CPAP Produces Variable Results New User

[marklang]

Thanks for the advice.  Based on your advice, I asked for a Resmed Auto BiPap, and it looks like I qualify for that.  The representative said some prefer Resmed and some prefer Dreamstation, but she had never heard anything about differences in the quality of the breathing between the different machines.  My doctor normally uses Dreamstation, but they seem open to my request.   It will take a few more days for them to get a Resmed unit.  Assuming they come through, I will be interested in your advice about those settings you mention as it is not clear how to use them.  I assume I am trying to get not just a low AHI but a breathing curve that is as close as possible to normal.

[Sleeprider]

Great choice. As you can see in my profile I have both Philips and Resmed auto bilevel machines and know their capabilities. You won't be disappointed and we can discuss the fine points as time and needs arise. Your titration pressures will be your starting point, and the Resmed offers a lot of opportunities for fine tuning if needed. My point was that there are more useful adjustments, but the defaults are usually perfect. At this point, just use it and if there is anything that can improve results or comfort, we can try to guide you through the fine tuning. Meanwhile be assured you got the best in class auto VPAP.

[marklang]

Disappointing.   I just got my new Resmed Aircurve 10 VAuto.   The first night I had an AHI of 22.61.  The pattern is pretty much similar to what I was experiencing with the Cpap at 16-20 cm.   I attached the overall pattern.   Basically, I had clusters of OAs mostly three times during the night.   I attached a close up view of a period before the OAs started.  Note that I am already having a pattern of breathing for a few cycles, and then the breathing becomes much shallower before it comes back again.  The tops of the breathing curves are already flat.   I also showed a sample of an OA.   The only difference is that the breathing declines to an even lower value which is detected as an OA.  

As the photo shows, I am running in fixed Bipap S mode set for 23 cm and 19 cm.   I had the ramp turned off.   (The Resmed has a quick ramp up anyway for a few seconds, which was enough to get used to it.)

Any thoughts about what is going on?   My sleep study showed I would be fine at 23/19 cm, but that is not happening now at home.   I am using a Dreamwear Full Face mask which the tech gave me when he did the last sleep study.  This seems to work well if I get my nose placed properly, which is a little tricky. 

Thanks for any advice.
 
Mark

[Sleeprider]

It's possible you are using a taller pillow or more pillow at home. The pattern looks positional, and many members have obtained nearly complete relief using a soft cervical collar or no-snore wedge. This typically happens as the chin drops towards the chest causing obstruction that air pressure cannot overcome.

[marklang]

Thanks.   I actually used my pillow for the sleep test.   However, it is possible I may have slept on it in a slightly different position.  I do have both a soft cervical collar I tried earlier as well as a pillow designed to keep the head positioned to open the throat.   I will try one of these tonight.

[marklang]

Another frustrating night.  I slept on my Popitz pillow, which is supposed to hold the head in the optimum position for air flow.  Certainly, there was no way my chin bent down toward my chest.   AHI 30.17 with the Resmed Aircurve 10 Vauto set for 23/19.  This data appears worse than I was getting with my Cpap set for 17 cm constant.   See the attached screen shots.  I have long clusters of events.  However, I included a closeup of a segment in the area before the first cluster that shows I had a pattern of breathing decreasing to a very low level, just not enough to detect as an OA.  So the problems seems worse than even the bad AHI number suggests.   This type of pattern was present before the clusters and after for quite some time.  I also included a closeup of a section where I had the best sleep, which is well after the first cluster ended.   Even in this "best sleep" time it seems like my breathing pattern is abnormal.  

I did have trouble with my Dreamware Full Face mask at he beginning of the night.   On other days it has worked for me with minimal leaks if I get it positioned just right.   However, last night I could never find a position that would stay.  As soon as I moved a bit, it started leaking.   So I went back to my Resmed F20, which works good except that it irritates my nose.   I put a band aid on my nose and used it for the rest of the night.

I will try sleeping with the cervical collar tonight.   However, I don't think this will be much different than the Popitz pillow.   If anyone has any suggestions, I am very interested.   It is strange that a hospital sleep test determines I will do well first on 17 cm with Cpap (did not work), and a second test with 23/19 cm Bipap, which also is not working anymore.  I used my own pillow in both sleep tests, and made sure they gave me an adjustable bed so I could raise my upper body just as I do at home.  The conditions were as close to home as one can get. 

Thanks again for the help.

[Gideon]

I would like to see the transition in breathing that occurs at about 2320, about 5 minutes prior to the detail above..  The 2 min segment you have is showing significant flow limitation.  Also bring in the tidal volume because you flow rate drops significantly when the issues occur.

You can squeeze the charts vertically by grabbing an edge and moving them.  Keep the flow rate the same size and add Tidal Volume and Flow Limitation.

With that said the clusters really seem like Positional Apnea.  What I see with the Flow limitations could easily be caused by positional apnea.  Can you try to sleep on your side for a night?  This is an experiment to see if we can impact the OA that you are getting.  

Note: Normal treatment would call for raising you EPAP for the OA and increasing the PS for the Flow limitation.  Not calling for this now because it really looks positional in nature.

[Sleeprider]

I don't buy the argument "there was no way my chin bent down toward my chest". Perhaps you are rolling onto your side, or moving out of position. The Popitz pillow is a pretty extreme ergonomic pillow, but what we are looking at is positional obstruction. I think you should try something else or find a way to monitor or video your sleep position to see what is going on. What mask did you use in the study?

[Gideon]

I agree, see if you can video your sleep.  Not doubting that you believe you are not doing anything to cause anything positional happening but the charts say that it is.

[Technopauper]

I recently changed from Dreamstation to Resmed and also have higher pressures (17+) - the Resmed machine feels completely different at even set higher pressures and for some reason breathing against it at those pressures seems far easier even though the same pressure.

I have got considerably better results from the Resmed too - please read my thread 'Chart Envy' for details of my very similar journey - push hard for the Resmed machine !

Rob