Moving on from CPAP

[SarcasticDave94]

Ok got it. My mistake.

[Sleeprider]

Thank you for working with me on this! I don't know how you guys can find the hours to do this. I started using CPAP again last night, and although I got about 8 hours in with one trip to the bathroom during the night, I still don't feel so good today. Maybe it's all the days off (since January 19, 2020). I get about zero help from my CPAP doctor. I went to using an ASV machine on the suggestions from this board. The OSCAR readings have been terrific since then. See last night's report:

But many nights I can't tolerate it and take it off. Usually it's because it disrupts my sleep, uncomfortable, that sort of thing.

I'm going to ask my PCP (not CPAP doc) for a nighttime oximetry study which has never been done to see if it really improves my O2 saturation from previous studies before starting CPAP.

Any other suggestions?

Thank you!

Okay, I'm on overtime tonight. Your chart below looks like a very good night of therapy, nearly free of events. The pressure support is quite high with the median at nearly 7.0 cm, but generally less than 9.0. That means the machine is supplementing most breaths, but respiration is amazingly steady and shows no apparent arousal or disruption.  My question before you posted this chart was, what are we treating here? So I did a review.




Let's review. When we first met, you were using a Resmed Airsense 10 Autoset.  I think we can agree, that your most recent graphs is a very different world from where we started.



We resolved the positional apnea with a soft cervical collar, and saw significant clusters of CA, mostly at the end of the night, and this was with fixed pressure at 7.0 and no EPR



So, now we can conclude that you had positional obstructive sleep apnea with therapy onset central apnea, mostly in transitional sleep, but we can't treat the centrals with CPAP. If there is going to be a solution, you needed to move to ASV, and you did. From the first night with ASV, you used a PS min of 5.0, and I think this is where we need to rewind. Here we saw your first complaint that is the same as what your current post has; your sleep was disrupted by pressure increases.



So you tried reducing PS min to 3.0, and your comment: "I had a terrible night, perhaps because I could barely feel the pressure compared to the night before?"




And finally we thought we had arrived. Your comment, "Best of all I slept through the night without waking up, and I felt clear and energized in the morning. I think I've finally achieved what I have been looking for since I started this CPAP journey over a year ago. Too bad it took so long."






And then at the end of that thread we got what is continuing in this thread (Ask me why this is spread out into 3 threads, because it all looks like the same issue to me).

Well I am still having problems with what seems to me intermittent excessive pressure and/or poor synchronization with my breathing using my new AirCurve 10 ASV machine. When I start out at night the machine seems to function pretty well and I can get to sleep. But after about 2-3 hours I wake up experiencing high pressure with lots of leakage past my mask. It feels like it's only partially synced with my breathing because when I exhale is when the leakage peaks. Sometimes I shut the machine down and maybe put it on later in the night and the process repeats.

And there we are, full circle, and tonight we are responding to a post that shows a nearly zero AHI and excellent therapy.

My friend, I'm sorry. We cannot help you beyond this point. I'm personally at the end of my wits for solutions to a problem that has no visible or apparent cause.  This might be as good as it gets.  I've given the best I have and i ain't got anything else. Good luck trying to get your PCP up to speed on this. I don't have anything more to suggest in terms of settings or PAP therapy to offer. Not trying to cut this off, it's just where I'm at. I think any residual issues probably lie outside of the ASV/ PAP therapy arena and are not in my wheelhouse.

[GaspForAir]

Well thank you Sleeprider and SarcasticDave for the huge level of work you put into this. I believe that CPAP works great if I could only tolerate it better. I will continue to look into improvements I can make so I tolerate it better, but Im am also going to look into Inspire cautiously.

Thanks again for your good work. I wish my own sleep doctor was half as smart!

[SarcasticDave94]

Sincerely, best wishes you get the sleep improvement you're looking for.