S-8 Titration ideas

[speaker626]

Need some help. The software added some confusion. In short, want advice on window setting ideas. And, help w a software question (obtained before the ban, of course).

Data from statistics page: based on previous 28 days, S-8 auto set 2, swift 2 pillows, Hi3 set at 4 (first number where I can actually feel warm air, otherwise, no logic to this).

1. Set Min 8.8 (my idea), Max 16 (no reason) AND, I just lowered it back to 8 a few days ago.
2. EPR- 3 (I set here as like it)
3. Median pressure- 9.0
4. 95th - 11.3
5. Max pressure- 13.3
AHI- 2.9 as AI 0.3 and HI 2.6
Leak 0.0 Median, .4 95th, .5 max (L/sec)

Actual titration suggested from original study- 8 (used with basic no frills (no data) cpap).
Note- I had jumped it up from 8 to 9 after 4 months of no improvement. That didn't help much either. But that's where the 8.8 idea came from.

So, formal question is what should windows (min/max) "probably" best be set at, though I realize some trial and error will still have to be made.

Second formal question- If it can be determined, what would a good number to be to set my basic cpap at if other needs service or is used for travel, etc. ?


Software notes- Summary graph by day-

Noted that a couple days my max pressure was 17.6 (place mouse on day and three numbers appear that I hope correspond to graphs on left). I thought the max pressure would be capped at 16 as that is how machine is set. Is this just software guess at what it might take to take care of apnea or is it allowed these excursions if needed? Mainly just curious.

Leak- don't understand "mask events". I seem to have one everyday that lasts about five hours , then a second one that lasts about 1.5 hours. It seems like I should be trying to get my 95th leak rate (.40) from the 28 day stat tab, down to the .18-.32 range (or whatever exact suggested resmed numbers are). Oh, is there a way to turn up volume on leak alarm? It's not as loud as my alarm clock so I don't seem to notice it. My dog does and sometimes will jump on bed and jump around and I wake up. I'm guessing it hurts her ears. If could hear myself, could turn down it down faster for her sake, and, correct leak faster.

Thanks in advance!

[brain_cloud]

Bump, and your graphs didn't come through. Try again? I'd like to see the one where it goes up to 17.6 even though you have the max set to 16.0.

[Big Daddy RRT,RPSGT]

Many people use the 95th percentile pressure as a good set pressure.

[speaker626]

Bump,

Sorry, did not try to send/attach graph. That's just the way I write. How can I get that particular data piece to you (or just to post)? I don't have Outlook. I can't get any copy/paste options to work from that graph page. Not so confident Resmed would help me out with this. Although I find it impossible that they don't monitor these forums so they should jump in and answer the question. Just thought of something simple (as I'm sure you did)- Assume I am correct. Drop the max pressure down to like the median pressure for one night and see if it goes over that new max on the detailed graph. I might try that. But still back to original question- what if I am right and it "shows" the spike over the set max pressure on the detailed graph. Does that mean it actually did allow the pressure to spike or is it showing a guess as to where the pressure should have spiked to given whatever various factors it considers? Being asleep during all this activity is a serious complication. At least you don't have to be asleep to try to fake an apnea and see if you can get unit to respond (not that I would do that).

Big D, agreed but that's no fun. Seriously, I am one of those people who really finds the therapy uncomfortable for many reasons. But, i know I can't quit. So, I might as well try to get unit to treat any apnea it possibly can as this makes it at least interesting.

[Big Daddy RRT,RPSGT]

Bump,

Sorry, did not try to send/attach graph. That's just the way I write. How can I get that particular data piece to you (or just to post)? I don't have Outlook. I can't get any copy/paste options to work from that graph page. Not so confident Resmed would help me out with this. Although I find it impossible that they don't monitor these forums so they should jump in and answer the question. Just thought of something simple (as I'm sure you did)- Assume I am correct. Drop the max pressure down to like the median pressure for one night and see if it goes over that new max on the detailed graph. I might try that. But still back to original question- what if I am right and it "shows" the spike over the set max pressure on the detailed graph. Does that mean it actually did allow the pressure to spike or is it showing a guess as to where the pressure should have spiked to given whatever various factors it considers? Being asleep during all this activity is a serious complication. At least you don't have to be asleep to try to fake an apnea and see if you can get unit to respond (not that I would do that).

Big D, agreed but that's no fun. Seriously, I am one of those people who really finds the therapy uncomfortable for many reasons. But, i know I can't quit. So, I might as well try to get unit to treat any apnea it possibly can as this makes it at least interesting.

CORRECTION:"Mask events" are sleep sessions (thanks Slinky).

If you are having mask leaks/alarms you might consider mouth breathing as a possible problem. Mouth breathing can slept through and make pap therapy hard to tolerate and ineffective.

If your looking for a pressure range...two above and two below your 95th percentile pressure is a good place to start so for you 9-13cmH2O. An upper limit is nice if you wake up at higher pressures and starting low is good if you hate pressure. But if you start too low you waste sleep time having respiratory events until you get up to a more effective pressure but some people like the pressure as low as possible as much as possible. I prefer to start near my 95th which is 13-14 so I use a min of 10 and a max of 20. I almost never need more than 15-16 but the pressure is there if I need it. Good luck finding your sleep zone.

[okitoki]

Sorry, did not try to send/attach graph. That's just the way I write. How can I get that particular data piece to you (or just to post)? I don't have Outlook. I can't get any copy/paste options to work from that graph page. Not so confident Resmed would help me out with this. Although I find it impossible that they don't monitor these forums so they should jump in and answer the question.

I have to do screen dumps before, so this might work (Assuming you are using a PC and not a Mac)

when you have the graph displayed in your screen, press "Print Screen" which normally should be next to the F12 button on the keyboard.
Open paint under menu option Accesories, and press Ctrl-V for paste. you should have a picture of the screen dump you did just now. Save the file as a .Jpg, unload it into a photo hosting site, and you can link to your post.


hope this helps... if you need more help, let me know

[Slinky]

Correction re: Mask Events. A Mask Event is Resmed speak and ResScan speak for what I think Respironics and EncorePro refer to as sleep sessions. If you had one Mask Event at 5 hours and then a second Mask Event at 1 1/2 hours you had two sleep sessions, you slept for 5 hours, took your mask off for whatever reason and then donned your mask and slept another 1 1/2 hours.

There is no way to adjust the volume of the Leak alert alarm. I sleep right thru it. God knows how but my friend spending the night in the bedroom below me could hear it. I just turned Leak Alert off.

Does the S8 II have the Mask Selection feature that the S8 does? If so, you need to use the Mask Selection for the Resmed mask you are using. If you are using a non-Resmed mask then you need to check the allowed vent rate for that mask at your 95th percentile of pressure and then set the Mask Selection to the Resmed mask setting whose allowed vent rate most closely matches your non-Resmed's mask. It is preferable that your 95th percentile leak remain 24 L/s or less, but your Resmed can compensate for up to 40 L/s. Beyond that your other data may not be accurate. I know from personal experience w/my Resmed S8 Elite that it could compensate for a large leak up to 1 cm higher pressure than my set pressure. If I remember correctly, my S8 AutoSet Vantage once compensated up to 1.4 cms of pressure higher than the top pressure I had set.

... Noted that a couple days my max pressure was 17.6 (place mouse on day and three numbers appear that I hope correspond to graphs on left). I thought the max pressure would be capped at 16 as that is how machine is set. ...

I'm not understanding just what you are referring to.

Keep in mind that EPR of 3 means that on expiration your Resmed is providing 3 cms less pressure than your lowest pressure setting of your pressure range. If you are trying to determine your best straight CPAP pressure you should turn EPR off as using it affects your 95th percentile reported pressure. EPR is destroying the effectiveness of your auto titrating.

The reason and idea for heated humidification is not to provide air that feels warm at the mask but rather water warm enough to provide the humidity level that is most comfortable to you w/o "rain out".

Have you tried generating a Report? Notice when generating a Report that you have the option of selecting what data you want to include: Detailed, Statistics, etc. When you save the Report you've generated, it is saved in pdf format. You can then post the pdf to photobucket and post it as an img here from photobucket.

[Slinky]

Its been a while - since 2007 or 2008 - that I've used my Resmed S8 AutoSet Vantage and I would have to dig to find my ResScan files which I just don't have time to do tonight or I would post a report pdf so you could clarify just what your question regarding the graphs is. I have to get to bed as I have an early appointment tomorrow.

[Big Daddy RRT,RPSGT]

Sorry about my mistake. Thanks for the correction Slinky. When the alarm volume and mask events were mentioned at the same time...."Mask events" is a weird way of reporting sleep sessions. I forgot about that.

In regards to EPR...If you own your own auto and intend to use EPR with a set pressure after finding your 95th pressure then leave it on. If you have borrowed an auto and you will go back to your pap unit w/o EPR you should leave it off. EPR can be very important for toleration. I don't like it myself but many do.

[Big Daddy RRT,RPSGT]

Would a forceful cough show up as a spike in pressure above your Max pressure setting?

[Slinky]

Good question, BigDaddy. Darned if I know the answer!! And I have had a couple of good coughs now and then w/mask & PAP on BUT its something I never thought to check for.

[speaker626]

Would a forceful cough show up as a spike in pressure above your Max pressure setting?

Slinky, my description wasn't very good. I'm frustrated w myself I can't describe it in writing so please let me try again. No, I haven't saved a report yet or copy screen to paint to ... because I am way too tired during the week. Anyway, I meant that my unit is set at a min of 8 something and max of 16. It's an S-8 auto set 2. So, in theory, the pressure should not go over 16. But, when I looked at the detailed graph (you can run mouse over each of the individual days and it gives you three numbers; max, 95th, med) I found a couple days gave me a max of 17 and change. It's hard to see on the actual bar chart number though I know a report should show this. Meaning, you could run a ruler from the top of the bar to the number, etc (or maybe I just have bad vision). Anyway, what I don't know is if the exact numbers the cursor lets you see would show in a report.

Someone noted that in theory the unit should NOT go over 16 if 16 is the max no matter what. End of story. Thus, I'm imagining things. But I'm saying "I think" mine really did. And, again, I base this on the specific numbers given for each day that I can see by putting my mouse on the specific bar chart area of a specific day in the "detailed" section. I know I have some 17s.

So pretend I am right and there really are 17s. The question becomes more of "did the unit actually throw more than 16 down the tube? I'm o.k. with that. I'm not really into rules anyway. This would just mean they might want to restate what Max means (i.e., Max means Max unless we deem it neccessary to exceed the max and this is exactly why we don't want you using the software. We are are under enough fire for using the totally ridiculous term "Mask Event" to mean Sleeping). Or, did the computer in the unit decide that (for whatever reason) a 17.6 was what was needed for that event to be correctly treated and thus simply recorded that number (to be seen in the detailed section and perhaps changes made by Doc, etc) yet did not physically/actually violate the no more than 16 max down the tube rule.

The coughing is interesting idea/potential cause. Still, I think I can solve this mystery by creating a massive apnea via breath holding and if the machine is trying it's best, it should get up to 20.

Big D, thank you. Yes, potential min max ideas were what I was trying to get help with.

On the EPR, yeah, I didn't need to mention it. I do happen to like it; breathing seems more natural.

[Slinky]

Look for a large leak at the high point of your pressure. The S8 II would be compensating for that high leak to an output of 17.6 to in an attempt to be providing you w/your 16 cms of therapy pressure at the mask.

[billbolton]

Still, I think I can solve this mystery by creating a massive apnea via breath holding and if the machine is trying it's best, it should get up to 20.

All APAP algorithms are entirely based on the concept that they need to deal with autonomous sleep breathing. What they do under other conditions is UNDEFINED BEHAVIOUR, for the algorithms, so you wont "solve" by holding your breath.

Cheers,

Bill