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Are these odd settings for an Air Curve 10S?
#1
Are these odd settings for an Air Curve 10S?
I had an Air Sense 10 Autoset for about 6-8 months and tried various settings that typically brought my AHI down to 1 and below, but I still felt awful every single day. In March 2018 I had a sleep study that showed 4.7 AHI and 18 RDI. Lots of RERAs/arousals, roughly 50 in about 2.75 hours.

Around April 2020, I found a new sleep doc and have good insurance. COVID was really bad then, so a home sleep study (Type 3) revealed about 13 apneas/hour. He didn't believe it. In-lab study showed 64 obstructive apneas/hour on my back and not many on my side. Had a titration study last month. They used an OmniLab titration machine. Started me on CPAP and as they ramped it up, centrals showed up, so they switched to BiPap. I was titrated for 9 IPAP/5 EPAP and given an Air Curve 10S at the doctor's office.  No idea why my AHI jumped so drastically.

Titration study states: "CPAP was titrated from 5 to 7 cwp with increasing central apneas and then BiPap from 8/4 to 9/5 cwp. Optimal pressure was obtained at 9/5 cwp. At optimal pressure, there were 0 apneas and 0 hypopneas, AHI was 0/hour, and lowest oxygen saturation was 95%. Titration included adequate evaluation time in REM sleep and while supine. At optimal pressure the patient was recorded for 89 minutes with a sleep efficiency of 98%. Sleep was consolidated with the use of BiPap at optimal pressure. The entire raw data recording was reviewed, epoch by epoch.

Diagnosis: Obstructive Sleep Apnea Syndrome (G47.33) controlled with BiPap at 9/5 cwp. Central Sleep Apnea Syndrome (G47.31) complicated use of CPAP."


This is an OSCAR screenshot from my Air Sense 10 Autoset APAP last month while self-treating. https://i.ibb.co/gwNGxPz/6-6-2020.jpg

I figured out those settings on my own using APAP mode, but typically saw centrals that seemed to go away around 8.4 or so fixed CPAP mode. But they came and went some nights. Pressure was starting at 7 and max of 9.

My doctor's office threw the Air Curve 10S BiPap at me, didn't explain much and told me the settings. I set it on IPAP 9, EPAP 5.

It was miserable the first night. I learned that the OmniLab that they titrated me on apparently doesn't have the Easy Breathe feature, so I turned it off after the second night. No ramp time needed and I turned that off. I feel best when I start straight out at 9/5 pressure.

The default breathing patterns on the machine were way too fast and frequent for me to be comfortable while sleeping. I changed them to this:
TiMax: 2.5s
TiMin: 1.0s
Rise Time: Min
Trigger: Very High
Cycle: Medium



First two nights on the Air Curve 10S showed a large amount of purple Clear Airway events in OSCAR. AHI of 9 and 4 on each day.  I emailed the lady who set me up with the machine and she was snarky and said it wasn't a magic wand. She also said "those aren't centrals."

This was my first night on it. I pulled the mask off a few times to take a break because I woke up feeling like I wasn't breathing even while using the machine. I felt awful
.

Looked at my data in OSCAR and I saw 45 CA events in 5.25 hours with just a couple of hypopneas and apneas.
https://i.ibb.co/m6TBCWX/Centrals1.jpg

A look at detailed Centrals data:

https://postimg.cc/LhVL1DQ3
https://postimg.cc/r0N05yjw
https://postimg.cc/94TqFYqT
https://postimg.cc/sv6WnXrB
https://postimg.cc/pm3FH6yR



I looked up the meaning of each of these settings and played with it until it was fairly comfortable. I could probably tweak it a little more. I take longer breaths and the default was for very quick, shorter breaths. I think that's where the crazy amount of Clear Airways were coming from for the first couple of days on the machine.

Those purple Clear Airway events in OSCAR turned into Unclassified Apneas (green marks) in OSCAR. As the days progressed at those settings above, one day I made it down to 1.10 AHI. 1 Hypopnea and 5 Unclassified Apneas in 5.5 hours. On another day before that, on the same settings, 5 hypopneas for an AHI of 1.79.

Oh and those green Unidentified Apneas? Setting the machine settings under Essentials to Plus mode shows me central apneas on the 10S machine itself. Very odd. "6.1 AI centrals last night. AHI of 5.2.  3.8 total AI" per the MyAir app.    In OSCAR, those will show as Unclassified Apneas.   I toss and turn all night, every 30 minutes or less per the motion camera trained on my bed. But in between, I probably move all night long about every few minutes. I just shift in position on my bed or move an arm or leg just a little. No movement issues were noted during my sleep study.

Really short of breath for most of the day some days. Only half of the day on other days (latter part of the afternoon/night). I feel better when doing something strenuous, but feel awful when resting. Cardiologist, EKG with ultrasound, Holter monitor for a month, etc. Nothing wrong. Endocrinologist...nothing wrong. Three ER visits for odd symptoms. Nothing found on blood work. Contrast CT scan of all organs in the abdomen. Nothing wrong. MRI scan of my head by my primary care doc (pending until this week). I've had Gastritis for months, GI issues, muscle shakiness, brain fog, etc. Primary care doc thinks I have Dysautonomia/POTS due to my dizziness, heart rate changes upon standing vs lying down, etc. Sleep related or another type of illness?
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#2
RE: Are these odd settings for an Air Curve 10S?
Do you happen to have the sleep study report? It's not mentioned in this thread. If you have it, you can post the redacted, detailed report. I'm thinking we'd see lots of central events, and if so, you can try a straight CPAP, not the S, to avoid the CA and maybe be fairly successful. It's possible that you may need an ASV if CA were extensive on that report. As you know, Sister Snarky you mentioned just doesn't know anything about CA to really help you going forward.
Dave

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#3
RE: Are these odd settings for an Air Curve 10S?
Previous thread from June http://www.apneaboard.com/forums/Thread-...her-issues

Your settings look fine, but not for you.
Let's cut back on the PS and see how you respond to it
Set IPAP=7 thus PS drops from 4 to 2.  That should help with the centrals.

Note that increasing pressure and increasing PS should also increase Central Apneas.  They didn't because Centrals can be very inconsistent.  The tech should have recognized this and I'll bet that if he continued higher the Centrals would have come back..  He found a pressure combination that "worked" on that night at that time during your sleep and did not continue the titration that would have revealed that he was wrong.  During that titration study, you failed at CPAP, then you should have failed at BiLevel wo backup, and if he persisted and put you on ASV it would have succeeded.  (ASV can solve pretty much everything, but it is expensive)

CPAP cannot treat Centrals, neither can BiLevel wo backup (your BiLevel).  With these machines, Centrals must be avoided since they cannot be treated.  Thus the above recommendations
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#4
RE: Are these odd settings for an Air Curve 10S?
(07-12-2020, 11:48 PM)jmr1068204 Wrote: I had an Air Sense 10 Autoset for about 6-8 months and tried various settings that typically brought my AHI down to 1 and below, but I still felt awful every single day. In March 2018 I had a sleep study that showed 4.7 AHI and 18 RDI. Lots of RERAs/arousals, roughly 50 in about 2.75 hours.
That means that UARS is a possibility
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#5
RE: Are these odd settings for an Air Curve 10S?
There's still the option of setting up a EERS on top of the settings, since these CA's are emerging from the treatment, I assume.
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#6
RE: Are these odd settings for an Air Curve 10S?
Alright, so I still feel quite dreadful everyday. Still seeing lots of events on the Air Curve 10S at 9/5 settings.

I think I go back on August 2 or something like that for them to review the first month of data. 

My POTS/Dysautonomia has been giving me a run for the money lately. Doc wants to put me on an anti-depressant for the 'anxiety' that it is known to cause due to the symptoms. Those seem to be pretty bad for the body. The 24/7 dizzy thing, feeling like I'm going to faint if I lean slightly over the sink to wash my hands and such. It's pretty miserable. Stomach aches and feels weird a lot, intestinal paints/discomfort every day, not going to the bathroom as often as I should be, sometimes kidneys/bladder don't seem as regular, etc. Just had a brain MRI with and without contrast last week. My primary care doc's statement to me was: "One of the first things I would say is that I feel extremely confident that there is no heart problem, lung problem or brain problem. That does not mean that what you are experiencing does not exist but that the fear that it is a sign of a more sinister underlying disease is misplaced. Because dysautonomia / POTS is not a disease that is measurable it is more a disease or condition that we have to diagnose largely based on a person symptoms. It's not like blood sugar or blood pressure necessarily where we can track it and anticipate problems. Essentially we learn from other people who have had this and what has helped and what hasn't. We have no idea why it starts and nobody else that I had with dysautonomia has had a strong family history so it does not seem genetic. Also interestingly most of my patients who have had it will outgrow it eventually. My patients who have had the most success with it over the years have been the ones who have accepted and often have started on an antianxiety medicine to help modify the anxiety associated with the symptoms. Certainly there are other things that one will learn such as having extra salt, sometimes using medications to boost blood pressure, being aware that very hot environments are likely to induce lightheadedness, etc. You will learn how your body functions best. I would also continue to work to optimize sleep but rather viewing yourself as someone with a potential life threatening disease, view yourself as someone with a conditions that needs management and once you figure out your optimal management it should only be a nuisance."



Then I have all of these "Unclassified Apneas" that keep showing up no matter what each night. Before I turned the Easy Breathe off with the 9/5 pressure, I had a huge amount of centrals with an AHI of over 9. Just back to back rapid-fire centrals in clusters. I turned off the Easy Breathe the second or third night after I got the BiLevel and those central apneas in OSCAR show up now as Unclassified Apneas. They look like either obstructive apneas or central apneas. Is there a true way to tell? I just feel uncomfortable and agitated all night, especially with my stomach and abdomen feeling weird or having a dull ache.

At this point I'm really confused. Is it just a pressure setting that is wrong or do I need something like ASV? I'm in the process of trying to get my original sleep study before the titration study to see if any centrals showed up on the regular sleep study. If they did, would I need ASV?

My newest settings allow me to at least breathe more normally: 

IPAP 9.0
EPAP: 5.0
Easy Breathe off
Ti Max 2.5s
Ti Min 1.5s
Rise Time Min
Trigger Very High
Cycle High

The original BiLevel settings that it came with new out of the package were ridiculous. It was something like TiMax 1 or 1.5 and Ti Min was about 1 or less. The other settings were also different and it made me breathe so quickly to try to keep up with it.

I feel absolutely fatigued daily. It honestly feels like I sleep better on my side/stomach without the machine than with it. All that I feel like doing every day is laying down to relieve the POTS/Dysautonomia. I've noticed that when I go to work feeling dizzy and bad in the morning, once I get to lifting things and moving around, the dizziness tends to go away and I feel better in general. I guess because I get the blood flowing more or something. I'm also increasing my cardio workouts regardless of dizziness.

Anyone out there had POTS/Dysautonomia and got rid of it? How long? Is it just because of my sleep?

I looked back at the month of June when I used APAP under various settings lower than the 9, usually 7.4 to a little over 8. I still had centrals popping up here and there. Sometimes a lot on one day and a little on another day under similar settings.


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#7
RE: Are these odd settings for an Air Curve 10S?
If you can zoom in on the UA events at about a 2-3 minute resolution, so that we can see the individual wave forms, we may be able to interpret the events. I think in VPAP-S mode with Easybreathe off, the FOT (forced oscillation technology) apnea detection is disabled, so an event type is not reported.

On your machine, I think you are able to select the Trigger Sensitivity setting, which is normally at a default Medium. Can you please let me know what setting you are using? With your history of CA events, I would want the setting to be on High.
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#8
RE: Are these odd settings for an Air Curve 10S?
So here's an odd question for you...I was using the above settings for the previous thing. Then last night on a whim, I turned the Easy Breathe on and my EPAP went from 5 to 6. I'm assuming the machine made this change because I don't remember doing it.

So I went from all of those weird Unidentified Apneas to one single hypopnea this over 6 hours this morning.

Does that lack of obstructions pretty much guarantee that I don't have central sleep apnea or can it "skip" some nights even if you do have it?

Or could this simple change change that I made last night indicate that it treated my CPAP-induced sleep apnea?

Or is it possible that my doctor's office CPAP person changed this setting wirelessly? I know for sure that it was 9/5 and it is now 9/6. Double checked on the machine, too.


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#9
RE: Are these odd settings for an Air Curve 10S?
Selecting Easy Breathe would not change the pressure. It can be set remotely by your doctor or DME. Generally if you are experiencing hypopneas, you would increase your EPAP pressure. Increasing yours could be why they were reduced, but one night does not make a trend. Having reduced events being reported means that your VPAP is working. Do not skip any nights.
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#10
RE: Are these odd settings for an Air Curve 10S?
Yeah, actually two nights ago it changed to EPAP 6 instead of the original 5. The night before I had 15 hypopneas, 4 unclassified apneas and 7 large leak events (nasal pillows work fine, but most have moved them) on the same EPAP 6/9. AHI of 3.25 for what is showing to be the date 7/19. But it looks like the days are one day behind on the OSCAR calendar, so Monday morning shows as Tuesday morning. This morning 1 hypopnea and 1 obstructive for a 0.33 AHI over 6 hours. Confused why on the same settings on different days I have considerably more events. No CA events for this morning. Would it just be intermittent central apneas under treatment or I don't have CA at all?
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