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AirCurve VAUTO vs AST
#31
RE: AirCurve VAUTO vs AST
SpO2 is remarkably better with your minimum pressure at 9.0 and the median is a full point higher.
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#32
RE: AirCurve VAUTO vs AST
I agree that the oxygen saturation appears improved. If you wouldn't mind modifying the y-axis on the SpO2 graph and reposting the chart it would be easier to evaluate. I'd set it to 85-100 so each tick mark is exactly 1%. (or 80-100% if that's what works out to even divisions on the chart)

My guess from the current chart is you are still having significant periods of time below 90%, especially 13:40-14:05 and 14:40-15:45 when it appears you woke shortly after. Also based on some of the jumps up and down I suspect if you turn on user flagged events in the preferences we'll see a number of near-apneas and/or near-hypopneas especially in the 15:25-15:40 timeframe.

Your leak rate looks great so if you want to bump up minimum pressure to 10 I wouldn't be afraid of doing that. Increasing minimum pressure is sustainable as long as you tolerate it and have minimal to no leaks. However once that becomes a problem I'd back down to tolerable pressure and wait until you receive the VAuto and can work with a higher pressure support. When you get the VAuto you'll want to borrow the oximetry module again if possible.

FWIW when I was working through this myself last summer I found that each increase in minimum pressure had diminishing returns and I could only tolerate so much pressure. I was doing it on a VAuto and also had too many centrals above PS of about 4 so basically I was between a rock and a hard place. My experience has been that any leak at all seems to defeat using minimum EPAP to increase oxygenation but your experience may be better.
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#33
RE: AirCurve VAUTO vs AST
Alshayed,

I have just set it to 85-100, so I guess it looks better. Please see the attached photo. 

There are two dips in the graphics. This is due to me changing the finger of the oximeter. I almost hung myself with the Air 10 cables... 

I can tolerate 10 as minimum pressure. As I noted with the full mask, the average pressure was higher than with this nasal mask and it started from 4 but quickly would bump to 13-15. 

The 5 days I slept with the full mask, I felt like I am high. Overwhelmed with energy. Saturation of 99% throughout the day and I was breathing fully, no more shallow, but it was way to uncomfortable for falling asleep so I moved to nasal. 

As for the vAuto, once I have it I will borrow the oxi or by that time I would have one of the recommended ones here, so I will be reposting results then. I guess I will also need your help to tweak the extra setting for BiPap Mode as it takes days to 'consult' with my pulmonologist and usually he agrees with what I have already done and/or read here.

What about EPR? Do I need to tweak it now too?

In regards to leaks, there are poses in which I sleep that either totally removes them or make them really bad. Up until all this, I was sleeping face down... literally. I am uncomfortable sleeping on my back as I gasp for air and sleeping on the sides has been tricky lately. My incorrect treatment from the last 2 years has left me with a frozen shoulder first on the right side, now on the left. Luckily I was able to unfreeze the right with a lot of exercise and pain and now I am in the final phrase of thawing the left one, but I still feel discomfort... The graph you see is kinda sleeping on the left side but not completely. In that position, there are no leaks with the either nasal or full face mask. 

Cheers


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#34
RE: AirCurve VAUTO vs AST
DayWalker, that's really interesting about the FFM vs nasal. Kind of sounds like your issue may be more nasal issues rather than OHS. Either way the VAuto will still likely be a better fit for you so it's good that you are getting that. I'm guessing you don't see any chance of trying a different full face mask?

EPR - don't change anything there, lowering it will probably make things worse. If you were having a lot of central apneas that would be the main reason to lower it. Or if you felt like you were hyperventilating.

The updated chart is very helpful. Now we can tell you're mostly just fluctuating between 89 & 90 % for those time periods. Bumping up the min to 10 may be all the extra you need at the moment to mostly stay >= 90%. If you do change the pressure and post a new chart, try pinning the SpO2 to the top and then make sure we can see the pressure chart as well.

Have you ever tried nasal rinses or something like Flonase to see if that would help with breathing through your nose? Don't use Afrin - it can cause significant problems, and look up any others that you might try just to be sure they are safe to use regularly.

Coffee
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#35
RE: AirCurve VAUTO vs AST
With regard to PEEP, it is the minimum EPAP pressure that improves oxygenation, so with EPR at 3, the minimum EPAP pressure is only 6.0 cm (9.0/6.0). It is the EPAP pressure we want to elevate to target oxygenation.
Sleeprider
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____________________________________________
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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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#36
RE: AirCurve VAUTO vs AST
Just had another thought, if you are using the N20 mask have you tried a nasal pillow mask? I think the nasal pillow masks may help "inflate" the nasal passages a bit better than the regular nasal mask. When I was originally using the Wisp (regular nasal) it seemed like it was putting some pressure on my sinuses and switching to pillows helped a bit. I think I've heard other people mention some better results with pillows too.
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#37
RE: AirCurve VAUTO vs AST
Alshayed,

I do indeed have very shallow breathing at times and some resemblance of OSH at a minimum and the SpO2 seems to confirm it. My guess is that the pulmonologist gave me the Air 10 to confirm it as he was seeing so little events but I was reporting back still feeling tired and having difficulty breathing deeply and without the ABG test. With the FFM indeed I didn't have that and on the second night, I felt way better with my breathing. Since the nasal mask, we were back to so-so breathing. Anyways, tonight we are somewhat back to the way I felt with FFM and the numbers have improved drastically (see the image attached). FYI: The resmed rep here has confirmed that the different setting on the APAP machine i.e. nasal/pillow/ffm command different pressure. Not sure if that is true but it seems like it.

I have not tried nasal rinses yet, but I am guessing this is the next step with Flonase as well as a nasal pillow mask. The thing is that due to my deviated septum, my left nostril is smaller than the right one so everything depends on which way I sleep too. The graph above is sleeping on my left side.

Sleeprider, so what you are saying is that I need to lower EPR too to improve oxygenation?

Please advise,

Cheers,


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#38
RE: AirCurve VAUTO vs AST
Congrats on the improved O2! I have a somewhat deviated septum too, but I feel I do benefit from treating stuffiness due to allergies. I use Flonase (takes a while to kick in, so keep at it), Azelastine (need a prescription in the US, anyhow), and Singulair (ditto). Allergy shots were finally starting to help when the clinic closed down due to the virus. I get to restart next week -- yay!

Sleeprider will come by to answer your question. I suspect he will say that you should keep EPR at 3 and keep raising your minimum. If that's the advice, I would say at a certain point (now? a little further along?) you might want to go up less than 1 at a time -- maybe .4. Stay at a given pressure for at least a couple of nights before inching up again.

I really hope you continue to see further improvement.
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#39
RE: AirCurve VAUTO vs AST
(05-16-2020, 09:11 PM)DayWalker Wrote: Sleeprider, so what you are saying is that I need to lower EPR too to improve oxygenation?

Please advise,

Cheers,

It's all about raising PEEP (EPAP) if the objective is increasing SpO2.  You raised minimum pressure, but with EPR your PEEP is 3-cm lower than the set pressure.  You could get the same result with a minimum pressure of 6.0 and EPR off.
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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#40
RE: AirCurve VAUTO vs AST
Sleeprider,

So if I am getting this right, I can start lowering EPR and keep or lower minimum pressure for increasing SpO2 rather than continue increasing the minimum alone since EPR essentially negates the effect of the minimum?

I am a bit lost here. We are talking about the Airsense Autoset 10, correct? since the VAuto is not here yet?

Please advise,

Best Regards,
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