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Tformhals wrote:Pressure was set at 6-12 with an EPR of 3. I need to check out the auto ramp feature I was probably 5 minutes in and it had jumped to 12. So I turned the ramp time on to 15 mins and fell asleep. I didn't know it had an auto feature. Am I understanding correctly that the machine will ramp up but not back down?

Yes. The machine will ramp up from the beginning ramp pressure but it won't back down. Until you turn the machine OFF and back ON.

The machine WILL back the pressure all the way down to your minimum pressure setting if the breathing is exceptionally stable and there no events, snoring or flow limitations happening.

Since your titrated pressure was 8cm and you were using 8cm before, I'd suggest thinking about using these settings:

AutoRamp ON
Starting Ramp Pressure 6cm
Min Pressure 7 cm
Max Pressure 10 cm

See if the machine wants to go higher than 10cm when you are asleep. You can always increase the max pressure later if you need to.

As for EPR: Set it where you need to set it in order to be comfortable. Yes, it may be that you'll need a bit more pressure if you use EPR = 2 or 3, but you might not. If you can't tell any difference in comfort when you are trying to get to sleep, then sure, turn it off. But if you are UNCOMFORTABLE with EPR off, then turn it back on to a level that maximizes your comfort.

When your ramp ends the pressure does not automatically jump to max pressure. It will vary between 7 and 10 depending upon whether you are having events. It may run at 7-8 for a while and then jump when an event is starting...then it retreats back to lower pressure.. Without Sleepyhead it's only a guess as to what is happening while you sleep. It's possible that the 7 minimum is too low and the 10 is not high enough.

Ok so I probably don't have the data formatted right but I looked for a little bit to find the post on how it should be formatted and am not finding it. The gap at 3:30 is where I got up to pee. Was also where I had the most events previous to that. You can see where the pressure spiked in the very beginning while I was still awake. Going to try the autoramp feature to try to eliminate that.

Lots of good advice here. But one question from me, what does your sleepyhead report look like when you are on straight CPAP at 8cm

https://sleep.tnet.com/resources/sleepyhead/shorganize

without the snore, and flow limitation graph, we're only getting part of the picture. you saying you didn't fall asleep till 2am?

Uncle_Bob wrote:Lots of good advice here. But one question from me, what does your sleepyhead report look like when you are on straight CPAP at 8cm

First night with a data capable machine last night. So I don't know that yet I only know what my AHI has been. Which has been up and down as low as 1.8 and as high as 7 on average nights. It was higher when I had a cold between 16 and 22.

No i was asleep by 10 10:15ish and slept until 3:30 ish

Tformhals,

Looks to me like you didn't have the ramp on at the very beginning of the night---i.e. the period between 21:39 and 21:50 (around the time you turned the machine off and back on.) And you are correct, the pressure almost immediately increased from your min pressure setting of 6cm to your max pressure setting of 12cm. My guess is that there is activity in the Flow Limitation graph during this 10 minute period, but you didn't post the flow limitation graph.

It also looks like you DID remember to turn the ramp on when you turned the machine back on at around 21:50. Your starting ramp pressure is currently set to 4cm and it looks to me like you do not have AutoRamp set to ON since the ramping up starts immediately after you turn the machine back on at 21:50. The ramp increases slowly up to 6cm over about 15-20 minutes. My guess is that you did fall asleep during that time and after that, the pressure remains at your min pressure = 6cm for the next 40 minutes or so because the machine sees no reason to increase the pressure. There's a small pressure increase at 22:50, most likely due to flow limitations that we can't see because you didn't show the flow limitation graph.

Starting at 23:20 we see the normal reactions of a Resmed AutoSet in the presence of a couple of events, most likely accompanied by either snoring or flow limitations.

Things get really bad a little after 2:00AM and they stay bad all the way to when you turned the machine off around 3:30. Any ideas what the heck happened between 2:00 and 3:30??

You turned the machine back on without using the ramp around 3:30, but my guess is that you either fell back asleep pretty quickly or your wake breathing was more regular than it was at the very beginning of the night. The pressure increase between 4:00 and 4:40 is most likely caused by flow limitations or snoring or both since there are no events scored during this time frame.

Always using the ramp would prevent what happened to you at the beginning of this night.

I'll add: I thought that if the ramp was enabled on a Resmed machine that it came on as soon as the machine was turned on. I apparently am either misremembering the way my S9 behaved several years ago OR the new AirSense machine's ramp works differently than the S9's ramp. Hopefully someone like PaleRider, Pugsy, or another Resmed user can come along and set me straight on how the ramp works on the AirSense machines.



Here's the data you linked to:

I posted a new screenshot with the data arranged according to this https://sleep.tnet.com/resources/sleepyhead/shorganize. How do I embed the photo so it shows up without having to click on it?

Edited to add that I got it figured out

Tformhals wrote:

Uncle_Bob wrote:Lots of good advice here. But one question from me, what does your sleepyhead report look like when you are on straight CPAP at 8cm

First night with a data capable machine last night. So I don't know that yet I only know what my AHI has been. Which has been up and down as low as 1.8 and as high as 7 on average nights. It was higher when I had a cold between 16 and 22.

You might consider backing the bus up and starting at CPAP 8cm with your data capable machine as a starting point and then go from there, while concentrating on getting your leaks under control. In my opinion there should not be any reason to use ramp or EPR at just 8cm. Just my opinion

Tformhals wrote:I posted a new screenshot with the data arranged according to this https://sleep.tnet.com/resources/sleepyhead/shorganize. How do I embed the photo so it shows up without having to click on it?

read the second and third page that's linked at the bottom of the page above.

Tformhals wrote:http://imgur.com/a/tXfDP

This set of charts doesn't contain what we're looking for.

You can turn specific graphs on and off by using the pull-down (pull-up?) menu at the far right LOWER corner of the detailed data window in SleepyHead. Each graph name has a bar that is either RED (off) or GREEN (on).

You need to turn the following graphs ON and everything else OFF and then resize the graphs if necessary so that these graphs are all visible at the same time:

The Event Chart
The Flow Rate graph
The Pressure Graph
The Snoring Graph
The Flow Limitation Graph

We've already seen the Leak graph and it does show some evidence of leaks between 2:00 and 3:30, but they stay below the 24L/min mark for the most part. It looks like your mask may have sprung a leak by getting dislodged during this time frame. I don't think it looks like mouth breathing, but others may beg to differ.

Got it I think