djam's therapy thread

[djams]

oh, i feel ya, bro. i've been here for three years. as a newbie, of course, i knew nothing. but it was always in the back of my mind that i'd give back. i had in mind that i'd someday understand all the technical gobbledygook that gets posted here. alas, that day never came. and likely never will.

but when pugsy took her annual vacation this year, i noticed that some of the new users' first post weren't being answered. so i took it upon myself to just welcome them. and offer some small crumbs of advice.

i try to remember what it was like when i first got here. i try to reassure people that they CAN do this. and i realized in it all that i DID know some stuff.

i'll never be the equal of lsat, chicago granny, pugsy or palerider. but i can at least chime in with the nickle and dime stuff.

you can do that too, once you feel you're ready!

Thanks for the encouragement. I'll tell you what: if I run across a thread where pugsy has stated that the OP has a "strong positional aspect" in their SH charts and recommends side sleeping, I'll throw out some pillow some pillow recommendations. Can't cause any harm there!

[djams]

I'm struggling with this. I want to help, but know that I don't have the knowledge necessary in most cases and have no business giving advice.

That, right there, puts you head and shoulders above people that have no friggin clue as to the limitations of their knowledge and understanding. They read something, misunderstand it, and then think they're the expert on the subject.

I don't want to come across like a know-it-all when I'm clearly not. Very easy to lose credibility. So... the struggle continues.

You sound wise.

Thanks palerider, that means a lot coming from you. Credibility is important to me even in this nameless faceless forum. Instilled in me by my dad.

And I do know that when I goof, you'll be there to correct me! That's actually a comfort. Heck pugsy too, she straightened me out on a particular aspect of a "for her" chart over the weekend.

[palerider]

I'm struggling with this. I want to help, but know that I don't have the knowledge necessary in most cases and have no business giving advice.

That, right there, puts you head and shoulders above people that have no friggin clue as to the limitations of their knowledge and understanding. They read something, misunderstand it, and then think they're the expert on the subject.

I don't want to come across like a know-it-all when I'm clearly not. Very easy to lose credibility. So... the struggle continues.

You sound wise.

Thanks palerider, that means a lot coming from you. Credibility is important to me even in this nameless faceless forum. Instilled in me by my dad.

And I do know that when I goof, you'll be there to correct me! That's actually a comfort. Heck pugsy too, she straightened me out on a particular aspect of a "for her" chart over the weekend.

Awe, you're gonna make me blush!


Everybody makes mistakes. When I'm training someone, I typically tell them that "if you're not making a few mistakes here and there, you're not trying hard enough... just *learn* from your mistakes, and don't repeat them!

[zonker]

Thanks for the encouragement. I'll tell you what: if I run across a thread where pugsy has stated that the OP has a "strong positional aspect" in their SH charts and recommends side sleeping, I'll throw out some pillow some pillow recommendations. Can't cause any harm there!

[djams]

I just watched this great ResMed video that was linked in another thread: https://www.youtube.com/watch?v=-gie2dhqP2c

I no longer feel that my pressure settings are optimal. Happy with my AHI numbers, but I'd like input on taming my flow limitations. The FL chart in the screenshot below is somewhat typical for me, a little on the low side as far as # of FL's. On this night, 7 RERA's, all associated with significant FL's, as described in the video. I have been in the habit of shrugging off RERA's as no big deal, because they don't fully wake me up. I feel differently now. During the past 2 weeks, I've had 4 nights with 6/7 RERA events.

Pretty sure the answer here is more minimum pressure. But I learned over the weekend about how EPR lowers the effective min pressure, so I'm looking for advice on how to adjust. Reduce EPR or raise minimum pressure? A little of both? Does it even matter?

I've been using my current settings for a full 2 weeks, I think that's a good baseline. Ready to work this problem. Please advise.

[Okie bipap]

I brought my flow limits under control by raising my pressure. When my wife first started treatment, they started her out at a low pressure and increased it slowly over a six month period. She started having a lot of central events and they were trying to keep them under control until she could adapt to the higher pressure. Once they got her pressure optimized, the flow limits settled down quite a bit. She still has flow limits, but they are not like they were at the lower pressure. My flow limits are much less since I raised my pressure to a minimum of 17.

[Pugsy]

More pressure is indeed the answer and there are multiple ways to accomplish that goal.
Pick your poison.
Actually I suggest trying all the options ...each for a week and see which option lets you feel like you sleep better and feel better in general.

[Okie bipap]

I learned early on that you make changes based on trends, not one night observations. I always went at least one week between changes and often went longer.

[djams]

I brought my flow limits under control by raising my pressure. When my wife first started treatment, they started her out at a low pressure and increased it slowly over a six month period. She started having a lot of central events and they were trying to keep them under control until she could adapt to the higher pressure. Once they got her pressure optimized, the flow limits settled down quite a bit. She still has flow limits, but they are not like they were at the lower pressure. My flow limits are much less since I raised my pressure to a minimum of 17.

Thanks Okie. I figured as much. If you've followed this thread you know that I don't do well with large pressure increases. I've been sneaking up, and was ready to stand pat until I watched the video, which got me reassessing my RERAs in SH. Also did a little test a bit ago - pressure up, EPR down. And was reminded just how much I like EPR. So unless someone comes along with a compelling reason, I'm just going to up the min pressure, and keep an eye on the centrals. I'm presently sitting at 10.2, starting today I'll resume the slow march upwards. I've got it set to 11 for tonight.

[djams]

More pressure is indeed the answer and there are multiple ways to accomplish that goal.
Pick your poison.
Actually I suggest trying all the options ...each for a week and see which option lets you feel like you sleep better and feel better in general.

Pick your poison indeed! As I respect your input so much, I believe I'll do just what you suggest- pressure this week, EPR next. Maybe next week, maybe longer - we'll see how it goes

[djams]

I learned early on that you make changes based on trends, not one night observations. I always went at least one week between changes and often went longer.

Agree 100% - I went through the dial winging thing. Counterproductive.

[Pugsy]

I like EPR so much that I would also do the minimum pressure first.
And depending on what I felt like with the EPR reduction experiment...I might not even make it a week with it.
I love EPR/pressure support. The AirSense 10 AutoSet would be perfect for me if it would give me EPR at 4 instead of 3 max that I am now using.

[djams]

I like EPR so much that I would also do the minimum pressure first.
And depending on what I felt like with the EPR reduction experiment...I might not even make it a week with it.
I love EPR/pressure support. The AirSense 10 AutoSet would be perfect for me if it would give me EPR at 4 instead of 3 max that I am now using.

Same for me! I will give it an honest try when I get there though.

[palerider]

Pretty sure the answer here is more minimum pressure. But I learned over the weekend about how EPR lowers the effective min pressure, so I'm looking for advice on how to adjust. Reduce EPR or raise minimum pressure? A little of both? Does it even matter?

Higher min pressure and lower EPR both have the same effect on pressure when not inhaling. If you like EPR then the answer is clear, raise minimum.

[djams]

Higher min pressure and lower EPR both have the same effect on pressure when not inhaling. If you like EPR then the answer is clear, raise minimum.

Pugsy, I just got a pass from the principal on the EPR assignment. Thanke PR.