Weeks worth of data, need some advice....

[DaveS_]

Hi all, been a while since I posted any data, but I got my new Resmed Autoset 10 and I have been experimenting with settings and such and I could use some advice. I've been playing with my pressures and even tried straight CPAP mode one night, but I feel like I'm missing something. I do have to say that my usage with this machine is much higher than when I had the DreamStation, and I feel pretty good when I wake up. Here's some screenshots of the past week. I am curious as to wheter I should try CPAP mode again, I think I was onto something there. Any advice is appreciated as everything I have achieved so far has been from the info I got here, Thx so much!

screenshot-20210908-151144.png (199.99 KiB) Viewed 1663 times

[DaveS_]

screenshot-20210908-163527.png (204.71 KiB) Viewed 1628 times

screenshot-20210908-163554.png (191.83 KiB) Viewed 1628 times

[DaveS_]

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[Julie]

Dave, we're not going through all of those - the last couple should be good, but in any case, why or why didn't you attach to previous thread so we can see previous info and make sense out of this new stuff. I'll let experts comment on the graphs though.

[DaveS_]

Dave, we're not going through all of those - the last couple should be good, but in any case, why or why didn't you attach to previous thread so we can see previous info and make sense out of this new stuff. I'll let experts comment on the graphs though.

Fair enough, I'll condense to three. Would appreciate some feedback opn CPAP mode versus APAP. I watched a video recently form LankyLefty on youtube where he mentioned something about how we should try to find a fixed pressure instead of a min/max.

Well, my last thread about possible changes was way back in March I believe? Totally different time and place.

[Pugsy]

Choose the mode that you feel like you sleep the best using and feel the best during the day.

[jimbud]

Your Flow limits look kind of crappy on the 4th and the 6th.
The 6th is worse and you are on fixed pressure of 12cm.
All three days with EPR of three.

In the future:

Why not get rid of the Mask Pressure graph and replace it with Flow Limit graph.
All you/we really need is the Pressure graph, unless one of the experts ask for it, the Mask Pressure graph is superfluous.

JPB

[DaveS_]

Your Flow limits look kind of crappy on the 4th and the 6th.
The 6th is worse and you are on fixed pressure of 12cm.
All three days with EPR of three.

In the future:

Why not get rid of the Mask Pressure graph and replace it with Flow Limit graph.
All you/we really need is the Pressure graph, unless one of the experts ask for it, the Mask Pressure graph is superfluous.

JPB

Will do. What exactly is "Flow Limit"?

[SakimaStorm]

Flow limits are partial obstructions. Some people sleep fine with them, others like myself find they create a number of arousals during the night, interrupting sleep. Your flow limits are controlled by the pressure support (on bi-level CPAP), EPR (on standard auto or fixed pressure ResMed CPAP) and to a lesser extent your IPAP. Whereas OAs are treated by your EPAP, hypopneas and flow limits are more affected by IPAP.

Your EPR is set to 3 and that is as high as a standard CPAP by ResMed can go. To go higher you would need a bi-level CPAP. Since your apneas are well controlled it is highly unlikely insurance would cover you getting a bi-level CPAP simply to lower your flow limits (also called UARS).

Your first graph had pretty low flow limits, likely because your IPAP was higher.

A lot of people like the auto mode as the machine adjust automatically to your breathing needs as they change during the night and from day to day. Others, like myself, do much better on a fixed pressure. It's a matter of comfort and preference. Ideally your EPAP would be right at the threshold that keeps most OAs away. And your IPAP would be at the threshold needed to keep hypopneas and flow limits in check. But not so high it creates CAs.

LankyLefty and Nick, both with videos on you tube mention fixed versus auto pressures. Both think if you can tolerate a fixed pressure, and can get your EPAP and IPAP set correctly, you'll likely get optimal therapy as long as your needs don't change much during the night e.g. pressure needed during NREM1 or NREM2 vs REM is fairly close, say w/in 2cm. If you are someone whose needs fluctuate a great deal e.g. EPAP of 10 during NREM1 and and EPAP of 18 during REM, then fixed pressure will likely be uncomfortable as you'd need to set it up around 18 for the whole night.

As a side note, in speaking with my pulmonologist, he said about 5-10% of his patients do better on CPAP versus Auto CPAP. Because set right, the fixed CPAP will prevent most OAs whereas the Auto CPAP is running at a lower pressure and needs to ramp up in response to either flow limits or OAs ... so it often gets you to the higher pressure after you have had an OA but then can prevent future ones from happening .... until of course it lowers the pressure and the cycle begins again.

Ultimately it comes down to finding the setting that are comfortable and also control to a reasonable level your events while you sleep.

I'm certainly no expert, but I hope this is somewhat helpful.

s.

[SakimaStorm]

Looking at your charts, I noticed the following:

Fixed 12.4, flow limits were a bit high, but your OAs, Hs, CAs seem well controlled.

12-14 IPAP (w/ EPR 3 yielding 9-11 EPAP) gave good numbers. Your OAs just before waking were likely SWJ (sleep wake junk) and you can likely ignore them. But ... You didn't sleep well, only 2 short sessions, with that settings. So even though the numbers were good, comfort is also very important.

I'd suggest trying 12-14 for a week, unless it is very uncomfortable, and seeing how you feel and how the numbers look. Try not to keep changing your settings each night, your body needs time to adjust to new settings. And when you do make a change, try to keep the change to .4 or .6 cm each time.

s.

[DaveS_]

Looking at your charts, I noticed the following:

Fixed 12.4, flow limits were a bit high, but your OAs, Hs, CAs seem well controlled.

12-14 IPAP (w/ EPR 3 yielding 9-11 EPAP) gave good numbers. Your OAs just before waking were likely SWJ (sleep wake junk) and you can likely ignore them. But ... You didn't sleep well, only 2 short sessions, with that settings. So even though the numbers were good, comfort is also very important.

I'd suggest trying 12-14 for a week, unless it is very uncomfortable, and seeing how you feel and how the numbers look. Try not to keep changing your settings each night, your body needs time to adjust to new settings. And when you do make a change, try to keep the change to .4 or .6 cm each time.

s.

Gonna try 12-14 for a few nights, thx for the input.

[jimbud]

What exactly is "Flow Limit"?

A little light reading:

http://www.apneaboard.com/wiki/index.ph ... limitation

JPB

Allergies can cause them also.
Ragweed tears me up this time of year.

[SakimaStorm]

Yes! My allergies as well. And some anatomical issues .... like a deviated septum can affect your upper airway resistance (UARS/flow limits).