Fifth Night

I know that one night does not a trend make, and I'm changing too many variables too quickly, etc...

However:

After completely ignoring the wishes of the DME and changing to auto mode with a range of 7-20,
and tweaking my EPR level to 2, I found these numbers this morning;

Pressure: 11.4
Leak: 0.02L/s
AHI: 11.7
AI: 2.2
HI: 9.5

I can't help but think this is excellent after just a few days.

And to think I was originally slated to receive straight CPAP at a pressure of 9. Even if that had
worked well, this is so much more comfortable.

I'm sure others will have more to say, but your AHI (the most important factor) is on the high side at 11, and this is the number you want to work on to see it come under 5. Maybe you shouldn't have rushed to dismiss the DME's advice so quickly, or make a big change all at once without more information. Straight Cpap (of 9 or otherwise) is not necessarily a bad thing and can be better for some patients than Apap.

I should clarify. I tried the straight CPAP setting at 9. The numbers were worse.

I assume then, that you have a pressure range set 7 cm-20 cm and have had that setting for jsut 1 night so far. It looks like your 95% pressure is 11.4 cm. The AHI is pretty good given that you have a Resmed meachine which counts Hypopneas differently. You AI is pretty good at 2.2.

If that's the case, I would raise the minimum to 9 or 10 in a few more days IF the AHI does not come down in that few days.

Hawthorne wrote:I assume then, that you have a pressure range set 7 cm-20 cm and have had that setting for jsut 1 night so far. It looks like your 95% pressure is 11.4 cm. The AHI is pretty good given that you have a Resmed meachine which counts Hypopneas differently. You AI is pretty good at 2.2.

If that's the case, I would raise the minimum to 9 or 10 in a few more days IF the AHI does not come down in that few days.

Actually, I've had 7-20 for two nights. Prior to that, it was 6-12. Prior to that, it was CPAP-9. Improvement happened after each change. I think I'll leave the settings completely alone until Thursday, then do as you suggest. THANKS!

Sounds like a good plan to me! Things are gradually getting better for you as you manage your own therapy!

What amazes me when I think about it is how passive patients who don't get a good initial evaluation must do, and how many there must be. They wind up in the hands of a DME who subjects them to what amounts to slow experimentation based on "medical necessity." I understand that to function, a business has to make rational decisions about profits and expenses, but the end result would seem to be a generic solution that is too frequently not in the best interests of the patient.

Could this be one reason why *PAP compliance is so notoriously low? I'm all for capitalism, but must the profit motive poison everything it touches?

Cavallo wrote:...Pressure: 11.4
Leak: 0.02L/s
AHI: 11.7
AI: 2.2
HI: 9.5
...originally slated to receive straight CPAP at a pressure of 9...this is so much more comfortable.

Looks good! I too was on CPAP at 9, but APAP in my case set 7-15 gives great numbers and much better sleep than I had using straight CPAP. My average 95thcentile for the 10 days I've had it runs 8.8-10.8 with AHI <3 and AI usually 0. The upper range of 15 (I've seen it at 12.6 following an event, no card reader yet, so no detailed data to know what my max pressures have been) is there for nights when I have a lot of congestion that narrows my airways. Neither my doc or I think I'll ever go to 15 (overkill), but I had no centrals in my PSG so less likely that a higher pressure if needed might induce them.

A week at that range is good advice. Do you have the ResScan software and reader? It does give you more detailed info...if you want the max data for therapy tweaking.

Muse-Inc wrote:A week at that range is good advice. Do you have the ResScan software and reader? It does give you more detailed info...if you want the max data for therapy tweaking.

I have ResScan installed, but no reader as yet. I'm debating whether to pay the full shot for the ResMed reader, or save my (now precious) pennies and just get the normal one.

Cavallo wrote:...I have ResScan installed, but no reader as yet...debating whether to pay the full shot for the ResMed reader, or save my (now precious) pennies and just get the normal one.

Me too! Unemployment reduces options. Considering telling my buddies that all I want for my bithday (over Thanksgiving weekend) is the card reader!

Which reader are you considering? I floated this one to the forum, but no-one has responded yet;

http://www.cardplustech.com/acr38u-ccid-p40/

ACR-38U, but then I waver to just getting the ResMed reader...

Muse-Inc wrote:ACR-38U, but then I waver to just getting the ResMed reader...

I troubleshoot computers all day for a living. I'm sure I could manage this. My source of waver is that I almost never have to soil myself with Windows. This would be an icky job if it didn't just work right the first time. The question is, are my lofty principles worth the extra money?

Cavallo wrote:...be an icky job if it didn't just work right the first time. The question is, are my lofty principles worth the extra money?

Icky..love it! As to the extra $... that's why I waver, so many other survival-essential things to buy/pay for and this is not critical as my AHI is <3.

Guess it depends on how much of a control-freak you need to be. I must have all the data, regardless. It's how I'm wired.