Maybe need a pressure increase?

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Pugsy
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Re: Maybe need a pressure increase?

Post by Pugsy » Sat Jan 06, 2018 9:37 am

Where do you see 13.5? I don't see it. I don't see anything circled.

I don't see a report from last night...just prior nights. Did you do the wrong link?

Can you look at the report examples shown in this thread and just do the graphs that are needed (don't need that AHI graph or the time at pressure graph).
viewtopic/t103468/Need-help-with-screen-shots.html
Hide the calendar and turn off the pie chart (Preferences/Appearance tab remove check mark for show pie chart).

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Re: Maybe need a pressure increase?

Post by Pugsy » Sat Jan 06, 2018 9:42 am

Okie bipap wrote:Perhaps the early morning cluster of CAs was SWJ. When my wife or I have this show up in the early morning, it usually happens when we are drifting in and out of sleep.
That's where I am leaning right now for what that ugly CA cluster might have been. If it happens again then maybe do the extra work to zoom in and try to see for sure if it looks like arousal breathing flags.

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Ruinednose
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Re: Maybe need a pressure increase?

Post by Ruinednose » Sat Jan 06, 2018 10:00 am

Pugsy wrote:Where do you see 13.5? I don't see it. I don't see anything circled.

I don't see a report from last night...just prior nights. Did you do the wrong link?

Can you look at the report examples shown in this thread and just do the graphs that are needed (don't need that AHI graph or the time at pressure graph).
viewtopic/t103468/Need-help-with-screen-shots.html
Hide the calendar and turn off the pie chart (Preferences/Appearance tab remove check mark for show pie chart).

I apologize here is the link I intended to send.

https://imgur.com/a/6EtP7

I didn't want to get rid of the pie graph because the info under it shows the pressure

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Pugsy
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Re: Maybe need a pressure increase?

Post by Pugsy » Sat Jan 06, 2018 10:16 am

The calendar and pie chart prevent the AHI and bar graphs and statistics from being easily seen in one image.
If you turn off the pie chart it does nothing to the statistics and information under the pie chart.

Your machine didn't go above 12 max IPAP or 8 EPAP max because it didn't feel the need to...it could have gone higher but didn't.
Part of that is the PS of 5 being available...it wanted to sit around 4 PS and that restricts the movement of the pressures to some extent.
It's just a coincidence that the EPAP max was 8 and IPAP max was 12.
If IPAP max had gone to 13.5 then most likely EPAP max would have been around 9.5 if the roughly 4 PS had held. Your PS has some room to roam around so it isn't always going to be a fixed number difference between EPAP and IPAP.

Actually a decent enough report last night...especially since you say you feel decent and feel like you slept decently. If me I might use these settings for a few nights and then try 1 cm more EPAP minimum to see if things clean up a little more but there's no urgent need to clean things up as long as you are sleeping good and feeling good.

The central clusters that you may see from time to time...I don't think they are real. I think that most likely they are SWJ breathing but if you see a CA cluster again we can do some extra work and zoom in on the flow rate to see what it looks like.

Here is a Respironics report in the format that I need to see for optimal evaluation.
See how clean it is and the basics are all there for easy viewing.

Image

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Ruinednose
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Re: Maybe need a pressure increase?

Post by Ruinednose » Sat Jan 06, 2018 10:27 am

Pugsy wrote:The calendar and pie chart prevent the AHI and bar graphs and statistics from being easily seen in one image.
If you turn off the pie chart it does nothing to the statistics and information under the pie chart.

Your machine didn't go above 12 max IPAP or 8 EPAP max because it didn't feel the need to...it could have gone higher but didn't.
Part of that is the PS of 5 being available...it wanted to sit around 4 PS and that restricts the movement of the pressures to some extent.
It's just a coincidence that the EPAP max was 8 and IPAP max was 12.
If IPAP max had gone to 13.5 then most likely EPAP max would have been around 9.5 if the roughly 4 PS had held. Your PS has some room to roam around so it isn't always going to be a fixed number difference between EPAP and IPAP.

Actually a decent enough report last night...especially since you say you feel decent and feel like you slept decently. If me I might use these settings for a few nights and then try 1 cm more EPAP minimum to see if things clean up a little more but there's no urgent need to clean things up as long as you are sleeping good and feeling good.

The central clusters that you may see from time to time...I don't think they are real. I think that most likely they are SWJ breathing but if you see a CA cluster again we can do some extra work and zoom in on the flow rate to see what it looks like.

Here is a Respironics report in the format that I need to see for optimal evaluation.
See how clean it is and the basics are all there for easy viewing.

Image

I think I've done it

https://imgur.com/a/iuHUP

Thank you again, so you suggest I increase the Min EPAP to 8? And leave the max IPaP to 13.5?

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Pugsy
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Re: Maybe need a pressure increase?

Post by Pugsy » Sat Jan 06, 2018 10:39 am

I would indeed increase EPAP to min 8 but I wouldn't limit IPAP max to 13.5 because there is pretty much no room for the machine to move around if it needs to move around. With your PS values that would mean essentially a 1.5 cm moving range. That's not much.

Why are you so afraid to let the machine increase the pressures? It won't do it without a good reason and from the looks of things I don't see it getting anywhere near the max.
Just because a machine can go somewhere doesn't mean it will and it doesn't affect the response time if it never goes there.

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Ruinednose
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Re: Maybe need a pressure increase?

Post by Ruinednose » Sat Jan 06, 2018 11:44 am

Pugsy wrote:I would indeed increase EPAP to min 8 but I wouldn't limit IPAP max to 13.5 because there is pretty much no room for the machine to move around if it needs to move around. With your PS values that would mean essentially a 1.5 cm moving range. That's not much.

Why are you so afraid to let the machine increase the pressures? It won't do it without a good reason and from the looks of things I don't see it getting anywhere near the max.
Just because a machine can go somewhere doesn't mean it will and it doesn't affect the response time if it never goes there.

I don't know why I'm afraid to do it, I still don't understand PS.

I've *heard* that too much pressure can create CA, but maybe I'm just dumb. I will increase the epap to 8 and iPap to 16 for starters?

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Re: Maybe need a pressure increase?

Post by Pugsy » Sat Jan 06, 2018 12:10 pm

Ruinednose wrote: I don't know why I'm afraid to do it, I still don't understand PS.
Took me a long time to understanding the roaming PS like you have on your machine in auto mode.
See if this helps. See what jnk says about the dance.
viewtopic.php?f=1&t=56581&p=531326&hilit=+dance#p531326
Ruinednose wrote: I've *heard* that too much pressure can create CA, but maybe I'm just dumb. I will increase the epap to 8 and iPap to 16 for starters?
What you heard is partially correct...too much pressure can cause centrals in some people but not all people.
Some people can get a truckload of centrals from 5 cm pressure...doesn't have to be a "high" pressure.
People get all freaked out over "centrals" and are afraid to treat the known problem (the obstructive sleep apnea stuff) because they "might" get centrals.
Well yeah...they "might" but they might not and if they do get too many centrals then it is fixable.
Why use sub optimal pressures because they "might" get centrals...not a smart idea. Fix the obstructive stuff as best you can with your machine and if centrals do pop up then we deal with them...but only deal with them when we have to ...don't use sub optimal pressures because you "might" have centrals pop up. You can just as easily not have any centrals pop up. I see pressures above 15 almost every night for part of the night and when using bilevel upwards of 22...and never any centrals to speak of.

Some centrals are normal...so don't freak out when you see a few here or there. Some are probably sleep onset centrals which are entirely normal. Some are probably a turn over in bed and hold your breath central. Hold your breath for 10 seconds...that's essentially a central apnea of 10 second duration...the airway is open but no air is moving.
Some central flagging...like your ugly cluster...I am not so sure they were even real. You don't seem to have them every night and they don't seem to be related to pressure (if they were you would have them all night every night) so I have my doubts as to whether they are even real or not.

Your OSA side of your therapy...a little sub optimal in the pressure settings and the obstructive stuff that was allowed to sneak past the defenses could very well be a factor in wake ups and thus increase the chance for SWJ central flags.
So my thoughts are "fix what we can fix with your machine" as best we can and then worry about centrals if they present themselves in numbers enough to warrant concern. Should that happen then we did deeper as to if they are real or not and cross the "what to do bridge" when/if we get to it.
Centrals are fixable if they require fixing but at this point I don't see you having enough centrals (that are real centrals) that will require fixing.

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Ruinednose
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Re: Maybe need a pressure increase?

Post by Ruinednose » Sat Jan 06, 2018 12:13 pm

Pugsy wrote:
Ruinednose wrote: I don't know why I'm afraid to do it, I still don't understand PS.
Took me a long time to understanding the roaming PS like you have on your machine in auto mode.
See if this helps. See what jnk says about the dance.
viewtopic.php?f=1&t=56581&p=531326&hilit=+dance#p531326
Ruinednose wrote: I've *heard* that too much pressure can create CA, but maybe I'm just dumb. I will increase the epap to 8 and iPap to 16 for starters?
What you heard is partially correct...too much pressure can cause centrals in some people but not all people.
Some people can get a truckload of centrals from 5 cm pressure...doesn't have to be a "high" pressure.
People get all freaked out over "centrals" and are afraid to treat the known problem (the obstructive sleep apnea stuff) because they "might" get centrals.
Well yeah...they "might" but they might not and if they do get too many centrals then it is fixable.
Why use sub optimal pressures because they "might" get centrals...not a smart idea. Fix the obstructive stuff as best you can with your machine and if centrals do pop up then we deal with them...but only deal with them when we have to ...don't use sub optimal pressures because you "might" have centrals pop up. You can just as easily not have any centrals pop up. I see pressures above 15 almost every night for part of the night and when using bilevel upwards of 22...and never any centrals to speak of.

Some centrals are normal...so don't freak out when you see a few here or there. Some are probably sleep onset centrals which are entirely normal. Some are probably a turn over in bed and hold your breath central. Hold your breath for 10 seconds...that's essentially a central apnea of 10 second duration...the airway is open but no air is moving.
Some central flagging...like your ugly cluster...I am not so sure they were even real. You don't seem to have them every night and they don't seem to be related to pressure (if they were you would have them all night every night) so I have my doubts as to whether they are even real or not.

Your OSA side of your therapy...a little sub optimal in the pressure settings and the obstructive stuff that was allowed to sneak past the defenses could very well be a factor in wake ups and thus increase the chance for SWJ central flags.
So my thoughts are "fix what we can fix with your machine" as best we can and then worry about centrals if they present themselves in numbers enough to warrant concern. Should that happen then we did deeper as to if they are real or not and cross the "what to do bridge" when/if we get to it.
Centrals are fixable if they require fixing but at this point I don't see you having enough centrals (that are real centrals) that will require fixing.

I can't thank you enough, you guys are the only support I have! It matters so much, the community here is invaluable. DMEs are total garbage

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Okie bipap
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Re: Maybe need a pressure increase?

Post by Okie bipap » Sat Jan 06, 2018 12:40 pm

When I first started, I had a good DME, but they lost their Medicare certification and I had to change. Thankfully, by then I had already taken over my own treatment and was making adjustments to my therapy as necessary.

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Re: Maybe need a pressure increase?

Post by softail99fb » Sat Jan 06, 2018 4:57 pm

Put your machine on c-pap. Put it on 15 and try to breath back on it as if you were sleeping. Lower it until you can, then try that when you sleep. My doctor had mine so high I woke up chocking from not being to exhale. I ended up leaving mine at 11.5. My settings are 11.5 and 6 with flex on 3. No one, no one needs anymore then they can exhale to and only you can determine that

TedVPAP
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Re: Maybe need a pressure increase?

Post by TedVPAP » Sat Jan 06, 2018 7:15 pm

Ruinednose wrote:
Pugsy wrote:The calendar and pie chart prevent the AHI and bar graphs and statistics from being easily seen in one image.
If you turn off the pie chart it does nothing to the statistics and information under the pie chart.

Your machine didn't go above 12 max IPAP or 8 EPAP max because it didn't feel the need to...it could have gone higher but didn't.
Part of that is the PS of 5 being available...it wanted to sit around 4 PS and that restricts the movement of the pressures to some extent.
It's just a coincidence that the EPAP max was 8 and IPAP max was 12.
If IPAP max had gone to 13.5 then most likely EPAP max would have been around 9.5 if the roughly 4 PS had held. Your PS has some room to roam around so it isn't always going to be a fixed number difference between EPAP and IPAP.

Actually a decent enough report last night...especially since you say you feel decent and feel like you slept decently. If me I might use these settings for a few nights and then try 1 cm more EPAP minimum to see if things clean up a little more but there's no urgent need to clean things up as long as you are sleeping good and feeling good.

The central clusters that you may see from time to time...I don't think they are real. I think that most likely they are SWJ breathing but if you see a CA cluster again we can do some extra work and zoom in on the flow rate to see what it looks like.

Here is a Respironics report in the format that I need to see for optimal evaluation.
See how clean it is and the basics are all there for easy viewing.

Image

I think I've done it

https://imgur.com/a/iuHUP

Thank you again, so you suggest I increase the Min EPAP to 8? And leave the max IPaP to 13.5?
In the future, we need to see the leak rate also.

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Use data to optimize your xPAP treatment:
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Ruinednose
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Re: Maybe need a pressure increase?

Post by Ruinednose » Sun Jan 07, 2018 9:35 am

Pugsy wrote:
Ruinednose wrote: I don't know why I'm afraid to do it, I still don't understand PS.
Took me a long time to understanding the roaming PS like you have on your machine in auto mode.
See if this helps. See what jnk says about the dance.
viewtopic.php?f=1&t=56581&p=531326&hilit=+dance#p531326
Ruinednose wrote: I've *heard* that too much pressure can create CA, but maybe I'm just dumb. I will increase the epap to 8 and iPap to 16 for starters?
What you heard is partially correct...too much pressure can cause centrals in some people but not all people.
Some people can get a truckload of centrals from 5 cm pressure...doesn't have to be a "high" pressure.
People get all freaked out over "centrals" and are afraid to treat the known problem (the obstructive sleep apnea stuff) because they "might" get centrals.
Well yeah...they "might" but they might not and if they do get too many centrals then it is fixable.
Why use sub optimal pressures because they "might" get centrals...not a smart idea. Fix the obstructive stuff as best you can with your machine and if centrals do pop up then we deal with them...but only deal with them when we have to ...don't use sub optimal pressures because you "might" have centrals pop up. You can just as easily not have any centrals pop up. I see pressures above 15 almost every night for part of the night and when using bilevel upwards of 22...and never any centrals to speak of.

Some centrals are normal...so don't freak out when you see a few here or there. Some are probably sleep onset centrals which are entirely normal. Some are probably a turn over in bed and hold your breath central. Hold your breath for 10 seconds...that's essentially a central apnea of 10 second duration...the airway is open but no air is moving.
Some central flagging...like your ugly cluster...I am not so sure they were even real. You don't seem to have them every night and they don't seem to be related to pressure (if they were you would have them all night every night) so I have my doubts as to whether they are even real or not.

Your OSA side of your therapy...a little sub optimal in the pressure settings and the obstructive stuff that was allowed to sneak past the defenses could very well be a factor in wake ups and thus increase the chance for SWJ central flags.
So my thoughts are "fix what we can fix with your machine" as best we can and then worry about centrals if they present themselves in numbers enough to warrant concern. Should that happen then we did deeper as to if they are real or not and cross the "what to do bridge" when/if we get to it.
Centrals are fixable if they require fixing but at this point I don't see you having enough centrals (that are real centrals) that will require fixing.

New photo

https://imgur.com/a/qHPP8

I increased min EPAP to 8.
I didn't increase max IPap by mistake

What changes do I make now

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TedVPAP
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Re: Maybe need a pressure increase?

Post by TedVPAP » Sun Jan 07, 2018 9:45 am

Your latest charts still doesn't show leak rate and you have zoomed in so all we see is pressure and flow rate over a short time period.

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Use data to optimize your xPAP treatment:
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Ruinednose
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Re: Maybe need a pressure increase?

Post by Ruinednose » Sun Jan 07, 2018 9:48 am

TedVPAP wrote:Your latest charts still doesn't show leak rate and you have zoomed in so all we see is pressure and flow rate over a short time period.

It's the default.. It's how it looks on my computer, what can I do to correct it?

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