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107 Days In -- Looking for Feedback
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AndyB Offline

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Posts: 71
Joined: May 2015

Machine: ResMed AirSense 10 Autoset with RERA
Mask Type: Full face mask
Mask Make & Model: F&P Simplus, ResMed AirFit F10; PR Amara View
Humidifier: ResMed integrated heated
CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #1
107 Days In -- Looking for Feedback
My question, simply put, is: how can I reduce the number of CA events I am experiencing currently?

Some background:

I was diagnosed in May 2015 with severe sleep apnea, after many years of loud and frequent snoring -- a sleep lab split-night study showed untreated AHI of 41, and a treated CPAP titration of 11 cmH2O. I received a ResMed Airsense 10 Autoset in mid-June and have been on APAP therapy for more than 5 hours, and usually between 6-7 hours, every single night since then.

I'm 70 yrs old, 5'8", weigh 165 and in pretty good shape. I don't have any other medical issues, and I'm physically active.

Like most newbies, I struggled for a few weeks finding a comfortable and effective mask. I eventually settled on a PR Amara View full face mask, but as a committed tinkerer I occasionally experiment with a F&P Simplus ffm and a ResMed AirFit F10 ffm in an effort to find the elusive perfect mask.

After switching to a full face mask in mid-July, my AHI is usually between 3.0-5.0, with occasional dips into the 2.0-3.0 range or increases into the 5.0-7.0 range. My lowest ffm AHI is 1.38 and my highest ffm AHI is 8.95. Leaks are extremely rare.

The concern:

Almost all of my AHI is comprised of CA events. Most nights I have 0-1 OSA events, 3-6 hyponeas, and 20-25 CA events. It is not uncommon for me to have 25-30 CA events in a night. I've spent hours studying SleepyHead data attempting to correlate my CA events with pressures, flow limitations, times-of-night and other data, all to no avail -- while it appears the CA events are more likely to occur at transition times (falling asleep or waking up), a very great many CA events simply appear to occur randomly during the night, well away from a transition time, pressure spike up or down, or any other potential cause I can identify.

I've tried different pressures with a ffm, without discernibly different results. I tried 8-13 (without EPR) for 2 weeks, then 9-13.4 (with EPR of 2) for 4 weeks, and now 9.4-13.4 (with EPR of 2) for the last 4 weeks. My current average pressure is usually 10.5-11.5, and my 95% pressure is usually 12.25-13.0.

Although my AHI results indicate that I am usually "technically treated" for sleep apnea by being under 5.0, and I feel pretty good, I always wake several times each night. I would love to have way fewer CA events than I do currently.

What do you smart folks think? Keep fiddling with pressure? Look into an ASV or Bi-Pap? I have a follow-up appointment with my sleep doc in a month.

I am very grateful for all the wonderful advice and generous spirit on this forum. Any thoughts and suggestions would be much appreciated.

Andy
09-27-2015 02:36 PM
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DariaVader Offline
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Machine: Resmed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10 for Her
Humidifier: H5i humidifier with ClimateLine heated hose
CPAP Pressure: 8-15
CPAP Software: SleepyHead

Other Comments: diabetes II, Thyroidectomized, Primary Immune Deficiency, and the list goes on :P

Sex: Female
Location: Oregon

Post: #2
RE: 107 Days In -- Looking for Feedback
I would be tempted to experiment with a straight pressure of 12 and no EPR and see if you are one of the folk who is sensitive to pressure change

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
09-27-2015 04:00 PM
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ginzo Offline

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Posts: 227
Joined: Aug 2015

Machine: ResMed Airsense 10 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Res Med Airfit P-10
Humidifier: Humidair S with heated hose.
CPAP Pressure: 10.0-13.0
CPAP Software: ResScan SleepyHead

Other Comments: I'm a mouth breather!!!

Sex: Male
Location: North Port, FL

Post: #3
RE: 107 Days In -- Looking for Feedback
Good luck, wish I could help. If you ever run into issues with LL's, I'm your guy! I was the LL king when I came/found this wonderful place. I'm still studying SH also to find little improvements.
09-27-2015 07:15 PM
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AndyB Offline

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Posts: 71
Joined: May 2015

Machine: ResMed AirSense 10 Autoset with RERA
Mask Type: Full face mask
Mask Make & Model: F&P Simplus, ResMed AirFit F10; PR Amara View
Humidifier: ResMed integrated heated
CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #4
RE: 107 Days In -- Looking for Feedback
(09-27-2015 04:00 PM)DariaVader Wrote:  I would be tempted to experiment with a straight pressure of 12 and no EPR and see if you are one of the folk who is sensitive to pressure change

Interesting idea. I may give that a try tonight . . . .
09-27-2015 09:47 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #5
RE: 107 Days In -- Looking for Feedback
(09-27-2015 02:36 PM)AndyB Wrote:  Although my AHI results indicate that I am usually "technically treated" for sleep apnea by being under 5.0, and I feel pretty good, I always wake several times each night.
I think, might help identifying the cause of waking up several times, sleep hygiene issue, air feel too cold or too warm, stuffy nose, dry mouth ..
Before CPAP, used to wake up several times, now once and at times sleep through the night

Does the the time of waking up correspond with an apnea
Any % of time in CSR or RERAs
(This post was last modified: 09-27-2015 09:57 PM by zonk.)
09-27-2015 09:54 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #6
RE: 107 Days In -- Looking for Feedback
(09-27-2015 09:47 PM)AndyB Wrote:  
(09-27-2015 04:00 PM)DariaVader Wrote:  I would be tempted to experiment with a straight pressure of 12 and no EPR and see if you are one of the folk who is sensitive to pressure change

Interesting idea. I may give that a try tonight . . . .

Hi AndyB,

Or, tonight you could try EPR of 1. And tomorrow, EPR of 0. Might help you get used to the lower pressure relief, which is likely to be less comfortable.

EPR makes it easier to breathe. One of the (many?) possible triggers for Central Apnea is when we slightly hyperventilate, which can wash out too much CO2 from our blood and lead to loss of respiratory drive. Less EPR tends to reduce the likelihood of this happening.

For some people, higher pressure is associated with CA. For others, bilevel or EPR or A-Flex or C-Flex Plus. For others, medications. For others, past tramatic brain injury. For others, slow blood circulation. Or some other medical condition or combination of conditions.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 09-28-2015 02:40 AM by vsheline.)
09-28-2015 12:12 AM
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AndyB Offline

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Posts: 71
Joined: May 2015

Machine: ResMed AirSense 10 Autoset with RERA
Mask Type: Full face mask
Mask Make & Model: F&P Simplus, ResMed AirFit F10; PR Amara View
Humidifier: ResMed integrated heated
CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #7
RE: 107 Days In -- Looking for Feedback
(09-28-2015 12:12 AM)vsheline Wrote:  Or, tonight you could try EPR of 1. And tomorrow, EPR of 0. Might help you get used to the lower pressure relief, which is likely to be less comfortable.


Thanks Vaughn -- I'm willing to tinker, so this is another interesting suggestion.
09-28-2015 07:12 PM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #8
RE: 107 Days In -- Looking for Feedback
When using a standard FFM I was having a lot of problems with CA's too. Until I read a few articles on CO2.
When I use the Fitlife mask, it has a LOT more dead space in it. It also feels a good bit more 'stuffy' but tolerable.
Yata! Almost no CA's.

Clue #2: My Devilbis mask has only 12 small holes and I get almost no CA's with it as well.

My Quatro FX ventilates a lot better so I get a ton of CA's with it but all the other stats are great.

What to do....

I took some blue painter masking tape and used that to cover some of the vent holes in the FX.
I left 18 open just for just for margin and tried it out with a dry run. It felt a bit stuffier just like the other two masks.
Then I tried it out over night.
Lo!
The CA's all but went away.

That makes me think that there is a sweet spot with the ventilation for each mask and
most OEM's don't bother to nail this down they just set it up figuring more ventilation is better.

Not quite so!

As usual YMMV. It's worth a try though.
If this simple trick doesn't work then be sure to consult with your
doc. You might need an Auto Servo machine.

Best of Luck!

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
(This post was last modified: 09-29-2015 03:02 PM by Shastzi.)
09-29-2015 02:59 PM
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AndyB Offline

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Posts: 71
Joined: May 2015

Machine: ResMed AirSense 10 Autoset with RERA
Mask Type: Full face mask
Mask Make & Model: F&P Simplus, ResMed AirFit F10; PR Amara View
Humidifier: ResMed integrated heated
CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #9
RE: 107 Days In -- Looking for Feedback
(09-29-2015 02:59 PM)Shastzi Wrote:  When using a standard FFM I was having a lot of problems with CA's too. Until I read a few articles on CO2.
When I use the Fitlife mask, it has a LOT more dead space in it. It also feels a good bit more 'stuffy' but tolerable.
Yata! Almost no CA's.

Clue #2: My Devilbis mask has only 12 small holes and I get almost no CA's with it as well.

My Quatro FX ventilates a lot better so I get a ton of CA's with it but all the other stats are great.

What to do....

I took some blue painter masking tape and used that to cover some of the vent holes in the FX.
I left 18 open just for just for margin and tried it out with a dry run. It felt a bit stuffier just like the other two masks.
Then I tried it out over night.
Lo!
The CA's all but went away.

That makes me think that there is a sweet spot with the ventilation for each mask and
most OEM's don't bother to nail this down they just set it up figuring more ventilation is better.

Not quite so!

As usual YMMV. It's worth a try though.
If this simple trick doesn't work then be sure to consult with your
doc. You might need an Auto Servo machine.

Best of Luck!

This is very interesting, and is consistent with my general understanding of CAs and possible CO2 washout issues.

Lately I've been trying 2 FFMs: an Amara View and an AirFit F10. Each has different vent rates and dead space volumes. I don't think I have enough data yet, but so far it appears i have fewer CAs with the F10, with a vent rate to dead space ratio of 0.191 (vs the Amara View at 0.215). I need to enlarge my sample set before drawing any conclusions.

Thanks again!
09-30-2015 03:54 PM
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Dee digits Offline

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Joined: Sep 2015

Machine: resmed autosense 10
Mask Type: Full face mask
Mask Make & Model: fisher&Paykel simplus
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CPAP Pressure: 10 cm
CPAP Software: Not using software

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Sex: Female
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Post: #10
Wink RE: 107 Days In -- Looking for Feedback
Is a "CA" a counted awakening? Sorry, I'm a recently diagnosed ApneaoidBigwink
(This post was last modified: 09-30-2015 04:26 PM by Dee digits.)
09-30-2015 04:24 PM
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