FROM AS 10 AUTO TO AIRCURVE VAUTO

[Sleeprider]

I was referring to your previous post, using PS 5.0.  A little more detail. Compared to PS 4.0 your pressure varied considerably less with a maximum pressure just over 16 rather than nearly 18 at PS 4.0.  The residual flow limitation appears to have resolved, and we see more complete inspiratory flow, and increase in tidal volume and decrease in inspiratory time with PS 5.0 as compared to 4.0.  This comes with an increase of CA events, so I concluded that you do better with PS above 4.0, but I think your optimum is less than 5.0.  You said, "I didn't feel bad" in spite of the higher AHI.  My suggestion of PS 4.6 is to keep the gains with higher PS, but to backup enough to bring your central events down just a bit.

[CROWMAN]

Made the change to PS 4.6. Below is result on day 2 after change. Day 1 was a higher AHI than normal. Day 2 is lower than normal. I have noticed that I am havinn dreams again with the VAUTO. Anything more to change?

[Sleeprider]

It seems your flow limit has not returned, and if this becomes a longer term trend, I think you have found a more effective and comfortable therapy setting. At t his point you're nearly dialed in, and any changes should be kept small and done for comfort. It's encouraging to hear you're sleeping better.

[CROWMAN]

Thanks much for your help and Fred's too. I will leave the settings alone for a week and see what happens. I beliive that the foam collar deserves lots of credit for lowering my AHI along with your settings to mitigate the flow limitationns.

[CROWMAN]

I thought it was time to provide an update. I remain at 4.6 PS and am still using the collar. I feel pretty good. Below are 3 screenshots - my last 3 days of data. The first is probably of my worst night ever. I beliieve it was caused by using a new Quattro mask to replace my old one. The second screenshot is after I made some fit corrections to reduce leaks. The third one (last night) is after a few tweaks to the mask fit. I selected these 3 screenshots to emphasize to others than getting leaks down to a minimum is really important.

I remain concerned about the number of centrals and flow limitations.

Any recommendations for further changes to VPAP settings?

[Sleeprider]

Incredible how bad the Dec 20 results look compared to subsequent nights. For me, the takeaway is not to rely on one night for radical changes.

[CROWMAN]

I could not agree more. Whenever I change out masks bad things happen, but not as bad as the 20 Dec night. Any recommendations for changes of my VPAP settings?

[Sleeprider]

Crowman, you AHI is fine except when it is not. We would need to look closer at the flow rate to see if there is something there, or hear a specific issue you have with the therapy. Basically, if you're comfortable with it, so am I without knowing any different.

[CROWMAN]

I would like it better, and to get rid of the groupings of CA and FL. Below are closeups for the 3 nights. I have been on CPAP/APAP/VAUTO for around 20 years and had 2 nights with an AHI of 0. The collar has generally kept me under 1.0 most nights. When I have an occasional bad night there are always groups of events (clusters) over a short period of time.

[Sleeprider]

I really don't know what to suggest. You have great results nearly all the time and considering options for higher pressure support or higher pressure, nothing stands out to me. At this stage of optimization, experimenting with relatively small changes in either PS or EPAP min is something you can certainly do. All your charts, are missing the pressure chart, so at any point in time, I don't know what the machine is doing from these charts.