Get to play Doctor

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Sircadian
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Get to play Doctor

Post by Sircadian » Fri May 15, 2015 11:27 am

Recently the wife failed a sleep test with an AHI of 8.5 , now she is on a loaner, AirSense 10 Autoset for Her, for 2 weeks. Wife mentioned to her contact at the sleep clinic that I was a bit anal about my therapy and that I utilized software to adjust my own machine. They laugh. Sleep center called the wife yesterday to see how she was doing, this is approx. 1 week after she started. The contact reads her results remotely and was quite surprised I hadn't changed the settings. Again, they laugh. Initially the wife had told me to keep my paws off her test and I was respecting that request. After hearing the contact's surprise, the wife mentioned, that it may be alright for me to fiddle with the settings. Contact even suggested a number to her that I might try. It was the same one I had contemplated (straight CPAP) as her permanent machine will be an S9 Elite (data capable).

Okay, so last night I played Doctor and adjusted the wife's pressure settings without her knowing. I laugh. She woke up cussing her results. Contact and me fail our experiment. Nobody's laughing.

Yes, this is only one night, but I was surprised at the slight increase in AHI. So, what I will do is post one of her nights before my fiddling and ask others here, with more experience, to see what they might try. Tonight I will secretly adjust again because my initial attempt tells me I'm no doctor Wife is unaware and I'm going to keep it like that while experimenting.

Her first week average AHI was ~1.75, here is one of her worst that I couldn't beat with my fiddling.
Image

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Last edited by Sircadian on Fri May 15, 2015 12:45 pm, edited 4 times in total.

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Krelvin
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Re: Get to play Doctor

Post by Krelvin » Fri May 15, 2015 11:59 am

Sircadian wrote:now she is on a loaner A10 for 2 weeks.
It is according to the chart an AirSense 10 Autoset for Her. There really is no such thing as an A10. AutoSense 10, AirCurve 10, AirStart 10 all would match A10 and there are several models of each class and they are different types of machines.
Yes, this is only one night, but I was surprised at the slight increase in AHI. So, what I will do is post one of her nights before my fiddling and ask others here, with more experience, to see what they might try. Tonight I will secretly adjust again because my initial attempt tells me I'm no doctor Wife is unaware and going to keep it like that while experimenting.

Her first week average AHI was ~1.75, here is one of her worst that I couldn't beat with my fiddling.
there are others much better at this than I but...

The chart indicates the machine is wide open min 4 max 20. that is basically the default setting for the machine with no changes.

So what are you actually changing?? What was the setting before you changed something?

Also, when you make a change you should use it for a couple days before changing again so you can see where you settle at.

One night does not make a trend.
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Sircadian
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Re: Get to play Doctor

Post by Sircadian » Fri May 15, 2015 12:08 pm

Krelvin wrote:
The chart indicates the machine is wide open min 4 max 20. that is basically the default setting for the machine with no changes.

So what are you actually changing?? What was the setting before you changed something?

Also, when you make a change you should use it for a couple days before changing again so you can see where you settle at.

One night does not make a trend.
Edited the machine model, thanks. Made the assumption the experienced would see the model on the chart.
Yes, she is on her 2 week titration which will give them the info from the Autoset, they are running it like many others (4-20) or wide open for the testing period. Per the chart.

I am changing her pressure to a constant value because the machine she will be issued next week is an S9 Elite. She returns the Autoset machine middle of next week, testing is over. I don't have a lot of time to fiddle around.

hope that clears up your questions.

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bwexler
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Re: Get to play Doctor

Post by bwexler » Fri May 15, 2015 3:56 pm

I don't know where you are located or who is paying for the machine, but if it were my wife, and insurance was paying for all or most of it, I would insist on nothing less then her trial machine. If I were paying out of pocket I would still think long and hard before accepting anything less then an APAP and probably the same as her trial machine.

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chunkyfrog
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Re: Get to play Doctor

Post by chunkyfrog » Fri May 15, 2015 5:58 pm

Heck yes!

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Sircadian
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Re: Get to play Doctor

Post by Sircadian » Fri May 15, 2015 7:04 pm

bwexler and chunkyfrog: thanks for the tip, would go that way if there wasn't a free gov't option. Anyone here who needs one ... gets one, at taxpayer expense. She will get the same machine as me .... S9 Elite. No frills but you will get the machine you need vpap, bipap, cpap.

Been titrated on an Auto and familiar with their options but I'm getting very good results with this Elite. Has all the same features, EPR, ramp, etc and fully data capable. Been thru the clinical menus on both and the auto only offers me 1 extra feature ... fluctuating pressure, which opens up that old can of worms ... totally happy with CPAP.

..Sirc

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Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
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postitnote
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Re: Get to play Doctor

Post by postitnote » Sat May 16, 2015 8:29 am

Sircadian wrote:bwexler and chunkyfrog: thanks for the tip, would go that way if there wasn't a free gov't option. Anyone here who needs one ... gets one, at taxpayer expense. She will get the same machine as me .... S9 Elite. No frills but you will get the machine you need vpap, bipap, cpap.
Free government option for a new machine?
Morbius, are you bored?

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Pugsy
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Re: Get to play Doctor

Post by Pugsy » Sat May 16, 2015 8:50 am

If the bulk of the AHI is CA/Central then changing the pressures isn't going to remedy the central index.
Compare the "good" night with the "not so good fixed pressure" night and see if the % of each category is the same or different.
The AHI of 2.70 above...has 1.66 CA index and 1.04 OA index...the CA index can't be used when figuring out pressure needs....gotta stick with what can be fixed with pressure and that's OAs and hyponeas.

So what setting did you finally sneak in and what were the results?

She's not going to need a lot of pressure though. If I were going to try to sneak a little tweaking in I wouldn't go to cpap mode right now though...all I would do is increase the minimum pressure from 4 cm to 6 cm and see what happens.

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Sircadian
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Re: Get to play Doctor

Post by Sircadian » Sat May 16, 2015 6:05 pm

postitnote wrote: Free government option for a new machine?
I'm in Canada, Sask. .. there is a program, SAIL (Sask Aid for Independant Living) that looks after anyone needing a machine.

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postitnote
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Re: Get to play Doctor

Post by postitnote » Sat May 16, 2015 6:28 pm

Sircadian wrote:
postitnote wrote: Free government option for a new machine?
I'm in Canada, Sask. .. there is a program, SAIL (Sask Aid for Independant Living) that looks after anyone needing a machine.
Ah! That explains a lot
Morbius, are you bored?

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Sircadian
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Re: Get to play Doctor

Post by Sircadian » Sat May 16, 2015 6:49 pm

Pugsy wrote:If the bulk of the AHI is CA/Central then changing the pressures isn't going to remedy the central index.
Compare the "good" night with the "not so good fixed pressure" night and see if the % of each category is the same or different.
The AHI of 2.70 above...has 1.66 CA index and 1.04 OA index...the CA index can't be used when figuring out pressure needs....gotta stick with what can be fixed with pressure and that's OAs and hyponeas.

So what setting did you finally sneak in and what were the results?

She's not going to need a lot of pressure though. If I were going to try to sneak a little tweaking in I wouldn't go to cpap mode right now though...all I would do is increase the minimum pressure from 4 cm to 6 cm and see what happens.
The reason I want to play with CPAP mode is because that is the machine she will have ... want to simulate what she has in a few days.

-You've seen the 4-20cm setting in my post #1. General idea of her graphs for the first 6 days of titration. Averaging ~1.75 AHI (showing you one of her higher nights).

-Thursday the clinic contacted her ... and she suggested if I was to fiddle, try 8 cm. I was thinking the same because (95% number for most nights) .... had poor results, worse than the previous open setting. Lots of CA's, knew raising pressure didn't help those, so, planned to reduce the pressure hoping CA's would diminish.

-Friday (last night) tried 7.4 cm. This also failed and gave her the worst results with greatly increased OA's.

-Tonight ... no use running it with a pressure range starting at 6cm because in a few days she won't have that option.
Thanks for the advice.


Image

Image

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Ipap 11cm, no ramp,EPR-2,Sleepyhead & Rescan, Win 8.1(64 bit)

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Krelvin
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Re: Get to play Doctor

Post by Krelvin » Sat May 16, 2015 8:17 pm

The problem with making changes every night is you can easily misread what is happening. It is common to have an off night which has nothing to do with the change you made. Normally, you make a change and use it for a few nights to see how it works before making the next change.

I realize that you have a short period of time however.
Current Settings PS 4.0 over 10.6-18.0 (cmH2O) - Resmed S9 VPAP Auto w/h5i Humidifier - Quattro Air FFM
TNET Sleep Resource Pages - CPAP Machine Database
Put your equip in your Signature - SleepyHead v1.0.0-beta-1
Kevin... alias Krelvin

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Sircadian
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Re: Get to play Doctor

Post by Sircadian » Sat May 16, 2015 8:28 pm

Here is an earlier image with original open settings ... what steady pressure might you try next?

She has kept events down with low pressures, near 6.6 or less.


Image

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Ipap 11cm, no ramp,EPR-2,Sleepyhead & Rescan, Win 8.1(64 bit)

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Sircadian
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Re: Get to play Doctor

Post by Sircadian » Sat May 16, 2015 8:31 pm

Krelvin wrote:
I realize that you have a short period of time however.
Yes, that doesn't allow me to wait ten days

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Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Ipap 11cm, no ramp,EPR-2,Sleepyhead & Rescan, Win 8.1(64 bit)

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palerider
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Re: Get to play Doctor

Post by palerider » Sat May 16, 2015 8:36 pm

Sircadian wrote:
Krelvin wrote:
I realize that you have a short period of time however.
Yes, that doesn't allow me to wait ten days
I'd say it'd be better to NOT fiddle, and gather as much auto data as you could, you've got tons of time to fiddle with set pressures in the future

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