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Is this normal or my APAP is simply stupid?
#21
RE: Is this normal or my APAP is simply stupid?
In theory yes. In reality Flex has very little of the effect of pressure support. This lack of capability is the main reason we strongly recommend ResMed.

Flex works fine for comfort, not therapy, and not for treating flow limits.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#22
RE: Is this normal or my APAP is simply stupid?
When you get your Vauto machine, accessing the menu is very easy. https://www.apneaboard.com/resmed-airsen...setup-info

You are currently using a minimum pressure of 9.0 and maximum pressure of 20 on your Dreamstation and are experiencing significant flow limitation, so we are going to start with a conservative minimum pressure and 4.0 cm pressure support. There are many more settings we may consider after seeing your results, but for now, most will be at default settings. Enter the settings menu and set the following:
Mode: Vauto
EPAP min: 8.0
Max Pressure: 20.0 (IPAP max)
Pressure Support: 4.0
Trigger Sensitivity: Medium
Cycle Sensitivity Medium
Ti Min: 0.30
Ti Max: 2.0
Humidifier to manual
Setting 3 or 4
Tube temp 27 C

This will provide pressures ranging from 12/8 to 20/16 (IPAP/EPAP). I'm certain you will feel more comfortable. We need to review your results and tolerance to flow limitation before making additional changes.
Sleeprider
Apnea Board Moderator
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____________________________________________
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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. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#23
RE: Is this normal or my APAP is simply stupid?
If your machine is used, always perform a Factory Reset simply because we do not know if the set any other settings. It provides a known place to start.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
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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. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: Is this normal or my APAP is simply stupid?
I will have sleep study in 5 days.

Meanwhile I found this:
[Commercial Link Removed] Search for: resmed aircurve 10 vauto autobilevel

As you guys suggested I will buy it.

I do have 1 more question,
Should I buy mask for it? What else is needed next to the machine?


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#25
RE: Is this normal or my APAP is simply stupid?
Your current mask will work fine with the new machine as they are universal fit. If you feel the mask is not comfortable, effective or has excess leaks, by all means you can replace it or replace components like the frame, headgear or just the cushion. The new Vauto will be very comfortable, and you will experience a completely different level of therapy with the pressure support. The settings I suggested above should be a good start.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#26
RE: Is this normal or my APAP is simply stupid?
Thank you so much!

I have two further questions:

1.

This device https://somnomedics.de/en/solutions/slee.../somno_hd/

https://somnomedics.de/wp-content/upload..._16-en.pdf

Can it detect UARS and flow limitations? I know everyone now sticks to UARS when their AHI is low because let's face it, it is hard to convince someone that "it is all in your head" but my inhalatory lines look dramatically flattened almost always and when it gets sever it goes on for 30 minutes until I wake up. That is why it is important to me that this guy who will do the study in few days will know what to look at. It says data analysis and report in that link:
Flow Limitation – obstruction level analysis
Automatic detection of RERA events


It's a German product so I guess they would not flat out just lie? Even though recently I have no more ideals like that, I've seen reputable European brands lie worse than Chinese. 

2. 

Second question... I've read from Dr. Barry Krakow that he uses ASV devices for UARS. https://www.sleepreviewmag.com/sleep-dis...a-and-sdb/

Now here it was suggested I should AirCurveTM 10 VAuto which is Bilevel (BPAP) that can change pressure settings during sleep from my undrstanding

How is ASV(AirCurve10 ASV) any different to that BPAP (AirCurveTM 10 VAuto )?
In other words, should I buy AirCurve10 ASV instead of Aucrive 10 Vauto as suggested?

I am asking this because I lost 1500 euros on Screamstation :Smile think it would be smart to get the best machine possible right away instead of gradual improvements that can prove costly if I have to buy the third machine. 

So I know you guys suggested AirCurve 10 Vauto but then lingering in my mind somewhere behind is that maybe you guys were too soft on my wallet. So please pull no punches, hit it for what it is. 
If AirCurive10 ASV is better, i'll get it. 


3.

Third is not a question, just a statement. AHI is such a horrible measure. Literally.  I noticed my desaturations always constantly happen and they wiggle from 90 to 97% usually 3-4 % oscilations constantly and they correspond with the flow limitations I see in the OSCAR and subsequent arousals and wakenings.

It is crazy how someone draws a line and says AHI 5 is that magic number and if you are woken up by desaturation less than 4% you are not included. 

I just don't get it.

I know that many people simply won't accept that they don't have sleep apnea, but I can also see that many people are stuck there in the middle of that grey zone.
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#27
RE: Is this normal or my APAP is simply stupid?
I can address the ASV from my point of view. I do have the ResMed AirCurve 10 ASV, and it works excellent for it's designed niche CPAP class purpose. I'm only sticking with the one specified purpose ResMed mentions and that is CA or Central Apnea. I am aware others have found the ASV useful to address other event types, so it does address more than just CA. The problem of getting an ASV with little to no CA is that some here on AB have tried it, and it was less than successful for them. When they were on VAuto it was better than the ASV as I recall. So evaluate your situation seriously and simply. Do you have CA to address? Yes, then ASV is THE answer. No, then the answer is VAuto. My opinion on this.

FWIW ResMed's 10 series ASV has no Ti, trigger, etc. manual controls; these values are automatically handled. The VAuto has those however. If you're in need of shaping those settings, this ASV is not for you. Another possible plus to the VAuto.
Dave

OSCAR
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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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#28
RE: Is this normal or my APAP is simply stupid?
The Somnomedics PSG is a sleep test instrument and the report appears to produce a useful standard group of information with AHI and RDI including RERA. It does not seem to specifically produce an index of flow limitation and I don't see a detailed flow rate chart that would facilitate that interpretation. Interesting it only uses a 4 Hz sample rate compared to 5 Hz for Philips machines and 25 Hz for Resmed. That data density would affect the refinement of the wave-form data that you are interested in.

Barry Krakow has used both bilevel and has moved to ASV for treatment of UARS. As Dave suggests we have seen mixed results with some finding the pressure variations disruptive, and others finding they adaptively treat flow limitation on a breath by breath basis. The ASV provides EPAP and minimum pressure support, and required a maximum pressure support 5-cm greater than minimum PS. If you need 4 cm to treat most flow limitation, you will still have a max PS of at least 9.0. The ASV targets minute vent, and will trigger IPAP and adjust PS whenever the respiratory rate or volume drops. With Auto bilevel you get auto EPAP and it provides fixed pressure support, relying on spontaneous inspiratory effort to trigger IPAP. In most cases auto bilevel seems to provide sufficient PS to counter flow limitation from UARS, however if flow resistance is highly variable, then ASV may be a good choice at a considerably higher price.

Your thinking on the use of AHI to qualify for therapy under insurance is in -line with my own. We know these criteria are strictly to transfer a large part of medical costs back to the patient or provide a basis for denial of coverage. If viewed in that context it may make more sense.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#29
RE: Is this normal or my APAP is simply stupid?
I want to share one specific detail that I have not shared so far.

I have shown flow limited breathing..

But weirdly it is not just flow limited like that but it oscilates up and down. 

Like 10 breaths it gets deeper breathing and then becomes more shallow.

What could that be?

Could that be mechanical obstructive flow limitation causes those oscilation or it is central?

Maybe if it is central, ASV is better?
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#30
RE: Is this normal or my APAP is simply stupid?
Hmm so in other words this sleep study with Somno HD can not detect UARS?

Also Somno HD PSG thing I see it says kHZ... that is kiloHertz.. meaning I guess?! 4000 Hz...

Are you sure Dreamstation and resmed only work on 4 and 25Hz?

I am confused

And here it says "flow limitation" in the attachmed i have put the screenshot

Further more in the report example it has a space that says "flow limitation index"


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