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[CPAP] Newbie would like some advice (Aircurve 10 VAuto)
#1
Newbie would like some advice (Aircurve 10 VAuto)
Hi all,

Been lurking for quite a while and am really impressed with the amount of help and support you all provide to your members. So first, thank you!

Had an at home sleep study that said that I had an average of 9 RDIs a night. Had a second sleep study that came out practically perfect. Both labs told me that they wouldn't treat me, unfortunately. I was suspecting UARS from my partner's observations (choking and gasping at night) as well as an ADHD diagnoses and severe daytime sleepiness. I figured that I could try a bilevel. Got a used AirCurve VAuto, replaced it with new parts and tried it out for a couple days.

Tried it with default settings
Mode - VPAP auto
Min EPAP - 4.00
Max IPAP - 25.00
PS - 4.00 

Also have attached last night's results. It is pretty fragmented because I've been helping a family member post-surgery, so I've been waking up every couple hours throughout the night to dispense meds, help them to go to the bathroom, etc. Hopefully we can get some meaningful data of it.


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#2
RE: Newbie would like some advice (Aircurve 10 VAuto)
Welcome to Apnea Board. The chart looks pretty good. Despite the segmented sleep, are you noticing positive differences? Any feeling of air starvation? I would consider bumping EPAP Min to the area of 5.4-6.0 with no other changes. See if that makes it any more comfortable.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Newbie would like some advice (Aircurve 10 VAuto)
Welcome to the forum

Numbers are excellent. On UARS a diagnostic sleep study would help.

Also scan the Flow Rate chart at a 5 minute view and look for rough spots, flow limits then post them for eval.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#4
RE: Newbie would like some advice (Aircurve 10 VAuto)
This looks pretty good. Almost all are central and many times centrals come at the start of therapy. Your body is not use to it and they will hopefully go away. I would not change anything tonight and see what is going on for another night and then make some changes. Your settings IPAP 8 (min epap + ps) and the high of 25. Many times Centrals happen because the large difference between the top and bottom pressure. But your top pressure got up to about 10 (10.22). So that is not a large difference. If it looks about the same tomorrow I would move the mim epap to 6 or 7.

Again Centrals are something that seems to happen when you first start out. The good things only one hypopnea and your flow limits are good. Leak rate is not perfect but no large leaks and no snoring. All in all a good report.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#5
RE: Newbie would like some advice (Aircurve 10 VAuto)
(10-17-2020, 06:51 PM)SarcasticDave94 Wrote: Welcome to Apnea Board. The chart looks pretty good. Despite the segmented sleep, are you noticing positive differences? Any feeling of air starvation? I would consider bumping EPAP Min to the area of 5.4-6.0 with no other changes. See if that makes it any more comfortable.

Thank you! Was feeling notably better this morning, like I didn't have to fight as much to get out of bed. The day before I felt a little like a balloon with too much air lol, so I turned off the ramp and it helped a lot. I'll try that setting out!

(10-17-2020, 06:53 PM)bonjour Wrote: Welcome to the forum

Numbers are excellent.  On UARS a diagnostic sleep study would help.

Also scan the Flow Rate chart at a 5 minute view and look for rough spots, flow limits then post them for eval.

Thanks! Requested the at home sleep study data, so it might be a couple days, but I'll grab the in-lab study. Can you clarify on rough spots? Attached a screenshot, but let me know if you'd like a different one.

(10-17-2020, 06:58 PM)staceyburke Wrote: This looks pretty good.  Almost all are central and many times centrals come at the start of therapy.  Your body is not use to it and they will hopefully go away.  I would not change anything tonight and see what is going on for another night and then make some changes.  Your settings IPAP 8 (min epap + ps) and the high of 25.  Many times Centrals happen because the large difference between the top and bottom pressure.  But your top pressure got up to about 10 (10.22). So that is not a large difference.  If it looks about the same tomorrow I would move the mim epap to 6 or 7.

Again Centrals are something that seems to happen when you first start out.  The good things only one hypopnea and your flow limits are good.  Leak rate is not perfect but no large leaks and no snoring.  All in all a good report.

That's good to know! I will try another night and if the data looks consistent, will move the min epap with Dave and your suggestions. You mentioned the centrals usually come at the start of therapy. Does that confirm that I have UARS? Sometimes I wonder if I really do have a sleep problem or not haha. 

Feeling very confident thanks to you all, especially when I was doing initial research. Knew I needed a bilevel, AirCurve was a good machine, etc. Very pleased, and excited to sleep now, thank you all again! Big Grin
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#6
RE: Newbie would like some advice (Aircurve 10 VAuto)
Central Apnea, in OSCAR they'd be clear apnea; either way when abbreviated they are CA and all refer back to Central Apnea. They are different than common Obstructive Apnea. Obstructive means that there's a physical blockage causing an apnea. Central Apnea is an event 10 or more seconds where you stop breathing without airway blockage. The most common CA type is treatment emergent. Simply this is a scenario where your PAP machine has made your breathing too efficient at removing CO2. It's a high enough level of CO2 that triggers the breathing response. Low CO2 equals the brain doesn't signal a breath. If your PAP notices this pause in breathing, it throws a clear airway flag. Again clear airway equals central apnea. The brain recalibrates to take in effects from the PAP; it corrects itself shortly.

Treatment emergent CA diminish in most within 3 months of PAP usage. Some patients need to dial back EPR or do other measures if treatment emergent CA get bad enough to take action. Also treatment emergent CA would be signified by looking at your sleep study to see what the event counts for CA were. We can help decipher it, but typically we're looking to see CA equals x then Obstructive/OA equals y. We compare CA/OA numbers. Most people have a bit of treatment emergent CA. And again, they drop off within 3 months of PAP use.

There are idiopathic CA, meaning medically they're of unknown reason. And there are pre-dominant or pre-existing CA. The last one shows on the sleep study as equal or more CA to OA. These last 2 CA will not go away after 3 or more months of PAP use.

There's a big bit of info. But I wanted you to see that in your case, CA are very likely the first category, the treatment emergent kind. To be sure, that is why your sleep study was asked for, as the study will answer the CA issue, and a whole lot of other things.

Free advice from us beats Dr. Dolittle's guesswork that costs you mini boat payments. Good eve. Coffee
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Newbie would like some advice (Aircurve 10 VAuto)
(10-17-2020, 08:03 PM)SarcasticDave94 Wrote: Central Apnea, in OSCAR they'd be clear apnea; either way when abbreviated they are CA and all refer back to Central Apnea. They are different than common Obstructive Apnea. Obstructive means that there's a physical blockage causing an apnea. Central Apnea is an event 10 or more seconds where you stop breathing without airway blockage. The most common CA type is treatment emergent. Simply this is a scenario where your PAP machine has made your breathing too efficient at removing CO2. It's a high enough level of CO2 that triggers the breathing response. Low CO2 equals the brain doesn't signal a breath. If your PAP notices this pause in breathing, it throws a clear airway flag. Again clear airway equals central apnea. The brain recalibrates to take in effects from the PAP; it corrects itself shortly.

Treatment emergent CA diminish in most within 3 months of PAP usage. Some patients need to dial back EPR or do other measures if treatment emergent CA get bad enough to take action. Also treatment emergent CA would be signified by looking at your sleep study to see what the event counts for CA were. We can help decipher it, but typically we're looking to see CA equals x then Obstructive/OA equals y. We compare CA/OA numbers. Most people have a bit of treatment emergent CA. And again, they drop off within 3 months of PAP use.

There are idiopathic CA, meaning medically they're of unknown reason. And there are pre-dominant or pre-existing CA. The last one shows on the sleep study as equal or more CA to OA. These last 2 CA will not go away after 3 or more months of PAP use.

There's a big bit of info. But I wanted you to see that in your case, CA are very likely the first category, the treatment emergent kind. To be sure, that is why your sleep study was asked for, as the study will answer the CA issue, and a whole lot of other things.

Free advice from us beats Dr. Dolittle's guesswork that costs you mini boat payments. Good eve.  Coffee

That's very fascinating, thank you for the explanation! There's a lot of pages in my sleep study, so I will link it when I am able to, since I am a new member!

I also reviewed the data from two nights ago, and it's very different from the first night! My mask wasn't fitting great in the past two days, maybe I need headgear that is tighter? Oct 17th I tried it with default settings, on Oct 18th I switched the EPAP to 6.00. Let me know your thoughts, thanks!


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#8
RE: Newbie would like some advice (Aircurve 10 VAuto)
OK quick summary, the later dated one has higher leaks, maybe it skewed or prevented accurate therapy and/or reporting, if this is a one-off thing no real worries or action. You may want to visit our wiki that explains how to adjust masks. You never want straps tight enough to be painful. If you cannot adjust that mask to control leaks successfully without adding pain, consider a different mask type, brand, or model.

Other than the leaks, it is possible the small pressure bump on Min may end up being helpful. Again it's difficult to assess until leaks are addressed. Keep at it regardless, we can coach through almost any PAP difficulty. Just don't give up.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Newbie would like some advice (Aircurve 10 VAuto)
(10-19-2020, 03:45 PM)SarcasticDave94 Wrote: OK quick summary, the later dated one has higher leaks, maybe it skewed or prevented accurate therapy and/or reporting, if this is a one-off thing no real worries or action. You may want to visit our wiki that explains how to adjust masks. You never want straps tight enough to be painful. If you cannot adjust that mask to control leaks successfully without adding pain, consider a different mask type, brand, or model.

Other than the leaks, it is possible the small pressure bump on Min may end up being helpful. Again it's difficult to assess until leaks are addressed. Keep at it regardless, we can coach through almost any PAP difficulty. Just don't give up.

Yeah, I noticed the higher leaks too. I'm using the Airfit P10 Nasal Pillow. I've been pulling the strap to take my mask off, and in the process I might have stretched it a bit. Washed it in hot water today so hopefully it reverts back to its original shape. I'll take a look at the wiki as well, will update in a few days! Thanks!!
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