AHI low at all pressures - Eye issues and still tired

OkyDoky · Post by **OkyDoky** » Tue Jan 27, 2015 8:21 am

You can get the clinical manual here. http://www.apneaboard.com/adjust-cpap-p ... tup-manual
Scroll down to Section Three your machine is there just follow instructions and they will email it to you.

palerider · Post by **palerider** » Tue Jan 27, 2015 8:51 am

johantv wrote:Thanks guys.

Last night I slept for the first time with the "VPAP S" and the flow from in- to exhalation is much more rigid with the VPAP as what I'm used to with the APAP.
Does anybody have a clinical quide (or the titration guide) for the Resmed S9 VPAP S so I know what to set on bi level.
I'm also curious what timax, timin etc. means. So if there is a whitepaper on the basics for bilevel it would be very much appreciated if this could be shared.

viewtopic.php?f=1&t=101513&p=972180#p972180

google for the resmed s9 titration guide, that's how I found it

tan · Post by **tan** » Tue Jan 27, 2015 6:02 pm

johantv wrote:Thanks guys.

Last night I slept for the first time with the "VPAP S" and the flow from in- to exhalation is much more rigid with the VPAP as what I'm used to with the APAP.
Does anybody have a clinical quide (or the titration guide) for the Resmed S9 VPAP S so I know what to set on bi level.
I'm also curious what timax, timin etc. means. So if there is a whitepaper on the basics for bilevel it would be very much appreciated if this could be shared.

Regards
Johan

Setting both trigger and cycle to "Very High" was really helpful for me

johantv · Post by **johantv** » Wed Jan 28, 2015 1:19 pm

I now got the manuals (titration and climnical guide). Thanks for the links

My current VPAP-S settings are:
ipap 10
epap 7
timax 2.0
timin 0.3
rise time 150
trigger med
cycle med

After 2 night VPAP-S my ratio's in rescan are registered as:
_______________MED________95%
I:E ratio_______1:1.95_____1:1.33
BPM___________ 17 _________21
Min.Vent_______7.4_________9.8
Tidal volume___400_________600

AHI as ever 0.8

Could anyone tell if the VPAP settings are normal. I'm not sure how settings are determined by my OSA consultant.
I noticed that except for ipap, epap and rise time all other settings are the factory defaults.

Julie · Post by **Julie** » Wed Jan 28, 2015 1:43 pm

The settings SHOULD be according to results of your sleep study, however far too many doctors (in cahoots with DMEs) just write for default settings with no regard at all to results... we think it's terrible and are constantly encouraging people to raise the low pressure settings into a reasonal realm of therapy, at least 6-7 or so for a few nights and then use software to get results, which they can post here for our comments.

The doctors may know about OSA, but seem very ignorant (or incredibly risk averse) when it comes to equipment and settings and software results.

palerider · Post by **palerider** » Wed Jan 28, 2015 1:49 pm

johantv wrote: Could anyone tell if the VPAP settings are normal. I'm not sure how settings are determined by my OSA consultant.
I noticed that except for ipap, epap and rise time all other settings are the factory defaults.

generally the trigger/cycle/TiMin/TiMax are only changed for special needs, (obstructive/restrictive lung conditions) or if you, for instance, often breath slowly, and so the machine cycles to epap before you're finished inhaling... you might want to tinker with the settings a little.

many people don't need to change them. (the respironics machines don't even offer that level of customization)

johantv · Post by **johantv** » Thu Jan 29, 2015 2:35 pm

I'm not confident the osas consultant had a lot of knowledge about the settings. I just had a sleepstudy and she told me she's not an expert in interpreting the PSG. Also I slept with S9 Autoset APAP before and was surprised she got the VPAP S knowing I prefer APAP. I had expected to receive the VPAP Auto.
Anyway, I must be happy she aranged a new PSG and the docter advised to try bilevel. I leave the settings at default for now and. will try it out as is.

johantv · Post by **johantv** » Sun Mar 08, 2015 5:29 am

Stopped the BI-LEVEL therapy. It wasn't the auto version but the Resmed S, so not ideal, at least not for me.

Now trying again with the S9 autoset. Trying to have pressure low so the impact of blowing air is a low as possible and hopefully thereby preventing wakening up 5 times a night. Experiencing some Aerophagia though.

So still trying to find sweet spot. Now APAP 5,6-7,6.

herefishy · Post by **herefishy** » Sun Mar 08, 2015 10:21 am

You might give a few days to staying at a fixed pressure rather than letting your auto fluctuate. Some find that just the bit of change in the pressure is enough to wake them, if only momentarily. Also, check http://www.dryeyezone.com for some enlightenment on your dry eye situation.

johantv · Post by **johantv** » Thu Mar 12, 2015 2:23 pm

Thanks for your reply. I tried fixed pressure in the past, but after a few days always 'missed' something. I'll give it another try, you never know

.

Also thanks for the link. I'm a little puzzeld why not more CPAP patients have the dry eyes issues. For me the issues started when starting CPAP.

tan · Post by **tan** » Thu Mar 12, 2015 2:45 pm

johantv wrote:Stopped the BI-LEVEL therapy. It wasn't the auto version but the Resmed S, so not ideal, at least not for me.

What did your SleepHead charts show for Bi-level? The initial setting of Bi-level were hard for me to tolerate until I made some additional tweakings.

Too tall · Post by **Too tall** » Thu Mar 12, 2015 7:10 pm

johantv wrote:Hi,

I'm new here (from the Netherlands). Since march 2014 I'm using the PAP. My AHI on average is 0.7 and in 7 months of PAP my AHI never exceeded 2.3
Since treatment started I'm having fatigued eyes. The Eye specialist couldn't find anything and suggested lubricating the eyes. Since this didn't help much I varied a little with pressure Iooking for possible eye-improvement.

The strange thing is that my AHI is the same (<1) at all pressures (4 months APAP 5-8.6 cmH2O, one month CPAP 5 cmH2O, one month increasing pressure to now APAP 6-12 cmH2O).
The period at CPAP at 5 cmH2O I got really tired and noticed Flow limitations were much higher as during APAP.

Currently I agreed with my specialist (She's not very experienced unfortunately) to have the pressure range set to 6-12 cmH2O and looking at the results at the beginning of December. The average (med.) pressure now is around 8 and the 95% pressure at 10. Most of the time the max pressure is between 10,5 and 11.5.
Still having some flow limitations (Sleepyhead 95%=0.06 and max every night around 0.5). Don't know If that's acceptable or not? With Sleepyhead v09.8-1 User Flags I also noticed a lot of small disturbances in flow rate.

With the higher pressure (max 12) I'm feeling some pressure/tingling heath on cheeckbones area during the day, stil feeling tired and sometimes some dizzyness.

QUESTIONS:

1) So I'm still looking for tips on the best pressure (never used EPR).

2) What is an acceptable flow limitation (sleepyhead).

3) Any comments on my AHI being the same on all different pressures is also welcome. My specialist was puzzled?!

4) Also advices on eye issues are welcome (no leak into eyes is present due to nasal mask p10).

Kind regards
Johan

PS. Sorry for all the typing errors...
PS. Is it not possible to upload pics?

My AHI doesn't seem to be affected by the pressure settings either. I'm on the lowest setting the machine will work with and it seems I'm sleeping better and longer.

johantv · Post by **johantv** » Sat Mar 14, 2015 4:47 am

Too tall wrote: My AHI doesn't seem to be affected by the pressure settings either. I'm on the lowest setting the machine will work with and it seems I'm sleeping better and longer.

And no side effects? Great for you. 5 cm made me very tired.

I'm currently lowering my pressure (last night the devil's pressure 6 - 6,6 cm). Let's see how that works out.

My highest AHI ever, after exactly one year APAP

, is still 2.3.

AHI low at all pressures - Eye issues and still tired

Re: AHI low at all pressures - Eye issues and still tired

Re: AHI low at all pressures - BILEVEL

Re: AHI low at all pressures - BILEVEL

AHI low at all pressures - BILEVEL

Re: AHI low at all pressures - Eye issues and still tired

Re: AHI low at all pressures - BILEVEL

AHI low at all pressures - BILEVEL