machine is responding very well to events when they happen.
Is it possible the machine is getting worn out? I don't know what the lifespan is on the machines, but I have had mine for six years, I have my machine almost every night during that time, and for at least 8- 9 hours on most nights.
If it were me I would trial a higher PS min - say 4cmh2o.
Yup, that is tonight's adventure!!
some people with M.S. experience weakness with the breathing muscles and need help with ventilation (especially at night).
Muscle weakness secondary to the ms itself is definitely possible. Could also be secondary to the changes in the medication which were made during the surgery in December. MS can also cause central apnea, as could the medication.

Note: I may be completely off track with your actual needs/problems, but it could potentially be helpful and I don't claim to be an expert.
Thank you...

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Re: Fired My Sleep Doctor

Post by Paper_Nanny » Thu Apr 27, 2017 9:43 pm

This is the graph from last night. Settings are: Max pres= 25; EPAP min= 7; EPAP max= 15; PS min= 3; PS max= 18. The PS min had been at 1. AHI of 14.27 was slightly better than 22.27 the night before. Still not good, though. And I am still so exhausted.

Image

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Julie
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Re: Fired My Sleep Doctor

Post by Julie » Thu Apr 27, 2017 9:45 pm

Oh my, your machine is definitely due for replacement (but do keep the old one for a back-up). Most insce. co's replace at 5 yrs, and you should talk to yours about that.