Getting a machine advice

[dolppl]

So I am finally getting my machine tonight. 

Resmed Airsense 10 Autoset.  Had to fight with the DME a little bit but was able to convince them to give me that machine.

I plan to set it for a pressure of 8 per the prescription and download the data tomorrow to see where we are at.

Any recommendations for getting the most out of my therapy specifically with wearing the mask every night? 

I know from the past that if I lay down before I am ready to fall asleep and put the mask on I will lay there wide awake all night trying to fall asleep.  It is like putting the mask on gives me a second wind or something.

So what I used to do was read in bed and when I start to get sleepy then slip the mask on and fall asleep.  Unfortunately more often than not I would fall asleep and wake up in the morning never putting the mask on that night.

Any thoughts?  I know the more I get used to it the easier it will become, just gotta get there.

[Gideon]

The rule of thumb is to use the machine, under pressure, and watch TV, Read a book, play a game, anything you enjoy to help you get used to the setup. Have you tries this?

Post your charts, see the organize link in my signature, and then we will help you to optimize your thyerapy.

[Sleeprider]

Your machine may or may not come with the SD card. If not, then any common SD card less than 32 GB will work. Most common are 8, 16 and 32 GB sizes formatted to FAT32. After you wake up, go have some coffee and breakfast. Many people immediately remove the card and try to read it the first day and are surprised there is nothing there. Best time to read the card is actually after noon.

Out of curiosity, was was the DME recommending?

[dolppl]

I just picked up the machine.  Looks brand new.  It did not have an SD card.  I have one, not sure the size of it.  I put it in the slot and it didn't give me any error or anything.  I will hope for the best. 

The DME was recommending the Resemed Airsense 10 just not the Autoset.

I have a call with the respiratory therapist at 3:00 Eastern today to setup the machine or something.  Looks like it is already set for a pressure of 8 per the perscription.  Anything I should ask them or is it better to talk to all of you?

[dolppl]

Nevermind he called early.  He was not of much help.

Any recommendations for what settings I should put this machine on?

Also, is there an alarm on this if I unknowingly take my mask off in the middle of the night?  That was a problem last time I tried CPAP.

[Sleeprider]

I would just use the prescription pressure and see where that takes you for the first night. Did your setup include the heated climateline tube (bronze color) or the standard slimline tube?

[dolppl]

It came with a slimline tube.  And the respiratory therapist was mentioning that there are heated tubes and better masks out there.  Not sure why they didn't talk to me about masks before i purchased them.  I would have sprung for the heated tube or a better mask.

I will definitely keep the pressure at 8 for the first night.  What about all the other settings?  EPR, ramp, humidity, etc.

[dolppl]

First night down.  Results are attached.  Not sure what to make of the results.  Seems similar to my diagnostic test with all the centrals and the Cheyne-Stokes breathing pattern towards the end of the night.  Definitely concerning.  Can someone let me know their thoughts on this?

I followed the instructions on organizing the charts.  First time posting the charts so if i need to adjust something let me know.  

I also added a zoomed in chart of one of the CSR areas.  

Thank you,



         

[Sleeprider]

With a fixed pressure of 8.0 in CPAP mode with EPR off, you have a moderate level of CA events. The flagging of CSR is incorrect in 99% of cases. Resmed calls all variable or periodic breathing CSR and they deserve to be criticize for that decision. It should be periodic breathing, and it is fairly common in new users of CPAP, and is closely related to your idiopathic central apnea.  As you approach the apneic threshold, respiration destabilizes and varies in flow rate resulting in the periodic breathing. This is strongly driven by changes in CO2 in your blood stream and as you ventilate more and drive down CO2, respiration becomes suppressed, then as respiration decreases, CO2 rises and increases respiratory drive.  In your case there is a significant amount of central apnea and hypopnea and this is also related to the same respiratory drive.  There are numerous leak spikes at this time suggesting movement, and that may also contribute to the events.

In Post #21 I provided an interpretation of your sleep study, and noted that your titration results were not particularly good at any pressure tried, and even at the titrated pressure of 8.0, you had numerous hypopnea which were called "RERA" due to the lack of oxygen desaturation. My impression of those events was that they were central in nature, and that is what we are seeing in this first night of CPAP.  There is some minor flow limitation, but I'm sure if we turned on EPR to address that,  you would have higher CA events.  I thing the best course of action is to continue with your prescribed pressure and see if time resolves the central apnea and hypopnea.  If it remains that this level or higher, we would want to consider moving to ASV.  Let's continue without changes for now.  If you are not happy with your mask, ask to change it.  I will suggest the Resmed Airfit P10 is much quieter, lighter and less obnoxious than the Mirage.  If you experience condensation or rain-out, your doctor can easily change your prescription to include a heated tube and the DME will then provide it.

[dolppl]

Thank you for the interpretation. I will keep settings the same and see what happens tonight. 

One thing I did notice was that at least 5 times throughout the night I woke up and had to open my mouth to exhale fully. It was like I had way too much air in my lungs and had to open the relief valve to get it to release. I noticed this also when I was wearing the mask at pressure while watching tv to get used to it. It was strange. It wasn’t like I was struggling to breathe against the pressure it was more that it was filling me up too much. Hard to explain. 

I also had one time throughout the night where I tried to sleep on my side (my normal sleeping position) and it was like my stomach bloated right out full of air I couldn’t exhale it all out. Had to roll onto my back to try to breathe more normally.