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Aircurve / Sleep Guidance
#1
Aircurve / Sleep Guidance
Hi! I could use some guidance I think. I've been using the AirCurve 10 for roughly two months. My apnea diagnostic and titration studies showed an AHI generally in the low moderate range but highly variable, with about 20% central events. The titration suggested EPAP = 6, EPAP = 10 on S mode. I subsequently tweaked that a bit and switched to VAUTO (in part so I could see flow limitations) with PS = 4, EPAP = 6 and IPAP = 11. This largely eliminated OA events, but not CA events. I subsequently changed trigger to HIGH, and then to VERY HIGH. As you can see in the overview graphic, increasing the trigger setting helped...especially for the CA events (HIGH got me into the AHI 2-3 range, and VERY HIGH generally under AHI = 1). 

A key concern of mine has been desaturations as pre-BiPAP even on nights with relatively few OA or CA events, my SpO2 would routinely fall into the 70s or lower. Overall, the BiPAP has been great at wiping out desaturations, even when I have apneic events (I was monitoring O2 earlier but only added OSCAR-compatible oximetry starting December 3). I do have arrhythmias, variable. I was also hoping that reducing my AHI/ODI would help my heart calm down (reduce pulse rate/changes and nighttime sympathetic load, and increase HRV). The latter hasn't happened yet but I'm still hopeful.

One thing I seemed to notice was that the low leaks / pressure changes seems to aggravate my heart/PC, were often associated with apneic events, and often woke me up. I especially would note the "chipmunk air," which led me repeatedly to wake up and adjust my tongue and head position. Sometimes the air noise woke me up as well. I feel more exhausted (or at least no better) since starting BiPAP but figure that that will get better. If I can reduce the leaks and awakenings. So, I added a chin strap (which I actually like as the straps allow me to position the P10 straps on top of them, totally eliminating the sliding of the P10 straps in my fine hair, as well a getting them tangled in my hair. But the chin strap didn't do much for the leaks/awakenings/high PCs. So I added MedVar tape, which is largely effective in keeping my mouth closed and the P10 pillows seem to keep my nasal passages open although I do note flow resistance, which I assume is nasal.

However, I don't think my body much likes the tape as it hasn't really improved anything and may be triggering desaturations, which only started with the tape. The tape does reduce, but not eliminate, leaks. I sleep on my back, which my heart prefers, but also because I get hip pain on my side.

I attach two OSCAR plots, one from last night and one from 3 nights ago, both with EPAP 6, IPAP 11, PS 4, P10 mask, chin strap and MedVar tape. Last night I had a cluster of OAs. I was supine all night and during the cluster (looks positional but I was still on my back then). The Viatom vibrational alarm woke me when my O2 went under 90% but I didn't turn onto my side until around 7:30 when I couldn't get back to sleep.

I'm thinking that perhaps I should not use tape (started roughly 10 days ago but not every night)? Do some people not tolerate it? Should I raise my pressures a bit? I was earlier thinking of lowering them a bit because of mouth breathing but more recently I was thinking of raising both by about 0.02, leaving PS at 4. 

I appreciate any feedback (greatly appreciate the wealth of knowledge on this site!).

Best wishes for the holidays!!


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#2
RE: Aircurve / Sleep Guidance
I don't see much in the way of problems with your positive pressure therapy other than perhaps a positional cluster on 12/20. You are sorting things out with your mask and the trends for your treatment are all improving. With regards to tape, I have never used it, and I suspect your need to stop leaks by using tape will diminish similarly to your therapy results. This appears to be very effective CPAP therapy and your pressure and SpO2 has very little variation. I have no immediate recommendations but to continue what you're doing to make it more comfortable and effective. You've done a great job up to now.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: Aircurve / Sleep Guidance
Sleeprider,

Thanks...your response is appreciated more than you probably realize. I have a couple of other tiny tweaks (collar, different mask...maybe Brevida) I'm considering but mainly I think I need to stop worrying and fiddling and simply "ride the wave" for a while.

Cheers!
Purplebear
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