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Help with Dreamstation settings

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vbrik +0 points · about 1 month ago Original Poster

Help required with settings on new machine

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vbrik +0 points · about 1 month ago Original Poster

I was diagnosed with severe apnea end of December and provided with a Dreamstation Auto CPAP plus Resmed F30 full face mask. Tend to find as a side sleeper that the mask often leaks around the top of the cushion around the nose area when pressure increases, no matter what I do with the fit. Have asked if I can switch to an F&P Simplus

My AHI was 35 prior to commencing with the CPAP treatment and now down to 5.5 but i'm looking to improve on this as get it down to 1 if possible and not sure how to fully interpret the data in Oscar yet, still learning. Do feel the min pressure is pretty low and wonder if still getting higher AHI due to this or not.

Could i have some advice or feedback please on the screenshot below and what I could potentially do to improve the AHI, plus any general observations on the stats/figures provided?

Many thanks,

Mike

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Sierra +0 points · 27 days ago Sleep Patron

Hi Mike,

Your post must have gotten delayed as a new user and when posting a graphic.

Yes, I think you should be able to do better than an AHI of 5 or so. OSCAR is showing a CA or central apnea of 0.56, which is a little concerning. Central apneas are more difficult to control because they tend to increase as the CPAP pressure increases instead of decreasing. The airway is already open so more pressure does not reduce them. Your main component of the AHI is Hypopnea. It can be obstructive in nature or sometimes central. I agree that your minimum pressure setting is low. I also see you are using FLEX which can have a negative effect. My initial suggestion would be to increase your minimum pressure to about 7.5 cm and turn the FLEX off, and then see if that improves your AHI. Later on if CA events become a problem, then you may want to limit maximum pressure to try and prevent them. You should be able to see if they are happening at random or mainly at a higher pressure. Once you sort things out with what is enough pressure but not too much there may be some advantage in switching your machine to a fixed pressure mode set at that ideal pressure. Hope that helps some.

Your leakage rate is not that bad. Ignore the higher curve on the graph. That is the total leakage including the intentional purge flow out the vent of the mask. If you right click on the leak rate vertical scale you should be able to set a leak rate red line at 24 or so. That gives you a good idea if your leak rate is too high or not.

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Dude +0 points · 27 days ago

On raising minimum pressure, yes to 7.5 for now, and higher in a few days or so, like 1cmH20. Flex is really worthless on a APAP. As far as your leaks... they are unacceptable to me period. Even though you have an APAP.... and the machine rams up, the minimum pressure could be doing it eventually and to have leaks is defeating the purpose of a higher minimum to prevent events and ramping up to max pressure. I would work on reducing your leak rate upon the pressure you achieve to achieve better therapy. CA's and OA's are next to nill, your hypopneas are alot but are hard to keep away. I manage to keep might few, but I have a bilevel machine. You partial obstructions, hypopneas, come in during the ramp up and is not helping, so to me it's not quite enough pressure.

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Sierra +0 points · 27 days ago Sleep Patron

The net real leak rate is hitting about 18 at most. The top trace in the leak graph on DreamStation machines is misleading and I don't know why they even display it. It is the total leak rate including the necessary purge rate. ResMed subtracts out the purge leak rate and only shows you the true leak rate. Yes, leakage from a full face mask especially when it blows into your eyes is very annoying, and can keep you awake. However, at this low leakage rate shown it should not impact the treatment pressure at all. Unfortunately the DreamStation machines do not show you the actual mask pressure like the ResMed machines do. However, I would be very confident that this leakage is not significant enough to impact mask pressure.

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Dude +0 points · 27 days ago

I'll go along with the two graphs are misleading however if the minimum pressure has leaks it will not be effective and the reason the machine has to ramp up. Do away with leaks as much as possible now and later when minimum pressure is raised can and leaks will be ruled out. You will not know when the minimum pressure is enough if leaks are present. Leaks means loosing therapy and machine ramping up isn't only about handling events, also means not enough minimum pressure is available.

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Sierra +0 points · 27 days ago Sleep Patron

Here is a screenshot of my ResMed machine on a night when leaks were hitting the redline limit of 24 L/min. ResMed displays mask pressure (the blue trace), and as you can see, the mask pressure is unaffected. See the area where the green cursor line is. Also note that there are no events when the leak rate is high. The pressure does fluctuate a little up and down with each breath and that is the reason for the ragged look of the trace. However it is that way whether or not there is a larger leak or not. While DreamStation does not show the mask pressure, I suspect it is highly likely to be just the same as a ResMed machine. They are both doing the same thing.

While it may be worthwhile to reduce leaks for other reasons, such as comfort, I would suggest it is a rabbit hole non-solution to the issue of higher AHI. There are other reasons for the high AHI. They probably can be solved with a higher minimum pressure unless the hypopnea are central in nature. You will notice that my hypopnea is not that good either, and I believe at least some are central in nature. It is very unusual for me to get under 1 for AHI.

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Dude +0 points · 27 days ago

I guess you missed the end of the night where you leaks escalated and have 4 Hypopneas, which btw are partial obstructions and Five OA's I see, at 3:00 am and following each other, is where your leaks were the greatest, so yes regardless of the mask pressure, you have events coming into play. I would suggest you read the graphs more carefully and you will see.

the Night before is 0.68

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Sierra +0 points · 27 days ago Sleep Patron

Do you appreciate that the way you have your machine is set up it is functioning essentially the same as a fixed pressure CPAP machine set at 14 cm, with the EPR set at 3 cm?

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Dude +0 points · 27 days ago

I sure do after wasting 5 months on a APAP. But the bilevel Vauto on Set has settings your airsense doesn't. I'm not getting my hopes up with under 1 AHI.

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