Looking for some help - almost 5 years and not feeling a lot better

[happydreams]

CAI = 3.62 out of AHI=3.87, so predominantly CA.  You are right Dave, it's unpleasant.  If I include UF2 (50% reduction for t>=9sec) there were 8 more arousals.

Out of sheer curiosity, I set UF1 to (50% reduction for t >=8sec).  Gentlemen and ladies, I went looking for trouble...  And I found it.  I was shocked to see the additional arousals.  Went from 8 events to 19 events.  This Event flags uses the UF1 definition in this paragraph.
   

Here's where I am aroused by a sequence of 3 8 second events in a cluster.  Not scored.  No flow event.  Almost back to normal after 2.5-3 minutes.  It seems like it would be disruptive.  And a second scenario.  Does not seem to be scored either, yet looks unsettled.  Flow event at 2:04, pretty much after nearly everything is over.  PAP pressure starts to rise at 2:04. 
   

Maybe it's all normal, maybe this is why I often feel worse than the ordinary numbers would indicate.  Some of the non "apneaic" events can still be quite disruptive, especially if they are clustered or have long arousal tails.  

For the sake of full disclosure even my million dollar day had these oddly defined UF1 events, but there were fewer of them and had shorter tails.  During that night I instantly went to sleep again after the UF1 event was over.  

Don't know if any of my poking about changes anything, but maybe it will just serve as a warning to not go looking for trouble.  I will turn back my UFx filters to 20 and 50 for 9 seconds.

[Crimson Nape]

I'm with Fred on this. Based on the fact that you are feeling worse, the tidal volumes aren't responding and are still low, and the preponderance of CA's, I think after one last night, it is wise to return to his recommended settings.    How long have you been on a Bi-level machine?  Based on your body's resistance to the new settings, I'm starting to wonder if you might have graduated to a different model machine. If and when you drop your pressures back down, I would recommend that you keep your Trigger at least on high.

[happydreams]

@Crimson Nape, it hasn't been long.  Started on this machine October 23, 2020, after being on a Respironics APAP for 5 years.  So only 10 days on the VAuto.  Been a tough transition, ResMed does therapy different, and apparently it takes me a while to adapt.  

The feeling of these higher pressures (or PS, I'm not sophisticated enough to discern that) isn't that pleasant for me.  Maybe I will get used to it, but I kind of feel lung stretched and a little sore there.  Don't know what that medically corresponds to but that's how it feels.

I am more than willing to try another night for the sake of science, but if there's no improvement, I need to revert to more comfortable settings.  If the more comfortable settings result in more other non CA events, that's ok, as long as the total number of events starts dropping a lot.  As it stands, this titration is tough on me and I will need a break soon.

Still not giving up!  

Thanks for your encouragement, knowledge and wisdom.  And thanks to everyone else that has offered suggestions, recommendations and insights.  Truly appreciated.  AB is an amazing resource for us struggling PAPpers.

[happydreams]

I'm going to say another night, just to make sure it is not a fluke.  If the same is true then revert

PS=3.0 over 8.4-12.

Apologies for the reply with quote everyone, it seems appropriate here.  

@bonjour
My million dollar day was on day 2 of PS=3.6 over 8.4 to 12.  Is the PS=3.6 appropriate, or should I go to 3.0 over 8.4-12?
If 3.0 was intentional, might I ask why?  I'm only asking as you may have inadvertently introduced a typo.  

3.0 or 3.6?

Thanks so much.  

I will try another night as you suggested.  If poor results will revert.

[Gideon]

Not a typo.  a PS drop from a good night, not the current one, looking to minimize your Central Apnea.  

Aslo contemplating an ASV trial as that machine, expensive as it is, is know to resolve a number of sleep issues other than the Central Apnea it is designed to treat.  ResMed ASV maintains Minute Vent and PR ASV maintains Tidal Volume.  Here most prefer the ResMed and have tried the PR ASV.

[happydreams]

@bonjour, thanks for the clarification.  It's very helpful to understand the motivation behind it as well.  
Thanks so much.  Although you must hear it a lot, here on AB, thanks a lot for your help!  I really appreciate it.

[happydreams]

Reporting in.  And not feeling all that well.  Pretty tired at quarter to nine in the morning.  Headache is slightly down, but overall not a good night's sleep.  If I include UF2's I was in apnea for 8:07.  OSCAR reports 6:05.  Either way, feel rotten.  And it's obvious from a deeper inspection of the flow data that there are numerous micro-events that are occurring and causing arousals which are not being flagged by the VAuto, nor captured by OSCAR's post processing filters.  This is not a criticism of either, only an observation that I seem to have these events.  

Still using a single unadorned low pillow and a soft collar.

20 CA, 2 H, 4 OA, 13 UF2 (average duration 9.4 sec, >= 50% reduction in flow).  TV=340 (median).  Basically no change in TV.  Feeling over-ventilated, or at the very least, lung stretched.  Still not used to the feeling.  Eye bags remain large.  Noticeable mask leakage or farting at night.  Minor leaks seem to arouse me,  even though I wear ear plugs at night.  Hesitant to keep cranking on the straps to control leakage as the mask is getting too tight.  (Which as I have learned can cause leaks!)

OSCAR Total Time In Apnea is slightly down from yesterday, by about 50 seconds, so some minor progress.  
   
Symptoms of aerophagia are appearing at these pressures.  This setting is (as of today) not working well for me.  So I am ready to go to @bonjour's recommended fallback settings.  (Reduced pressure range and reduced PS.)  Which, for the sake of fair accreditation was a setting very close to that suggested by @Crimson Nape.  Thanks to you both.  

Looking forward to your suggestions and comments.

Re: mask.  I have finally got some of the mask templates to print in the right size.  I will contact my DME to see if I can try a few.  It's kind of expensive to just go out and buy them randomly.  Unfortunately I have not found a service like sleepglad that offers remote mask fitting direct to consumers.  Sadly, sleepglad's business plan is to sell or license their capabilities to DME's or other businesses.  Haven't located any other similar mask fitting assistance software.  Please let me know if there's a place that does do this.  Thanks.

[sheepless]

everything you describe suggests your pressure is too high (e.g., ca, aerophagia, feeling over ventilated). again, keep your max at 12 or below, consistent with how-you-felt at different pressures posted above.

[becker44a]

. . .
Re: mask.  I have finally got some of the mask templates to print in the right size.  I will contact my DME to see if I can try a few.  It's kind of expensive to just go out and buy them randomly.  Unfortunately I have not found a service like sleepglad that offers remote mask fitting direct to consumers.  Sadly, sleepglad's business plan is to sell or license their capabilities to DME's or other businesses.  Haven't located any other similar mask fitting assistance software.  Please let me know if there's a place that does do this.  Thanks.

Hi happydreams,
If mask fitting templates are available in .pdf format, they should print in the right size. It is supposed to be part of the Postscript / pdf design to do that, regardless of the resolution of the printer used.

When I needed to change masks years ago, I found that Supplier #26 had a great mask return policy.  You could return a mask within 30 days, for any reason, any number of times.  I lucked out and hit on my first try with the Simplus.  I recently looked at their site again, and it appears that their mask return policy is still in effect, the same or better.  This could ease the financial side of your mask hunt.

Hope this helps.

[happydreams]

Thanks @becker44a that's good to know about Supplier #26.  Makes it a lot easier to try stuff.

Yes, pdf is supposed to make all this transparent to us mere mortals.  But our friends in the OS department also stick in helpful(?) printing features like scale to page and auto rotate and center.  At least on my OS, those extra features interfered with true scaling.  Sorted it all out.  You would think auto rotate and center wouldn't muck up scaling, but it does.  Only needed an extra 0.4% scaling to print out dead on.  100% was real close.  100.4% was exact, at least according to my Starrett machinist scale.  

Why did I bother with all that?  At least on my F10, I'm right on the border of sizes.  This go around, I thought if the printed guide was more accurate, it might be easier to get the sizing right at one go.  Also, to think twice about things when in between sizes.

Thanks for your help!