Help with Pressure Settings for New APAP User

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: Help with Pressure Settings for New APAP User

Post by Pugsy » Sun Sep 12, 2021 7:54 pm

ApexAZ wrote:
Sun Sep 12, 2021 7:35 pm
Calm down, chief.
Make no mistake.....this is calm.

You haven't seen me riled up yet but you don't know near as much as you think you do.

Have a nice day. GFY
ApexAZ wrote:
Sun Sep 12, 2021 7:40 pm
Just because it was a nurse doesn't mean they didn't get the titration right
Did you miss the part about there not being any titration sleep study being done????

And now is where I tell you to stop hijacking this thread and arguing.
You stated your point of view...that's fine but you need to accept the fact that people don't agree with your point of view and move on. Other people get to have their point of view as well.

What I won't allow is further derailing and arguing in this thread. It isn't helping anyone to continue this bullshit.
Further such chit chat will be promptly removed....you are new here but everyone knows I give one warning only and you just got yours.

My apologies to the OP for letting it go this far and my part in the ugly. It won't happen again.
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Re: Help with Pressure Settings for New APAP User

Post by palerider » Sun Sep 12, 2021 8:00 pm

ApexAZ wrote:
Sun Sep 12, 2021 11:31 am
I don't think it's a good idea to just adjust settings without consulting a doctor, personally.
Then you're in the wrong place.

Please go away while Pugsy (who is not a him, you presumptive jerk) is still being nice.
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el344
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Re: Help with Pressure Settings for New APAP User

Post by el344 » Mon Sep 13, 2021 8:27 am

Last night's OSCAR data. I'm horrified by the massive clusters of apneas, but I am heartened by the 5 relatively long periods with no obstructive apneas and relatively few central apneas.

At his request I bumped the minimum pressure up to 9. Tonight I'm going to try to persuade him to let me turn the max up to 13.2. Baby steps, but still steps. He is still committed to making this work.
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Re: Help with Pressure Settings for New APAP User

Post by Pugsy » Mon Sep 13, 2021 8:52 am

At some point I would suggest at least reducing EPR a bit. It might reduce the central clustering.
While the really dense clusters could maybe be related to the OA clusters causing arousals there are the 2 smaller central clusters at the beginning of the night with no real OAs associated with them that does make me a bit worried.
I don't know how many or even if any of those centrals are related to EPR but there is a chance some of them are and that's why I would like to see how much of an impact (if any impact) reducing or turning off EPR might have.

If he needs EPR to be comfortable there is a setting available where EPR is available in ramp only and then we make use of the ramp feature.

I have seen reducing EPR/PS cause marked reduction in centrals. I have a friend who gets about 15 centrals per hour with PS (think EPR) of 4 and essentially none with PS of 3. Now I don't know if the same would hold true for your husband but it wouldn't be impossible and certainly worth trying.
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Re: Help with Pressure Settings for New APAP User

Post by palerider » Mon Sep 13, 2021 9:35 am

el344 wrote:
Mon Sep 13, 2021 8:27 am
Last night's OSCAR data. I'm horrified by the massive clusters of apneas, but I am heartened by the 5 relatively long periods with no obstructive apneas and relatively few central apneas.

At his request I bumped the minimum pressure up to 9. Tonight I'm going to try to persuade him to let me turn the max up to 13.2. Baby steps, but still steps. He is still committed to making this work.
Raising the min helps, you may be getting close to a reasonable min pressure. Right now, his effective min pressure is *6*, because of EPR adding a minus 3 to the min pressure, getting the effective min up to 8 may smooth out the jaggies. (that would mean a set Min of 11.

He really needs to understand that during some times, (possibly REM sleep?) he needs *more pressure* to be able to hold his throat open and let him breathe. that higher pressure (which will happen while he's asleep will help keep him asleep.

There's no way to even guess how much more pressure is needed, it might be only a couple of CMs, but we can't know until he lets you stop restricting the machine's ability to treat the apneas.

Keep at it :)
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Re: Help with Pressure Settings for New APAP User

Post by Okie bipap » Mon Sep 13, 2021 2:00 pm

el344 wrote:
Mon Sep 13, 2021 8:27 am
Baby steps, but still steps.
The only thing I can offer at this time is encouragement. It sometimes take a while to get things regulated where it will work. When my wife started, she had a hard time getting the pressure right. We were seeing the sleep lab every two weeks for quite a while. It took four months before they got her pressure adjusted properly. I offered to adjust it for her, but she said she would rather have them do it. She has had her machine for three and a half years now, and is doing fine with it.
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el344
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Re: Help with Pressure Settings for New APAP User

Post by el344 » Fri Sep 17, 2021 9:54 am

Progress is being made, in small increments. He's tolerating a high pressure of 15 with a minimum of 10. Still way too many central apneas in clusters. I think some of the issue is positional, but he's both a side sleeper and a back sleeper and I have no idea which position he's in at what time. We have elevated the head of his bed, which has improved his reflux and may have improved his AHI. He has agreed to start reducing the EPR value until we get it down to zero.

As always, all suggestions are welcomed.

And can I just say a huge thank you to all who have worked on OSCAR!
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Re: Help with Pressure Settings for New APAP User

Post by Pugsy » Fri Sep 17, 2021 10:30 am

Proceed with the attempted reduction in EPR so we can get an idea if EPR is a factor (or not) in those centrals.
Reducing EPR will also effectively increase the pressure overall a bit which is obviously needed.
So try a 1 cm drop in EPR....or try EPR only during ramp and make use of ramp feature (either manual or auto ramp if you think he can get to sleep within 30 minutes).

Also can you give us a zoomed in segment of those centrals? Particularly interested in the central cluster starting after the obvious break in therapy at around 03:30.
Try this...click on the events tab on the left side...then click on the CA/central category....scroll down until you see the 03:30 (or close) time frame....highlight and click on the 3rd flagged event after the break in therapy...click on that event.
All the graphs will change scale and that 3rd flagged event will more or less be in the middle.
Grab us a screen shot of that image and DON'T change the scale from what clicking on that one event gives you.

I want to see the very beginning of when the flow rate starts when the machine was turned back on on the immediate left side. 3rd flagged event should show both the blank space when machine was off and the flow rate associated with a few events. I suspect a chunk of the flagged events are awake breathing flagged events and if that is the case then at least some of them can be ignored.
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Re: Help with Pressure Settings for New APAP User

Post by el344 » Fri Sep 17, 2021 12:13 pm

Wow! The zoom stuff is way cool.

I did the third event after 3:30 and also the event at 3:30 itself. I wonder if all this is connected to his COPD in some way.

Thank you for looking at this.
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Re: Help with Pressure Settings for New APAP User

Post by palerider » Fri Sep 17, 2021 1:59 pm

So, yes, the minimum pressure is too low (it's effectively 8, due to EPR), and you see where the pressure gets down, then he starts having apneas, the pressure goes up but he keeps having clusters, likely until he's awake enough to move around or something and get them stopped.

Raising the base pressure, either through raising the Min pressure, or decreasing EPR (or both) will likely alleviate that, he may only need a couple more cms of base pressure to get things more under control, and if we can control the initial apneas, that might prevent the clusters, and will keep the machine from needing to go up as much in the first place.

Pugsy and I agree (we agree on most suggestions about improving therapy) that decreasing the EPR *may* cut down on the centrals, the overall number isn't too worrying, but the extended clusters of them can result in oxygen desaturations, but dropping EPR is an easy thing to try. The reason that EPR can cause problems is that the more of a difference between the inhale pressure and exhale pressure, the more it ventilates the user, and the more ventilation, (the greater Tidal Volume, ie, the volume of each breath) the more CO2 is blown off. CO2 is what drives the desire/need of your body to breathe, and if you blow off too much, your body just won't feel any need to breathe for a number of seconds, and sometimes that's long enough for the machine to flag a central apnea. Centrals aren't worrying unless there's a bunch of them in a row, they're not stressful like obstructives are, where he's fighting to try and breathe.

If you could right click on the vertical "Flow Rate" words on the chart, then select X-Axis, pick 'override' and set the numbers from -60 to 60, it'll make those zoomed in screenshots much more meaningful.
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Re: Help with Pressure Settings for New APAP User

Post by zonker » Fri Sep 17, 2021 4:10 pm

palerider wrote:
Fri Sep 17, 2021 1:59 pm


Pugsy and I agree (we agree on most suggestions about improving therapy)
yup.

the only time i read of disagreement between you to is when you want to make a BIG pressure change and pugsy wants to make a MINOR pressure change.

but that's just down to how each of you roll in life and i've never seen it where one of you says raise pressure and the other is against it.
8)
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Re: Help with Pressure Settings for New APAP User

Post by el344 » Fri Sep 17, 2021 4:19 pm

palerider wrote:
Fri Sep 17, 2021 1:59 pm
If you could right click on the vertical "Flow Rate" words on the chart, then select X-Axis, pick 'override' and set the numbers from -60 to 60, it'll make those zoomed in screenshots much more meaningful.
I found how to reset the Y, but the X eludes me.
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Re: Help with Pressure Settings for New APAP User

Post by ChicagoGranny » Fri Sep 17, 2021 4:47 pm

el344 wrote:
Fri Sep 17, 2021 4:19 pm
I found how to reset the Y, but the X eludes me.
The x scale is changed as you zoom in and out.
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Re: Help with Pressure Settings for New APAP User

Post by palerider » Fri Sep 17, 2021 10:22 pm

el344 wrote:
Fri Sep 17, 2021 4:19 pm
palerider wrote:
Fri Sep 17, 2021 1:59 pm
If you could right click on the vertical "Flow Rate" words on the chart, then select X-Axis, pick 'override' and set the numbers from -60 to 60, it'll make those zoomed in screenshots much more meaningful.
I found how to reset the Y, but the X eludes me.
Sorry, I meant Y axis, apologies.
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Re: Help with Pressure Settings for New APAP User

Post by palerider » Fri Sep 17, 2021 10:23 pm

zonker wrote:
Fri Sep 17, 2021 4:10 pm
palerider wrote:
Fri Sep 17, 2021 1:59 pm


Pugsy and I agree (we agree on most suggestions about improving therapy)
yup.

the only time i read of disagreement between you to is when you want to make a BIG pressure change and pugsy wants to make a MINOR pressure change.

but that's just down to how each of you roll in life and i've never seen it where one of you says raise pressure and the other is against it.
8)
We each usually end up in the same place, I'm just trying to get there sooner ;)

You see how it's much easier to tell what's happening in the breathing since it's not all squished.
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