jaye8898 wrote:Yes, will make sure they correct it. After all, if it was right I would need a different type of machine, wouldn't I. An apap I think?
Actually you are using an APAP...I think you meant ASV machine.
djhall wrote:That is just my impression and an explanation of what _I_ see when I look at those graphs. I'm sure Pugsy will tell you I got everything wrong.
Actually nothing wrong.
The only thing I would suggest that person do when evaluating minimum pressure needs as they don't go by the 90/95% pressure thing as it is easily skewed and the only time I would pay much attention to 90/95% pressures is long term trend as in at least a months worth of data. I never base minimum pressure needs on an occasional night where the 90/95% pressures are elevated.
Did you know that often if the minimum is just raised a little (like .5 or 1.0) that the 90/95% pressures will stabilize and not go so high? I have seen it happen often. That 90/95% pressure is really just a number and it isn't the holy grail of numbers for where cpap mode should be use or where the minimum should be. It is just too easily elevated by freak stuff to be that conclusive unless someone is looking at several months of trends.
I think that in OPs situation here that most likely 0.5 cm or 1.0 cm increase in minimum would be needed to clear up the clutter...if the clutter persists and she wants to clean it up. I think that if she used a little more minimum that the upper pressures she is seeing will likely fall. If the machine does a better job preventing the collapse of the airway then it doesn't have to play "fix it" mode all the time with the higher pressures...instead it just does "prevent it mode".
Also...when evaluating minimum pressure needs and increasing...I never suggest that someone make a substantial jump in pressure unless there is an obvious urgent need...like AHI of 10 to 20 and all obstructives.
Even then I would still suggest a person go up slowly in most situations because they might get lucky and not need as much pressure as originally thought. There are some exceptions to this general way of doing things but on a whole..go up slow as it makes adjusting easier and might get lucky and not need as much.
I suspect in the OPs situation here that the increase in events in the middle of the night or either REM related, supine sleeping related..and/or combination of both and it would take very little more pressure to clear those up (not that they really urgently need clearing up since she reports sleeping very well) and her 90/95% pressures would in turn most likely be lower in general.
You have a real good understanding of how this stuff works. I wouldn't say you were wrong at all with what you said.
I would only explain a bit further how the 90/95% thing works because I have seen first hand that it isn't the holy grail people tend to think it is. It can be the holy grail in some situations but that can't be determined with just a handful of reports.
It's too easily skewed. I have some examples somewhere of mine that offers a pretty clear picture of what I mean. If you want to continue your education process about it I would be happy to share those with you so you can see what I mean. Just send me a private message..or if you want to do it publicly start a thread about it and I will jump in. It would give me time to go find that thread where I showed it off.
Mainly when I was using the APAP...I would sometimes see 90/95% pressures of 17 or 18 cm...fluke nights ...maybe once a week or so. Long term over 6 months (and I did the actual report to verify) the 90% pressure was only 12.2...my minimum at the time was 10 cm. So long term the 90% pressure actually came real close to the overall average pressure of 11.4 I think it was. 90% because I was using Respironics and that's what Encore reports. SleepyHead defaults to 95% instead of 90 but it can be changed to 90 but it really isn't that big of a deal and that's why I don't go into the difference. 5%...not a big deal in a number that doesn't mean all that much to start with.
So anytime you want to continue your education just send me a note or just ask. That's how I got to the point I am today...I asked hundreds and hundreds and hundreds of questions (made quite a pest out of myself I imagine)..read for hours and hours and hours...and have looked at thousands of reports..not just my own. It's the only way to learn.
Some questions took repeated explanation to get through my thick skull too. I am still working on understanding how ASV settings impact things..that one is hard to wrap my brain around when the situation is complicated.
Oh, I don't always practice what I preach though...sometimes I make drastic changes all on my own but when advising others I tend to take the safe approach unless I get the sense that they are also up to a challenge.
In this situation with the OP here I already knew that she is using a trial machine and won't get her permanent machine until compliance is met and then she gets a new machine..she's using office demo right now and I got the sense that she didn't want to do anything that might jeopardize her insurance paying for her machine as her situation isn't typical in regards to how her insurance does things. They could look for any excuse in the world to deny paying for a machine and I wouldn't want to risk that happening.
I may have to RISE but I refuse to SHINE.
