Asking for a relative: What changes to settings for Resmed S10 AirSense 10 AutoSet?

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The change in pressure, especially changes that rapid, are causing a sleep disaster.

The machine doesn't increase the pressure without what it thinks is a good reason to go up in pressure.
Ever think that maybe what the machine is wanting to go killing with more pressure might be a causing the wake ups?
A lot of time people blame the pressure increases for waking them up when it actually is whatever is causing the pressure to go up that is the real culprit.

Does your relative complain of any nasal congestion at all?

The ramp is slow or appears slow simply because all it is doing is going from 4 to 5 ....it doesn't treat anything or record anything during the ramp period. Most people shouldn't even need ramp when the minimum pressure is 5 cm.
Is your relative actually asleep at the end of the ramp period? It appears that the ramp time is set for close to the max of 45 minutes.

How long does it take him/her to actually fall asleep?
There might be all sorts of stuff happening apnea wise and flow limit wise during the ramp period that isn't getting flagged.

The detailed nightly report is much better report to use to try to evaluate what is going on during the night.
This particular report is missing a lot of setting details.
See this thread for what we like to start with.
viewtopic/t158560/How-to-post-images-for-review.html

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He wakes after the pressure rises, but NOT because it does, but because of whatever caused it to go up.

I don't think you should be interpreting things for your relative, yet, anyhow.

Go with Pugsy's reading and wait til she has more to say... follow her suggestions and/or ask for more if necessary.

Yes...it does appear he wakes up after the pressure goes up but at this point it's the "why does it go up" that is more worrisome because the "why" could also be the cause of the wake up.

You may or may not see a definitive reason for the increase in the flow rate or even flow limitations and the fact that absolutely nothing gets recorded during ramp means all that goes on during ramp is hidden from viewing.

The machine is setting essentially a new minimum pressure for some reason and it's a quite high new minimum pressure. The airway is restricted or it wouldn't be doing what it is doing. The periods of actual usable data are very short because of the ramp being so prolonged. Now why it is happening...million dollar question right now.

Obviously he needs to sleep longer and have more consolidated blocks of sleep. He probably feels like crap just from poor sleep if nothing else.

Some things to check out...sleeping position first...does he spend much time on his back....then does he do a lot of what we call "chin tuck" in whatever position he sleeps in? Chin tuck..chin down more towards the chest area...does his bed pillow sort of push his head in a position that puts the chin closer to his chest. Both supine sleeping and chin tuck can cause the airway to be more restricted/smaller and need more pressure. His flow limitations are active but I have seen much worse so I don't know that FLs are the entire problem here.

There's no way I would make pressure change recommendations without more information. I don't like guessing and I simply won't do it when there is some data available AND I get some questions answered. It's not in the patient's best interest.
I assume no in lab sleep study was done using cpap to figure out optimal pressures????
I do trust the machine to auto adjust properly per the auto adjusting algorithm though. It goes up for a reason so I first look for the reason and then we decide if the reason warrants continued trial or do we reign it in a bit. I just don't see that little bit of FL activity being 100% of the reason. I could be wrong but I just don't see it based on what I have seen on thousands of other FL graphs and pressure responses.

I assume he's using a full face mask if he has known nasal issues??? Is this correct? Sometimes the position that some full face masks end up putting the jaw in will cause a need for more pressure. Sometimes they actually make chin tuck worse.

So...if going by what is shown on this report...his minimum needs to be up around 15 and the max probably at 20 and I know that's what you don't want to hear and I doubt he would want to do that but I can't offer anything else without a lot more history and information.
If you want to advise him to restrict the max even more...I can't support it because I don't have enough information at this point.

His machine is hitting the max of 15 for a reason and pretty much staying up there and likely wants to go higher and it wouldn't be impossible for the reason that the machine wants to go higher is causing the wake ups.
If nothing else...the maximum needs to be increased to 20...the machine is setting its own new minimum anyway and doing it fairly quickly.
If you restrict the max to a lower number then whatever the machine is wanting to kill with more pressure is likely to still happen and it might cause more wake ups...if that's possible here.
Ramp time needs to be reduced though.

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Only thing I would suggest now without more in depth information.
Shorten the ramp time A LOT. We just don't know what is happening during ramp and it might be important to know.
Increase the max to 20 and see what happens.

Also need some other history questions answered...Medications, other health history, stuff like that. I always like to look at the big picture and not just numbers because numbers don't always tell us a complete story.
Case in point here...AHI numbers point to good therapy results but his sleep quality doesn't and good numbers don't guarantee good sleep.
I have that problem myself but in my case I know why my sleep quality is less than ideal and it's not from anything related to the machine or my therapy. I wish it were because it would be much easier to fix if it were machine or apnea related. I get to die for good numbers but I also wake a lot during the night....but my reason for wake up is simply pain...good old arthritis pain. Some nights I win the battle and feel fairly decent during the day and some nights the pain wins the battle and I feel like crap during the day. Welcome to the joys of getting old.

You were right about one thing...his sleep cycles are so short he's not getting enough of any stage sleep most likely and that's a recipe for disaster. He's simply not sleeping long enough to transition through the various sleep stages and we need them all and in normal percentages to have any chance in hell to feel better. It's not just the probable lack of REM going on here...it's messed up sleep cycles all the way around. He's probably not getting the sleep stage before REM either or if he does then it's not enough most likely.

dpeterzell wrote: ↑

Thu Dec 31, 2020 9:33 pm

That’s really interesting. Well the AHI, as diagnosed by your machine (not always the best measure), looks really, really good. It’s really low, and even lower than what I get. The fact that it seems to be working so well at very low pressures seems to indicate that your obstructive sleep apnea is very mild at worst, and that the low pressures are treating it.

The night you showed is a disaster, lots of wakups, lots of resets, starting pressure WAY too low.

a minimum of 11 max of 20 would be better starting points.

dpeterzell wrote: ↑

Thu Dec 31, 2020 9:33 pm

BUT that rapid shift in pressure after the slow ramp up is KILLING your sleep.

No, the apneas are what's killing sleep, because the starting pressure is FAR too low.

dpeterzell wrote: ↑

Thu Dec 31, 2020 9:33 pm

it is making it impossible for you to get much REM sleep, too.

Right end result wrong cause.

dpeterzell wrote: ↑

Thu Dec 31, 2020 9:33 pm

Look at what happens during the slow ramp up in pressure whenever you start up the machine (i.e., every time you stop and re-start the machine). You seem to sleep really, really well at those low pr
essures.

There's no evidence of that, at all. More likely, they're not asleep at all.

dpeterzell wrote: ↑

Thu Dec 31, 2020 9:33 pm

If there are events that are causing it to shoot up so high, then I don’t see them in what you sent. So the machine, stupidly, is blasting you with pressure that is waking you up. It's no wonder you keep waking up during the night.

No, the machine isn't stupid.

dpeterzell wrote: ↑

Thu Dec 31, 2020 9:33 pm

The change in pressure, especially changes that rapid, are causing a sleep disaster.

Disaster, yes, but not for the reason you assumed.

Get your friend in here, get them to post some normal screenshots, the "sleep report" pdf sucks.

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Given your friend has been using CPAP a while, ramp and such a low ramp pressure is probably not as critical.

As Pugsy stated 45 minutes is a long time for only 4-5 CM of pressure with no monitoring.

Another consideration is for him to try AutoRamp, with a higher ramp pressure, closer to his therapy minimum anyway.

AutoRamp will attempt to determine if you're asleep and then switch to therapy mode. Unlike timed ramp, AutoRamp will monitor you and switch to therapy mode if required.

AutoRamp will switch to therapy mode under the following conditions:

• 30 breaths of stable breathing (this is the believes you're asleep threshold)
• 30 Minutes since starting machine
• 5 consecutive snore breaths
• 3 obstructive apneas or hypopneas within 2 minutes

When I was using the AutoSet, I loved the AutoRamp. *For me*, it did a great job of determining when I was asleep and I could look at my previous night and tell how long it took.

So assuming your friend takes palerider's advise on setting minimum pressure to 11, and ramp is important to him. I would turn on AutoRamp and set the ramp pressure to 7-9 or whatever your friend is comfortable with.