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I've been using my APAP for a week, symptoms wors V2e.
RE: I've been using my APAP for a week, symptoms wors V2e.
I was considering replacing the motor in the Aircurve with the one in my current Autoset. But given my Autoset is partially paid for by insurance, I won't do it to avoid incurring any significant penalties. I should be able to get a sanitized and functional Aircurve 10 VAuto this coming week for a minimal price. 

In the meantime, I'm trying to understand what are the important goals that CPAP therapy is trying to achieve. I understand that especially in the case of UARS patients, flow normalization is when optimal therapy is achieved, but I'd like to know what the importance of median Tidal Volume, prolonged flow limits (longer than 20 mins), and factors like minute vent have to play in achieving comfortable and optimal sleep. Like I've mentioned before, my median Tidal Volume seems to be around 20% lower than the minimum tidal volume expected for my Height and BMI. 

I would also like to mention that apparently, my insurance doesn't help to cover the costs of orthodontic procedures and appliances that would possibly help to alleviate my symptoms. A septoplasty, turbinate reduction, and nasal valve correction are due according to my ENT, but the wait for such a procedure will take months at the minimum. 

Since life and responsibilities aren't waiting for me to fix my nasal passageways, I'm asking the above questions so that I can attempt to mitigate my symptoms (primarily cognitive) so that I can function well enough to do what is required of me. In case there is any advice that can be given, I have uploaded my results from last night (most CA's are fake and are actually indicative of changing positions). 

My nurse recommended that when I start Bipap therapy, I start at settings of EPAP 11, IPAP 15 with PS 4, which according to my results (double peaks, flat flow curves, and obstructive apneas) sounds about right. 

Part 1:

   

Part 2:

   
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RE: I've been using my APAP for a week, symptoms wors V2e.
I'd also like to ask. Recently I've been having an issue that's been waking me up, especially during the last part of the night. I'll wake up to find that the tip of my nose and the skin above my upper lip is tickling, and it's pretty uncomfortable. I wipe my mask every single day with non-alcoholic baby wipes before bed. It also happens at sleep onset and therefore increases my sleep latency on some nights since I wake up to itch my face under the mask. I do not have a thick mustache by the way.
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RE: I've been using my APAP for a week, symptoms wors V2e.
Your numbers may be low for a reason or they could just be lower then average. If due to restrictive breathing one would expect the numbers to increase as EPR/PS is increased, not sure that I have noticed a clear trend of increased ventilation with higher EPR.

Chasing increased TV, MV and decreased flow limits can be helpful but it can also be harmful. Pressure and PS are only helpful if they actually help improve breathing and sleep sleep quality. As I have been saying this whole time CPAP treatment is about finding the best balance, you can't treat every single bad breath and the best treatment comes from treating as many bad breaths as you can with minimal invasiveness.

I definitely wouldn't pull your autoset apart because you would void its warranty not to mention the potential insurance ramifications. You would be much better off getting your machine repaired or finding another donor machine to take a blower from. 

Your nurses recommended settings are too high imo. EPAP of 11 would be 4 cm increase over your current settings, add in higher PS which and you are asking for aerophagia, central effects etc. You want to stay with similar settings as you are currently using but increase PS to 4 cm. That would be a min EPAP of 7 cm with 4 PS (giving 11 cm IPAP) and then you can set a max IPAP of say 15 cm to allow the machine some room to increase pressure as it sees fit. You have to remember that on autoset your set pressure is IPAP and EPAP = pressure setting - EPR whereas on vauto you set EPAP and add PS to get IPAP.

As much as I would love to tell you how to find a magical treatment that will solve your symptoms overnight I don't think it is possible and I would not be putting off other treatments like what your ENT recommends because it is possible that they may be required to find the relief you are looking for. Unfortunately your health and physical abilities don't care about your life/responsibilities and you have to figure out how to make due while continuing your search for answers.
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RE: I've been using my APAP for a week, symptoms wors V2e.
Got it, will inform my nurse that I'd like to start titration with min EPAP at 6 cmH2O, and a max IPAP of 14cmH2O at PS 4, with room to increase min Epap to 7. I will hopefully receive my Aircurve by tomorrow or Saturday. 

In the meantime, besides cleaning my mask, what are tips to deal with facial itching when putting on the mask. It's pretty unbearable somedays.
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RE: I've been using my APAP for a week, symptoms wors V2e.
Hi everyone, 

I got a used (5000 hour) Aircuve 10 VAuto from a non-profit organization today and unfortunately encountered an issue with the motor where it was producing significant motor whine. According to research, this indicates a pneumatic failure and the device should be replaced, which will happen soon. 

The Nonprofit also offers a Resmed VAUTO Set S9 and I'll request that they do more extensive device testing to ensure its functioning properly. In the case that everything is fine, what are the differences between the S9 and the 10 VAUTO (Therapeutic value/range, noise, size, maintenance). In the case that it'll meet my needs, I will purchase that for a cheaper price instead.
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RE: I've been using my APAP for a week, symptoms wors V2e.
Make certain you know the full correct machine name, ResMed 9 or 10 AutoSet or VAuto, etc.

VAuto Set isn't sounding accurate/correct as a model name. I would make certain the hours and that there's no motor noise as you keep ending up with noisy machines.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: I've been using my APAP for a week, symptoms wors V2e.
That's the name that the provider provided. I'm sure that it is a BIPAP machine based on their price system. and that the provider just incorrectly told me the device name. In the case that it is the Resmed S9 VPAP Auto, what are the differences that I've stated in my most recent post?

My main issue with the nonprofit is that they refuse to state the use hours on the device. I've tried asking what the reason was, with no excusable response. However, if the device is functioning, an Aircurve 10 VAUTO sells for 200$, and a 9 VPAP sells for 150$, which is a steal by my standards.
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RE: I've been using my APAP for a week, symptoms wors V2e.
Beyond the outer form-factor, colors, and that I think the ResMed 9 Series has a separate humidifier unit, different power cord and brick, different heated hoses I think, and I think that covers the differences.
However therapy and control algorithm as best I know are the same (or very close) between ResMed 9 and 10.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: I've been using my APAP for a week, symptoms wors V2e.
I'll likely request the VPAP 9 then if it's in good condition. In the meantime, I'd like to request some analysis on why higher pressures (13cmH2O - 14cmH2O) cause significant inspiratory flow limitation. Here's a graph from last night to show you what I mean:

Significant flow limitation at 14cmH2O:

   


Close view:

   


Just trying to understand why this seems to be the case when higher pressures would indicate that the airway is being kept open during inspiration. I understand that pressure support / EPR assists flow limitation by reducing breathing-related effort, but I just don't get why the above would occur. I'll request that an ENT does a CT scan to get a more comprehensive look at my upper airways and determine whether there are issues with my palate or epiglottis.

I'm going to attempt to use the Aircuve 10 with 5000 hours use time, and see if it still helps at PS 4. Hopefully, the motor whine doesn't mean the device is entirely useless.
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RE: I've been using my APAP for a week, symptoms wors V2e.
To add to the post above, there were 2 other instances where significant flow limits occurred at pressures between 13cmH2O-14cmH2O. While one was from a used Aircurve 10 with possibly inaccurate data, the other instance was from using my current Autoset which should be accurate. Close-ups will show that the limitation occurs during inspiration.

Used Aircurve 10 VAuto (With motor whine):

   

Airsense 10 Autoset:

   


It appears that high pressures paradoxically cause more inspiratory flow limitation rather than alleviating it. Some reasons as to why that might be would be appreciated.
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