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First Night - ResMed AirSense 10 AutoSet
#1
First Night - ResMed AirSense 10 AutoSet
I made the switch from the trial F&P SleepStyle machine to the AirSense 10 last night. The results are posted below for comments. The settings are what I was using on the F&P which was kind of blind exercise as it did not talk to SleepyHead. The AHI of 4.4 is in the poor end of the range of AHI's I was getting with the F&P, where the best night over 2 weeks was 2.2. The sleep tech told me my average was 3.7 over the two weeks when I returned the machine.

Unfortunately it looks like CA's are going to be an issue preventing me from getting down into the 1.0 range. My initial thoughts are that increasing the maximum pressure above 10.6 is not going to do much. So, I'm thinking I will reduce EPR from 3 to 2, and see what it does over a few days. Comments?
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#2
RE: First Night - ResMed AirSense 10 AutoSet
Reducing the EPR is a good move it will increase the minimum pressure on exhale which should help with the obstructive events. Also the reduced EPR will drop the pressure support which should help reduce the CA events.
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#3
RE: First Night - ResMed AirSense 10 AutoSet
Ron AKA,
The pressure induced CA's can take a week, or so, for your body to level out. What is the average event length of your CA's? I can easily have one flagged just by changing sleeping positions. Could you be tossing and turning?
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#4
RE: First Night - ResMed AirSense 10 AutoSet
(04-05-2018, 10:52 AM)Crimson Nape Wrote: Ron AKA,
The pressure induced CA's can take a week, or so, for your body to level out.  What is the average event length of your CA's?  I can easily have one flagged just by changing sleeping positions.  Could you be tossing and turning?

I am about 15 days into CPAP treatment. I certainly change positions during the night. My sleep study indicated 40% of the time on my back, and the rest on one side or the other. I certainly do not have the hose placement sorted out yet, and fight that thing falling off the side of bed and the weight of it pulling on my nasal pillow mask. By time in CA do you mean the number in brackets after each event in the event list? If so the longest time is 18 seconds. The average is 13.4 seconds.
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#5
RE: First Night - ResMed AirSense 10 AutoSet
(04-05-2018, 10:35 AM)Walla Walla Wrote: Reducing the EPR is a good move it will increase the minimum pressure on exhale which should help with the obstructive events. Also the reduced EPR will drop the pressure support which should help reduce the CA events.

I did an event by event analysis of the OA events to record the pressure they occurred at. Of the 16 events only one was close to the maximum pressure setting of 10.5 cm. So I concluded there would not be much benefit in increasing max pressure. Although it is a bit subjective the beginning of the event always seems to start when the mask pressure is at a minimum. The average pressure at event initiation was 6.4 cm. Of the 16 events 11 occurred after a successful exhale, but the inhale failed. The other five were after a successful inhale and then a exhale. but still started at minimum mask pressure. Not sure what that all means, but I have reduced the EPR to 2 and we will see what happens. The pressure at event initiation is bound to go up, but will the number of events significantly reduce...
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#6
RE: First Night - ResMed AirSense 10 AutoSet
The airway usually collapses at the lowest pressure which is on the exhale with EPR. Reducing the EPR will increase that bottom pressure and hopefully prevent the airway from closing.
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#7
RE: First Night - ResMed AirSense 10 AutoSet
Your flow limitation is almost nothing as well as snore. Accordingly, the pressure you are at seems to be working. I would not raise the pressure but would decrease EPR by 1 and then leave it for a week. You could then move EPR down another notch and then eventually off. Right now though your OA is greater than your CA so as others opined, decreasing EPR which raises exhale pressure should help with the OAs and hopefully some of those CAs. Don't make changes too quickly. One night does not make a sample size.
Coffee

Happy Pappin'
Never Give In, Never Give Up




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. 
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#8
RE: First Night - ResMed AirSense 10 AutoSet
(04-05-2018, 06:53 PM)sonicboom Wrote: Your flow limitation is almost nothing as well as snore.  Accordingly, the pressure you are at seems to be working.  I would not raise the pressure but would decrease EPR by 1 and then leave it for a week.  You could then move EPR down another notch and then eventually off.  Right now though your OA is greater than your CA so as others opined, decreasing EPR which raises exhale pressure should help with the OAs and hopefully some of those CAs.  Don't make changes too quickly.  One night does not make a sample size.

I agree. That is the plan.
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#9
RE: First Night - ResMed AirSense 10 AutoSet
Well one night certainly does not make a trend, but if there was a trend in reducing EPR from 3 to 2 it is in the wrong direction. Results:

AHI: increased from 4.42 to 4.57 (yes, a small amount but in the wrong direction)
CA events: increased from 12 to 19 (wrong direction)
OA events: reduced from 16 to 14 (yes better from the higher EPAP pressure but not much better)
Total time in apnea: increased from 6:46 to 7:06 (not much but in wrong direction)

A couple of screen shots from last night are attached. My thinking on this was to try EPR at 2 for a few nights, then at 1 for a few nights, and finally off, if I was seeing improvement. I could see ending up at Max 10.5, Min 8.0, and EPR OFF.  

Now I am wondering if I am heading in the wrong direction? The other avenue to follow would be to leave EPR at 3, and increase the minimum in steps of 1 cm or so. Another very different end point could be Maximum 10.5, Minimum 10.0, and EPR at 3. This is almost like a fixed pressure BiPAP with a modest IPAP to EPAP differential of 3 cm. My thinking is that EPR like a BiPAP is helping me maintain breathing cycle strength and avoiding CA's, and even trigger some OA's? And worse still that perhaps I have the wrong machine for my situation.... Perhaps I need more than 3 cm EPR.

On the expanded time scale screen shot I picked out one series of events that concerns me a bit. If you stand back and ignore what the A10 classifies the events as, it kind of looks like Cheyne-Stokes, or Periodic Breathing, with a period of about 45 seconds. That worries me a little. Comments?
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#10
RE: First Night - ResMed AirSense 10 AutoSet
The problem with racing to conclusions based on one or two nights is the inability to duplicate pre sleep conditions from one night to the next. Did you eat exactly the same foods? Did you last drink at the same time? Did you last eat food at the same time? Were food or drink too close to sleep onset? Did you take meds? Did you take them at the same time? Did you drink alcohol? How many? etc... I notice all of these things effect my AHI. So I would leave things be for another few nights. To ease your mind an AHI under 5 is considered treated and in time you will figure out whether you can improve AHI on this machine or whether you might be a candidate for BiPap - a question well down the road.

The most important factor above all else is how you feel. Keep a daily log of how you feel and then match that up with your AHI, CA, OA, and H. Most of us find that we don’t necessarily feel our absolute best with our lowest AHI scores. I have had a few nights of 0 AHI where I felt worse than a night with a 1.0 AHI. Go figure. (Both are rare for me. I average about .5)
Coffee

Happy Pappin'
Never Give In, Never Give Up




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. 
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