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[CPAP] ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
#11
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
The Vauto is an excellent machine, but the chart you posted shows you using very low pressure. I would really prefer to see a daily details chart which offers a lot more information. We really can't tell much about your settings or how events arose with this summary data.

The choice you should be making is between a Resmed Airsense 10 Autoset, not the fixed pressure Elite, and the Resmed Aircurve 10 Vauto. The Airsense 10 Autoset should be similarly priced to the the Elite, but will offer auto-adjusting pressure. The Vauto is probably overkill for you since your pressure is apparently quite low. Please consider posting a daily detail chart, there is so much more we can do with that.
Sleeprider
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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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#12
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
Say "no" to the Airsense 10 Elite. It offers fixed pressure only, and it provides pressure support (called expiratory pressure relief on this machine) only up to 3 cm H2O. No one can guarantee that you will benefit from the options of auto-adjusting pressure or greater pressure support, but you certainly might.

The settings for your trial of the VAuto are very, very odd. They have you using CPAP mode, rather than VAuto mode. You're on a fixed pressure of 4.6, which is so low that you get almost no benefit from the EPR level of 3 that was set for you. (EPR/PS drops the pressure when you exhale, but the minimum pressure the machine can generate is 4, so with a fixed pressure of 4.6, you get a pressure drop of only .6 cm H2O.) In addition, most adults find that pressures that low leave them feeling air-starved.

If you still have the trial machine, you might try setting the machine to VAuto mode with an EPAP minimum of 5 and an IPAP maximum of 12, with pressure support of 3. (Pressure support is added to your EPAP; EPR is subtracted from your IPAP. Go figure.) To change your settings, see the link to CPAP setup manuals at the top of the page. If you think you'd somehow lose your subsidy by doing this, then of course don't.

Most clinics recommend against mouth taping, but many of us do it. The two big reasons the clinics worry about it are: you might suddenly vomit in the night and inhale the vomitus, which can be fatal, and your power might go off and you might sleep through a slow suffocation. Both those scenarios are wildly unlikely. As for the first, by moving your lower jaw you should be able to release the tape. Test the tape out to make sure that works. As for the second, you can put a circuit alarm in a plug on the same circuit as your machine. I don't know whether you have access to Somnifix tape strips, but if you do, they are what I'd recommend you start with. There are some lower-cost alternatives you could try later.

It can take a while to feel the benefits of PAP therapy. The odds are good that with the right machine and the right settings, you will sleep more comfortably and soundly.
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#13
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
After posting, I just saw Sleeprider's post. You are in the best of hands with him.

You did post a daily chart, and it showed flow limitations to which you might be sensitive. Your sleep study also showed a lot of RERAs. My thinking on the VAuto is that you then have the option of using more pressure support to address the flow limitations and RERAs if needed. However, it is true that you could have pressure support/EPR up to 3 with the ResMed Airsense 10 Autoset machine. Given that you say cost is not an issue for you, I would still lean a little toward getting the machine that may have more than you need, rather than one that might have less.
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#14
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
Thanks Dormeo, I missed that a daily detail was posted on the previous page. Sleepki, you have not tried the Vauto yet. It was setup in CPAP mode with fixed pressure at 4.6. What is wrong with your supplier/doctor? The idea of using a trial machine is to find an effective pressure, and that usually means putting it in auto mode and looking at the results. Based on what we are seeing in your results, you should probably ask for the Airsense 10 Autoset, not the Elite. You can start in Autoset mode with a minimum pressure of 6.0 and EPR at 2 and you should be very comfortable and have much more effective therapy. If you go with the Vauto, put it in Vauto mode and use EPAP min 4.0, Max Pressure 12.0 and Pressure support at 3.0.

If you still have the machine, make the changes using this tutorial https://www.apneaboard.com/resmed-airsen...setup-info
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
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Attaching Files
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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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#15
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
A possibility for why you still feel like crap on cpap is that you have huge leak spikes throughout the night. If whatever mask you’re using is actually creating a good seal, then your mouth is blowing open a lot. If it’s blowing open that much here, then it’s impossible to know from the data that Oscar gives you how often your brain is waking up each time your mouth drops open. It can be as fragmented as snore arousals to the EEG. If your mouth drops open 4 times a minute or your lips sputter then your mouth may be waking you excessively. You would only be able to truly know by using something that tracks arousals for a couple days. Home sleep testing with EEG. Your AHI is fine between 1-2, so you’re getting plenty of pressure, if the algorithms in the blower are accurately adjusting for apnea and not leak, which they do more frequently than people think (over-titrating for leak is common). Try mouth taping for a couple nights and see if you can stop all leaks. It’s a simple and easy test to try. If suddenly your leak spikes go away and you feel like you are getting more rest, the mouth breathing has probably been wrecking your sleep (you just wouldn’t know it). The downside to any of these software trackers is none provide EEG data so you don’t know how rested the brain is. There are other wearables that can help account for that, but there’s the cost of investment in it. Too many times the arousal index never gets discussed and all the focus is on breathing and AHI. Problem is, if the brain isn’t resting and it’s waking up as much as when you had untreated apnea, but the root cause is something other than apnea now waking you up, you still won’t feel any better.
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#16
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
Sorry for the radio-silence, was offline for 2w. Thank you so much for the replies Everyone! 

Machine choice. It sounds like I should just get the vAuto, it does everything that the Autoset does and it's superior to the Elite in terms of fine-tuning the settings. So even if I don't need the vAuto/autoset functionality I can pay a premium to have the functionality as "an option". So I'll just do that then. 

Testing auto. We did test auto in the beginning of the trial, but it felt like I was suffocating and I was burping excessively the next day. See detailed report below of one sample day.

Mouth taping. Thanks, that is what my intuition is telling me to try. And to dreaming1's point, your reasonings reg. still no refreshing sleep echoes my what my intuition is telling me -- my brain is not refreshed due to other causes. 


Will post again when I purchase the machine (hopefully next week). Then I'll order the bleep mask too. 


Example on auto-setting (felt really bad). 
   
   
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#17
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
Well, if that was auto mode, pressure did not move at all, and didn't see to have the need to go higher than 7.5/4.4. In my book, that is fixed pressure. You cou,ld get the same therapy on the Elite fixed pressure CPAP with a pressure of 7.4 and EPR 3, so there is no value to the Vauto for you. The advantage to the Vauto is that you can dial in pressure support in increments of 0.2, so feel free to reduce PS to a comfortable level. It appears you could just reduce pressure to 7/4 to get the minimum pressure possible.
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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#18
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
Thank you for checking the data. 

So, if I want this lower increment changes. Would it make sense to then settle midway for the autoset model instead of vauto? Thoughts?
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#19
RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov)
To my mind, the question is whether you're going to try EPR/pressure support greater than 3. This is often recommended for people with UARS. But you can't get more than 3 with the Autoset.
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