CPAP Ramp Pressure start

[SirGaspAlot]

So what were the event category totals and the number of hours used?

The bathroom breaks...probably related to the ANP stress hormone and if/when the apnea events get reduced and thus reducing the stress hormone in your blood stream then if the sleep apnea events are the lone cause of the nocturia...it should go away.

There's a very small chance that if the OAs and hyponeas along with any snores, FLs or RERAs (the obstructive stuff) is better prevented that the number of centrals will also reduce.
Fix or try to fix a known problem (in this case the obstructive stuff) with the machine you have and cross your fingers that you get lucky and the central stuff that this machine can't fix will reduce in number.
It's a big maybe...but hey, at this point you don't really have anything to lose.
Tackle a known problem that is fixable with your machine and see what problems are left over that we can't fix with this machine. I have seen this idea work..not often but I have seen it work so it's not totally impossible.

Thank you, pugsy, I will post a Sleepyhead report later when I get home with all that in there. Dreamapper is great to a degree but it doesn't show all that. I wish it did.

[palerider]

I am on a Govt computer at work, so theres understandable restrictions on what can be loaded,

Simple solution, post from home.

[palerider]

Do you understand that for 20 mins you've lessened your therapy (of a whole 6 cm of pressure) by that time? Six is so low that even with no ramp time at all you're still getting relatively little therapy, let alone having curtailed what you might get by 20 mins. Why are you so afraid to abandon the ramp altogether (or at least shorten the time greatly) and/or raise your min. pressure by at least 1-2 cms?

Because theres no setting for that on dreamstation patient settings. There is no option to turn it off altogether. The choices are 2/4/5/6. I begin at 6. Same as starting at my beginning pressure anyway. Not sure where you were going with that.

Two things, you disable the ramp completely from the clinical menu, just set ramp time to zero.

Second, I believe that the only time ramp works on a respironics machine is when you hit the ramp button.

Don't hit the button.

[SirGaspAlot]

Gotcha. Another dumb question, has anyone ever gotten into any issues with the DME after resetting these? I did make the pressure changes myself to the levels the Dr. prescribed, and I did explain that to them, but then emails went dormant since. Is that a touchy thing?

I'm no nerd, but I can be just savvy enough to tweak things here or there behind the scenes.

[palerider]

Gotcha. Another dumb question, has anyone ever gotten into any issues with the DME after resetting these? I did make the pressure changes myself to the levels the Dr. prescribed, and I did explain that to them, but then emails went dormant since. Is that a touchy thing?

I'm no nerd, but I can be just savvy enough to tweak things here or there behind the scenes.

Depends on the DME, there's the control freaks who think they're in charge (they're not), and then there's the ones that accept reality "ok, whatever works for you".

The DME is just .... walmart. they sell you shit. No matter what kind of airs they want to put on themselves.

[SirGaspAlot]

Then that's my approach. I mean, if they sold you a set of crutches and one of the wingnuts fell out and it folded up making it hard to walk I sure as hell am not going to wait for them to come to the door to fix it. Perhaps that's why the eerie silence. I'm good with that.

[palerider]

Then that's my approach. I mean, if they sold you a set of crutches and one of the wingnuts fell out and it folded up making it hard to walk I sure as hell am not going to wait for them to come to the door to fix it. Perhaps that's why the eerie silence. I'm good with that.

Yeah, how would you feel if they said "YOU CAN'T ADJUST THE HEIGHT ON THOSE! IT'S AGAINST THE LAW!"?

Or told you that it required a doctors orders before you padded the tops that were digging into your armpits?

[SirGaspAlot]

I know you had a crap load of CAs/centrals last night..
How many OAs and hyponeas and FLs and snores did you have?
If giving me total numbers...give me total hours of use also..
or give me hourly averages and was there in dense clustering of OAs and hyponeas?

Heres my Sleepyhead data from last night. I cant imagine how my oxygen levels were. Totals are in the usual location in Sleepyhead. My CAs are whats exhausting me.

[Pugsy]

Roughly 1/3 of last night's AHI was obstructive in nature (the OAs and hyponeas).
You have omitted the Events graph and included the snore graph...the Events graph is more important and it includes the snores anyway but no need to redo this image.

The only real difference in this new setting is fixed PS at 4 instead of auto adjusting bilevel at 2 to 4.
The max IPAP difference...doesn't really matter because it doesn't look like you ever come close to it at least last night.

My idea...try to reduce the obstructive stuff with a little more EPAP and IPAP.
When you increase EPAP that forces IPAP up when in auto mode.
So at some point consider trying 7 minimum EPAP (keep everything else the same) and even 8 minimum EPAP. That will force IPAP up by 4 cm...show initially 7/11 and 8/12 and keep PS at 4.

I don't think PS is the cause of your centrals and I don't think messing with PS is the answer in your situation.
Besides...I like to keep all variables to a minimum whenever possible.

The idea behind this...more EPAP/IPAP to reduce the obstructive stuff and maybe..just maybe...some of those centrals are post arousals and the arousals are maybe related to the Obstructive stuff. Yeah...I know a lot of maybes but it's not totally impossible.

Your choice of course.
My gut feeling is you need ASV but you aren't going to get an ASV tomorrow...and might as well try something. It's better than twiddling your thumbs.

[SirGaspAlot]

I must be nuts, I think I understood all of that and why. You guys are awesome.

I have a followup with my Dr. On 8/11 and I'm going to show them everything. Will see how it goes, but by then, if it isn't done, I'm going to start tweaking this thing.

I also duked it out with my DME over backup battery for my Dreamstation since we've been having a lot of outtages here lately, the wife and I called the insurance ourselves and found out since its a bipap that its covered, they really believed its a luxury, but certainly not on a bipap, so that looks like its getting resolved.

[SirGaspAlot]

So it appears my Obstructive Apnea are dropping like crazy but the centrals are climbing. Is this the typical pattern when they eventually go away? The obstructive dropped to almost nothing last night and I'm sporting a cold and sinuses are acting up. *8Edit**- My mistake, I had 15 Obstructive events and 60 Centrals, my eyes must not have been seeing too well this morning. Still, this seems to be the pattern.

[Pugsy]

I'm sporting a cold and sinuses are acting up.

Data obtained when we are ill can't be relied upon as meaning much of anything. We have to just shrug our shoulders and ignore it all and move on to when we aren't ill.

Are you sure it is a typical cold and not the nasal mucosa acting up because it doesn't like whatever humidity setting you are using.

[SirGaspAlot]

Sore throat, still, I suppose it could be. Hopefully not a long duration, I'll get back when its gone.

[D.H.]

The ramp is a comfort feature, not a "clinical" feature. Therefore, you can set it to whatever you like best. If the pressure doesn't bother you, you should disable it entirely.

Note that Respironics has a "Smart Ramp" feature and ResMed has an "Auto Ramp" feature. These are the same concept, though the implementation might vary. The idea is that if you fall asleep or have breathing difficulties during ramp time, the ramp accelerates to full pressure sooner that it would otherwise.