Clear Airway Apneas TOO HIGH. ResMed AirCurve 10

[Gideon]

The trouble with making two changes at once is you don't know which or if both impacted the result. My goal was to jump you into reasonable results, that worked.
I'd like you to use these settings for at least two more nights because one night does not make it a trend. After that, we will see what needs to be done.
And do tell us how you feel? Be critical, what isn't working and what is. Be as specific as you can be.

[Amitaba]

Thank you Gideon.  Yes, I agree that it is difficult to evaluate which of two variables is the one responsible for a change.  I will leave all settings the same for a two or more nights to see if the results are similar.  I certainly hope they are.  In addition, please know that I am most grateful to you for taking an interest in my therapy.  

As for "How do I feel".  I am a pretty high energy person.  I rarely get overly sleepy regardless of my AHI.  I just seem to power through most challenges without being overly aware of things like low quality sleep.  That said, I definitely feel more refreshed this morning than yesterday morning.  I am also feeling more optimistic about the possibility of benefitting from the therapy.  I refused to use a machine for over 10 years. I used a Mandibular Advancement Device "MAD" and finally admitted that it wasn't doing much for me.  My high blood pressure, declining short-term memory and other problems just kept advancing, so I called my Sleep Doctor and went through several tests in order to get started with CPAP. Resmed AirSense 10 auto. After using that for just a week, I became concerned that it was not effectively controlling my Apneas. I was able to get one of the local Medical Equipment suppliers to lend me the ResMed AirCurve vAuto for a short while. I had hoped it would help me immediately, which obviously was not the case.  So here I am, getting educated and becoming responsible for my treatment.

I have found that it is nearly impossible to have a regular interaction with the doctors.  They are just too busy trying to keep-up.  I do not believe that they have the time to really analyze the details of an individual's PAP data and titrate the settings to an optimal level.  The whole experience has been frustrating and caused a great deal of anxiety for me.  I am now 100% convinced that Sleep Apnea is a huge health issue and I am committed to getting it under control.  Once again, I am very grateful to you and this Forum.

Best wishes
Amitaba

[Gideon]

As a point of discussion only, if you were to set your Trigger back to Medium that is essentially the AutoSet. The VAuto is more versatile and thus better than the VAuto so I'd rather you keep the VAuto. I will most likely ask for 1 night at trigger= medium just to confirm if that was the benefactor for you. Then trial very high to see if you get a bit of further improvement.

[Amitaba]

Yes, I will very likely keep the 10 vAuto.  I see how much versatility it has.  I'm just wondering if I should consider the ASV? I know they are expensive, but maybe I can find a gently used one.  Do you think it will be of great benefit?

[KeepSmiling]

Amitaba,

The decrease of AHI, seems to be mostly from the Central Apnea (CA) events.

I suggest you increase the Trigger to Very High, to drop the CA even more, and

Increase the EPAP by 1 cm to help with the Obstructive Apnea. (OB).

Yea, open mouth not a good idea. Leaks are a pain. Do you think some of the leaks be from around your face?

[KeepSmiling]

Yes, I will very likely keep the 10 vAuto.  I see how much versatility it has.  I'm just wondering if I should consider the ASV? I know they are expensive, but maybe I can find a gently used one.  Do you think it will be of great benefit?

Amitaba,

Yes the AirCurve 10 is more versatile, it just takes more time to dial in personal correct settings to give the best treatment.

The ASV has some medical contradictions.

[Amitaba]

           
Hello Gideon, Keepsmiling, and all those interested in this post.
Last night's sleep was mixed.  During the first part of the session 2hrs 11min., my AHI was quite low 0.92 .  The second part 3hr 36min was higher AHI 4.72 , but quite reasonable.  The third part  -1hr 8min - UNACCEPTABLE with AHI 25.58 .  Settings were unchanged from the previous night and the overall AHI was 6.94, which is quite similar to the previous night.

It is clear to me that the changes to "Trigger" are largely responsible for these overall improved numbers.  I have no idea what happened during the last hour of sleep that caused my AHI to skyrocket.  Be reminded that I do tape my mouth closed for the night and I do remember that during the last hour of sleep Excess Air developed behind my lips (like an inflated balloon), which I had to release. I felt like I was fighting the pressure.  This phenomenon is clearly related to the big jump in AHI - largely recorded by ResMed software as "Clear Airway Apnea" 

I hope there are important clues in this information and appreciate any insight/suggestions.

Best wishes,

Amitaba

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Here is the Data sheet on the entire night's sleep

[Gideon]

Daily charts please. That is where we can see correlations. Based on the info here I want to (DON'T DO THIS) increase min pressure and increase PS, based on SUMMARY DATA. It is the detailed daily charts that actually provide the correlation of what is happening and why.

[Amitaba]

           

Thank you Gideon.  I am not sure of the best way to provide Daily Chart Images.  Attached to this post are 3 charts which, together include the charts that come up on Oscar.  I do not know how to attach the whole set of charts in one document. Please advise as to any better method. 

I hope this helps your analysis of what is going on.

Best wishes,
Amitaba

[PaulaO2]

Okay. May I suggest something? In your first post in this thread, you mentioned you had been on xPAP therapy for 45 days but was on your 2nd machine. Then you started making changes based on the great suggestions here.

Question: did your sleep doc or anyone else consider or mention pressure induced central events? Do you have the diagnosis of mixed apnea?

Suggestion 1: stop making changes. let it sit and brew for a while. Your brain is having to adapt to something new. So is your blood chemistry. Let it sit. xPAP treatment isn't a "tonight/this week I set the pressure to this" thing. It is a "let's study the data and determine trends then try to find what works best" thing. A single night of data or even 3 nights of data in a row really doesn't mean much. What you want are 7-10 days worth. Then you look at the daily data. And you look at your daily activities. Did you do more physical activities the day it went low or high? Did you drink more wine another day?

Suggestion 2: pressure induced central apnea happens to a lot of people. The pressure from the machines confuse some brains into determining if a breath is needed. What needs to happen is time. The brain needs to adjust. Typically this is done by first starting out using a max pressure much lower than what you actually need. Like, say, if you need 15 max, you'd start at 8. After a month or more (my doc used 3 months but he never looked at actual data, the idiot) you increase the max. Do this in steps until you are at the max you need to eliminate the obstructive events. The other thing to look into for pressure induced central apnea is the exhale relief pressure. Some do better with no relief, some do better with higher. My AHI, most nights, is below 4. But most nights about 50% of that number is central events. My max is set to 20 although with weight loss, my 95% is now down to about 17. I also did a trial of setting the exhale relief to see if it did any different. Not sure what happened to that thread (I think it was on a now gone version of this forum eons ago) but I do best with it at 3. If I remember correctly 1 caused a hella increase in central events. If you have the dx of mixed apnea, then a VPAP is really the only way to treat that. A bilevel might, not sure.

Suggestion 3: pick a change you want to focus on. Any particular setting change. Focus on just one. When you get it to the best you can get out of it, rest a week or more, and try another setting.