The more I try, the worse it gets.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Tue Apr 15, 2014 5:50 pm

Ok, I have 2 new tricks to try tonight. Yahoo!!!!!

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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Tue Apr 15, 2014 5:55 pm

went to apply the new settings and the PS only goes up to 3?

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Re: The more I try, the worse it gets.

Post by kaiasgram » Tue Apr 15, 2014 6:16 pm

lliann wrote:went to apply the new settings and the PS only goes up to 3?
No, so something is off -- check to make sure you're not in CPAP mode. Also check your IPAP and EPAP numbers -- if min EPAP is 10 and max IPAP is 17, you should be able to set PS at 4. Set IPAP and EPAP before you set PS.

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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Tue Apr 15, 2014 7:22 pm

I checked all the settings in all the modes. PS in vauto only goes to 3. In S mode, there is no PS...just Easy Breathe. And in cpap mode not PS just a start pressure of 4. ??

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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Tue Apr 15, 2014 7:40 pm

I have checked and rechecked. PS only goes from 0 to 3. I don't know why. Should I change the settings to ipap 16 epap 13?

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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Tue Apr 15, 2014 7:45 pm

Ok, apparently my best trait, to make up for being dense, is tenacity.

Soooooo

Robysue said to do epap 14 and ipap 17. Kaiasgram said epap 10 and ipap 17.

When I put in epap 14/ipap 17/ipap, the PS will only go to 3. When I put in epap 10/ipap 17, it will then go to 4.

Now what?

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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Tue Apr 15, 2014 7:50 pm

this is my last one for tonight. I promise.

I think it was yours truly (ME!) who did the numerical typo on the epap. So I think I have it for tonight.

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Re: The more I try, the worse it gets.

Post by kaiasgram » Tue Apr 15, 2014 8:35 pm

lliann wrote:this is my last one for tonight. I promise.

I think it was yours truly (ME!) who did the numerical typo on the epap. So I think I have it for tonight.
Sending PM now

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Re: The more I try, the worse it gets.

Post by kaiasgram » Tue Apr 15, 2014 8:40 pm

I was just trying to figure out the "ifs" of the different IPAP and EPAP settings and why you couldn't get higher than 3 on the PS. Robysue is following your therapy more closely than I have been, so stick with her and Pugsy's recommendations for sure. I wasn't recommending any particular settings.

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Re: The more I try, the worse it gets.

Post by kaiasgram » Tue Apr 15, 2014 8:49 pm

PS can't be greater than the difference between IPAP and EPAP, that's what you were up against before. If, hypothetically, you set IPAP at 20 and EPAP at 12 then you could set PS all the way up to 8 but not higher.

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Re: The more I try, the worse it gets.

Post by robysue » Tue Apr 15, 2014 11:56 pm

lliann wrote:Ok, apparently my best trait, to make up for being dense, is tenacity.

Soooooo

Robysue said to do epap 14 and ipap 17. Kaiasgram said epap 10 and ipap 17.
No, I said
MIN EPAP = 10
MAX IPAP = 17
PS = 4

(These settings will cause min IPAP = 14 and max EPAP = 13, but you do NOT set the min IPAP or max EPAP on the machine.)
When I put in epap 14/ipap 17/ipap, the PS will only go to 3. When I put in epap 10/ipap 17, it will then go to 4.

Now what?
You want EPAP = 10.

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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Wed Apr 16, 2014 7:01 am

robysue wrote:
lliann wrote:Ok, apparently my best trait, to make up for being dense, is tenacity.

Soooooo

Robysue said to do epap 14 and ipap 17. Kaiasgram said epap 10 and ipap 17.
No, I said
MIN EPAP = 10
MAX IPAP = 17
PS = 4

(These settings will cause min IPAP = 14 and max EPAP = 13, but you do NOT set the min IPAP or max EPAP on the machine.)
When I put in epap 14/ipap 17/ipap, the PS will only go to 3. When I put in epap 10/ipap 17, it will then go to 4.

Now what?
You want EPAP = 10.
I'm sorry Robysue. I did catch my error that I was the one to type in a wrong number for the epap at 14. When I saw Kaiasgram message, I knew I probably created the problem somehow so I went and tested some scenarios on my machine. Thats when I saw that the variation of 17 and 14 was what was stopping the PS from going to 4. I did finally end up with 17 and 10 and ps 4.

And to both Kaiagrams and Robysue, when I wrote So and so said...please know I am very well aware of the difference between a helpful 'suggestion' and telling someone to do something. My wording was bad and please understand that I know these are all helpful suggestions but what I do is my choice to do. I really do know that and I am so grateful for all of your help. I have benefitted so much from it all ready.

Ill go read my doohickey after I get my morning tea but I wanted to write this first.

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Re: The more I try, the worse it gets.

Post by Pugsy » Wed Apr 16, 2014 7:27 am

FWIW...I agree with this
Vauto mode
EPAP 10
PS of 4
IPAP max of 17
all the rest of those settings I would leave at the defaults (like Ti max and min and trigger and cycle.)
lliann wrote:I don't know the math equation of how my events totalled 12.37
AHI of 12.37
is made up of
Apnea Index which is made up of central index and obstructive index
plus
Hyponea index

But let's look at last night's AHI since I can't scroll back far enough to get the break down for the 12.37 AHI
and besides...last night's report was an improvement.
AHIApnea / Hypopnea Index 8.10
Your last nights' AHI is 8.10 and it is made up of these sub categories
HypopneaHypopnea 0.39
ApneaUnspecified Apnea 0.00
ObstructiveObstructive Apnea 2.70
Clear AirwayClear Airway Apnea 5.01
and the Obstructive Apnea index is down to 2.70 which is a huge improvement and if your central (clear airway) index wasn't elevated your AHI would be significantly improved.. Look back at the other Obstructive apnea indexes in the double digits...this drop to 2.70 is huge improvement.

The Centrals...don't know what to make of them from last night...with the itching it is entirely possible that we have some awake breathing centrals getting flagged too. So maybe awake breathing...maybe the meds suppressing things but Benadryl isn't known to be that bed.

Last night's experiment was a success despite the centrals and the itching.
the EPAP increase greatly reduced the OAs.
I don't think the centrals are related to the pressures at this point. I think they are more apt to be related to either awake breathing irregularities getting flagged by mistake or meds. Need more nights of data without itching and meds complicating things....in other words...need a night without a lot of wake ups no matter the cause.

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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Wed Apr 16, 2014 7:30 am

Here are the readings from last night.

This was the scenario. I took 1/2 a doxepin because I was still in itch mode. It helped with falling asleep. Had a little hangover this morning but its going away much faster at the lower amt.

The cats were with me the first half of the night. I have to accept that they probably are responsible for some of my events because they move around. And Eli found the tubing and I think he was starting to chew on it. So that was the stop as I got all the cats out of the room.

The pressure did seem a lot more and I have to read your description again. Maybe it didn't go to 14 (the air I recognized) because the machine decided in auto mode that I just need all of 17 if not more. (is this a usable theory?)

I fiddled with the nose pillows a fair amt. It felt like there was air coming through. I could try the larger size tonight or switch to the zest?

Again, I understand any reactions to my wording of saying who said to do what. I worked at a hospital and a doctors office, so I am well aware of ownership of actions. Hope you will continue to work with me.
Image

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Re: The more I try, the worse it gets.

Post by Pugsy » Wed Apr 16, 2014 7:47 am

lliann wrote:Maybe it didn't go to 14 (the air I recognized) because the machine decided in auto mode that I just need all of 17 if not more. (is this a usable theory?)
Maybe more than 17 was needed..can you turn back on the pressure graph if you are using variable pressures so we can see that graph...don't need respiration graph and it will move down if you turn pressure graph back on. Don't need mask pressure graph though.

Again though...if adjusting anything...it would be EPAP first and not just add more room to IPAP range.

Looks like a lot of fiddling with the mask...along with fiddling with the kitties
and likely a lot of those centrals in the first half of the night are awake/semi awake breathing irregularities due to sleep disruption from the kitties. If you were aware of them often during the night then there is also going to be even more times where they disturbed your sleep that you don't remember.
So the first half of the night really can't be evaluated with much importance.

That last hour ....big leak...over 30 L/min. Pushing large leak spikes at other times but fairly constant for the last hour.

Your AHI last night 10.39

of which 6.20 of it is the central index which we just have to set aside right now as it has too many chances of it being compromised by awake/semi awake breathing due to mask fiddling and cat fiddling.

That leaves roughly 4.xx for the OA and HI (these are the obstructive type of events) and that's still better than double digits Obstructive events.

Centrals...you are just going to have to set them aside right now...mentally remove them from the AHI or just add the OA and HI indices together and omit the clear airway (central) index for now.
We don't treat centrals with your machine...we hope they go away we hope that we don't make them worse.

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Last edited by Pugsy on Wed Apr 16, 2014 7:58 am, edited 1 time in total.
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