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2 years on - How am I doing?
#21
RE: 2 years on - How am I doing?
(11-12-2019, 04:30 PM)Mozammil Wrote: Regarding the symptoms: I am waking up with a headache quite regularly. At about 3-4pm at work, I feel the need to take a nap and generally started feeling a bit more tired than usual.


Hi Mozammil

How are you feeling now after these changes?

Is it better?  Is it worse?  No different?

If it is different how so?

WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#22
RE: 2 years on - How am I doing?
(11-16-2019, 08:37 AM)Sleeprider Wrote: I guess the question is whether you feel better or not with these changes.  EPR should help with comfort and the flow limitation, but the flow limit and snores are still impressive.   I think you should be using a bilevel machine like the Resmed Aircurve 10 Vauto, which has higher capability for pressure and pressure support. Your AHI is certainly acceptable, but the snores are an indication of continuing obstruction or airway resistance.  If you continue to have arousals and don't feel like your sleep quality is adequate, then a bilevel is the next level of therapy to consider.

Sleeprider, 

I can see that the Autoset has about run it's course.

Given that we are still seeing high Flow Limitation as well as high Snores and we brought some pressure relief by raising ERP would we not also now recommend he try and increase in Pressure Min of 1 - 1.5cmH20 to see how many he can knock down with the present machine?  

WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#23
RE: 2 years on - How am I doing?
(11-16-2019, 08:37 AM)Sleeprider Wrote: I guess the question is whether you feel better or not with these changes.  EPR should help with comfort and the flow limitation, but the flow limit and snores are still impressive.   I think you should be using a bilevel machine like the Resmed Aircurve 10 Vauto, which has higher capability for pressure and pressure support. Your AHI is certainly acceptable, but the snores are an indication of continuing obstruction or airway resistance.  If you continue to have arousals and don't feel like your sleep quality is adequate, then a bilevel is the next level of therapy to consider.

I understand. Since I have just relocated, that will be quite a challenge. I looked up used ones on eBay and they are really expensive. I will see what I can do as soon as possible.

(11-16-2019, 12:23 PM)WillSleep Wrote:
(11-12-2019, 04:30 PM)Mozammil Wrote: Regarding the symptoms: I am waking up with a headache quite regularly. At about 3-4pm at work, I feel the need to take a nap and generally started feeling a bit more tired than usual.


Hi Mozammil

How are you feeling now after these changes?

Is it better?  Is it worse?  No different?

If it is different how so?

WillSleep

I am not sure. Last night was pretty tough, but I just took a nap of 3 hours now from 1pm - 4pm and the AHI dropped to 0.3 and I feel a lot better. However, I'd really have preferred not to take a nap during the day..

(11-16-2019, 12:28 PM)WillSleep Wrote:
(11-16-2019, 08:37 AM)Sleeprider Wrote: I guess the question is whether you feel better or not with these changes.  EPR should help with comfort and the flow limitation, but the flow limit and snores are still impressive.   I think you should be using a bilevel machine like the Resmed Aircurve 10 Vauto, which has higher capability for pressure and pressure support. Your AHI is certainly acceptable, but the snores are an indication of continuing obstruction or airway resistance.  If you continue to have arousals and don't feel like your sleep quality is adequate, then a bilevel is the next level of therapy to consider.

Sleeprider, 

I can see that the Autoset has about run it's course.

Given that we are still seeing high Flow Limitation as well as high Snores and we brought some pressure relief by raising ERP would we not also now recommend he try and increase in Pressure Min of 1 - 1.5cmH20 to see how many he can knock down with the present machine?  

WillSleep

From 13 to 14.5? 

I just checked the settings on my CPAP. When I first started therapy, my AHI was 61. The pressure set by the physician was 6 - 18. Given that I have to keep increasing it, would you say my Apnea is getting worst?
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#24
RE: 2 years on - How am I doing?
(11-16-2019, 12:33 PM)Mozammil Wrote:
(11-16-2019, 12:28 PM)WillSleep Wrote:
(11-16-2019, 08:37 AM)Sleeprider Wrote: I guess the question is whether you feel better or not with these changes.  EPR should help with comfort and the flow limitation, but the flow limit and snores are still impressive.   I think you should be using a bilevel machine like the Resmed Aircurve 10 Vauto, which has higher capability for pressure and pressure support. Your AHI is certainly acceptable, but the snores are an indication of continuing obstruction or airway resistance.  If you continue to have arousals and don't feel like your sleep quality is adequate, then a bilevel is the next level of therapy to consider.

Sleeprider, 

I can see that the Autoset has about run it's course.

Given that we are still seeing high Flow Limitation as well as high Snores and we brought some pressure relief by raising ERP would we not also now recommend he try and increase in Pressure Min of 1 - 1.5cmH20 to see how many he can knock down with the present machine?  

WillSleep


From 13 to 14.5? 

I just checked the settings on my CPAP. When I first started therapy, my AHI was 61. The pressure set by the physician was 6 - 18. Given that I have to keep increasing it, would you say my Apnea is getting worst?

Hi Mozammil

"The pressure set by the physician was 6 - 18. Given that I have to keep increasing it, would you say my Apnea is getting worst?"

Not at all.  The only point of making any pressure change would be to improve your therapy based on what is showing up in your charts after you have been using xPAP for a while.


"Raise Min Pressure From 13 to 14.5?"

I was hoping Sleeprider would reply because I did not want to disrupt the conversation and direction Sleeprider he is giving you.

If he does not reply ...

Yes continue to seek out a VAuto via through the Doc or via Craigslist, Facebook Marketplace, etc.

As far as making more changes while still using the Autoset:
  • It all depends on if you have achieved your goals of losing the morning headache and not being as tired.  When you achieved your goals stop making changes.
  • Since last night was not yet great honestly would be good for you to see what the EPR change produced on a good night before making other.  
  • Looking at your chart I don't see the harm in trying a change in Min Pressure from 13 to 14 cmH20 to see if that helps to quash some of the Flow Limits and Snores.   After that based on what changes you see in the charts you might want to drop Min Pressure back down to 13 or try a little higher.   
WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#25
RE: 2 years on - How am I doing?
(11-16-2019, 06:13 PM)WillSleep Wrote:
(11-16-2019, 12:33 PM)Mozammil Wrote:
(11-16-2019, 12:28 PM)WillSleep Wrote: Sleeprider, 

I can see that the Autoset has about run it's course.

Given that we are still seeing high Flow Limitation as well as high Snores and we brought some pressure relief by raising ERP would we not also now recommend he try and increase in Pressure Min of 1 - 1.5cmH20 to see how many he can knock down with the present machine?  

WillSleep


From 13 to 14.5? 

I just checked the settings on my CPAP. When I first started therapy, my AHI was 61. The pressure set by the physician was 6 - 18. Given that I have to keep increasing it, would you say my Apnea is getting worst?

Hi Mozammil

"The pressure set by the physician was 6 - 18. Given that I have to keep increasing it, would you say my Apnea is getting worst?"

Not at all.  The only point of making any pressure change would be to improve your therapy based on what is showing up in your charts after you have been using xPAP for a while.


"Raise Min Pressure From 13 to 14.5?"

I was hoping Sleeprider would reply because I did not want to disrupt the conversation and direction Sleeprider he is giving you.

If he does not reply ...

Yes continue to seek out a VAuto via through the Doc or via Craigslist, Facebook Marketplace, etc.

As far as making more changes while still using the Autoset:
  • It all depends on if you have achieved your goals of losing the morning headache and not being as tired.  When you achieved your goals stop making changes.
  • Since last night was not yet great honestly would be good for you to see what the EPR change produced on a good night before making other.  
  • Looking at your chart I don't see the harm in trying a change in Min Pressure from 13 to 14 cmH20 to see if that helps to quash some of the Flow Limits and Snores.   After that based on what changes you see in the charts you might want to drop Min Pressure back down to 13 or try a little higher.   
WillSleep

Hey WillSleep, 

I increased the pressure to 15. Trying to keep the range a bit low. Here are the graphs for last night. 

   
   

Did you notice any improvements? It felt a bit better today although I was still a bit sleepy by 15:00...

Also managed to get an appointment with a sleep doctor, but it's on 7th January.. will have to do with the CPAP for now it seems Sad
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#26
RE: 2 years on - How am I doing?
(11-19-2019, 04:51 PM)Mozammil Wrote: Hey WillSleep, 

I increased the pressure to 15. Trying to keep the range a bit low. Here are the graphs for last night. 

Did you notice any improvements? It felt a bit better today although I was still a bit sleepy by 15:00...

Also managed to get an appointment with a sleep doctor, but it's on 7th January.. will have to do with the CPAP for now it seems Sad
  

Hi Mozammil, 
 
The chart looks really good.  
 
 
"Did you notice any improvements?"
 
Settings - you are a probably done.   
 
It is very likely that you have arrived at settings that are as good as the Autoset is ever going to get.  
  
From here you can try .4 cmH20 less pressure to see if and .4 cmH2O more pressure around that 15 cmH20 pressure level just see if you like the difference. A little less pressure might be a little more comfortable and little more pressure might knock down some more flow limits but come at the cost of less comfort.
 
But frankly you have dialed in your Autoset really well and I personally would leave it alone and use it like this for a week to see if the good results are stable.  
  

Two next steps to get a better night's sleep
 
1) More impact from Positional & Sleep Habit Improvements 
 
Rather than tweaking settings from here I expect you find will benefit from working on develop habits to avoid chin tucking and avoiding sleeping on your back and continuing to improve your other sleep hygiene habits.   The collar is a great start.
 

2) Monitor Craigslist and Facebook Marketplace  --  buy a VAuto.  

A VAuto "MIGHT" help you sleep better.  

You have taken the Autoset to about it's limits.  A VAuto is genearlly a more advanced version of that same machine but will allow you to increase Pressure (~EPR) higher than 3 and additional features that might help you knock down more Flow Limits and do it with less pressure.   Which means more comfort, less hassle with leaks, less sleep disrupting arousal, possible more oxygenation at night ... all which might help you sleep better at night.     

I frequently have seen VAuto's on Craigslist FB Market Place and Ebay for $350 to $550 depending on how many hours they have.   There are vendors that sell VAutos with warranties for ~$800.     Many people here have found an outright purchase of a VAuto for less than $1000 a fast route and better use of money than waiting for a Sleeplab test to get setup and then paying the $400-$1000 out of pocket deductible for the Sleep Test.   Check with your insurance company for your costs.
 
Rather than wait till January to start a number of folks here often encourage people to keep that appointment buy also a used VAuto now so you have a machine with more access to settings you can tune to better adjust your therapy.  

ResMed Series 10 Aricurve VAuto BiPAP  


WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#27
RE: 2 years on - How am I doing?
Mozammil, your AHI has always been low and the purpose of any changes to therapy has been about getting you to feel better and more rested. Objectively, I don't see any difference in your results from 11/13 to your most recent post, so we can only rely on your subjective sense of how you feel. I see pretty much the same issues with persistent flow limitation throughout. The problem is that most sleep doctors will look at your AHI of less than one per hour and everything else you tell them will go in one ear and out the other because your treatment is completely successful based on the parameters they consider and that are covered by insurance. At least that's how it goes in the U.S. German physicians may give more importance to how your feel, but it is still going to be an uphill battle to change therapy mode to bilevel PAP, because it's very hard to show it is medically necessary.

I don't see improvement in therapy with higher pressure, so for starters, you should do what is most comfortable with this machine, not what someone tells you to do. I think EPR is helpful, but not enough to make a difference. Most people with this kind of upper airway resistance, low apnea and hypopnea and high arousal (RERA) rate, find the pressure support of bilevel does help, or you can look for a root cause for the apparent flow restriction. The Resmed Aircurve 10 Vauto can help you with much lower overall pressure. The strategy in setting it up would be to use enough EPAP to avoid obstructive apnea, but add in pressure support to resolve the rest including the snoring and flow limits. That's about all any positive pressure device can offer. If the problem is anatomical, then the specialist you need is an ENT (otolaryngologist).
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#28
RE: 2 years on - How am I doing?
Hey WillSleep and SleepRider,

I was able to acquire a ResMed AirCurve 10 VAUTO, AutoBIPAP on eBay for 485 Euros. It will be delivered next week (maybe Monday)

Thank you a lot for the suggestions! I might need some extra help to configure the BIPAP when it's here though Smile
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#29
RE: 2 years on - How am I doing?
(11-22-2019, 02:48 AM)Mozammil Wrote: Hey WillSleep and SleepRider,

I was able to acquire a ResMed AirCurve 10 VAUTO, AutoBIPAP on eBay for 485 Euros. It will be delivered next week (maybe Monday)

Thank you a lot for the suggestions! I might need some extra help to configure the BIPAP when it's here though Smile
 
Awesome!  Congratulations.
 
Just let us know when you have the machine and are ready to start.
 
WillSleep

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#30
RE: 2 years on - How am I doing?
That's great news. With the Vauto, we want to set the EPAP min setting to the level that stops obstructive apnea (OA), then use pressure support to take care of the rest. I'm going to suggest settings a bit lower, and depend on the Vauto algorithm to help us out. Basically I'm going to set you up at my settings:
Mode: Vauto
EPAP min 9.0
IPAP max 20.0
PS 4.0

I'd rather start out here than have your current EPAP min of 12, and we will see where that takes us. Be sure to delete all user data before starting and setting up the machine, use a fresh SD cart (format to FAT 32), and you should be all set to go.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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