Newbie?

[Black Sheep]

Howdy, until 6 years ago, I was one of my late mum's caretakers. Since a month and a half ago I did a polysomnography in a fully equipped sleep lab and since then I am officially a user myself. So I changed my profile from my mum's stats to mine, also the machine, tube and mask that I use.
I'm a man of 57 years and weigh 278 lbs and 5' 8" tall with a BMI of over 42. The meds I use are: enteric coated aspirin 81mg, Tenormin 100mg for tachycardia, Lipitor 20mg for cholestrol, glocuphage 2000mg and Jardiance 10mg for type-2 diabetes.
PSG results found AHI 97.8 and lowest oxygen desaturation of 52%. Diagnosis: Severe OSA + PLMD & hypoventilation related to Obesity Hypoventilation Syndrome. Recommendation of my doc: Non supine position BIPAP Pi=17, Pe=8 + humidifier, oronasal mask, ramp from 6 for 15 minutes plus supplemental O2 2 L/min.
My Doc wanted Respironics or Weinmann and as I have no insurance I chose Resmed Aircurve 10 VAUTO. As there is no DME in my area, my machine was unadjusted, so I adjusted it to spontaneous mode with min. EPAP 8 and max. IPAP 17 with 15 minutes ramp from 6. As I had no prior knowledge of pressure support(PS), based on my internet searches I set PS at 9(not the doctor, me). For about a month I used this setting with a median AHI of 4.1. After a month I decided to use auto bipap mode with the same setting with a median AHI of 2.1. Now I want to tweak my settings if possible, to lower AHI even more. I want to raise max. IPAP to 25 and after a week if all is well, try reducing PS 1 cm H2O every week till I reach PS 3 or 4 and see what happens. Any help would be greatly appretiated. Below you will find my last night graphs.
   
   

[SarcasticDave94]

I'd believe a PS of 9 to be rather extreme in your case, that is assuming besides apnea events your breathing is normal. I'm pretty sure you want to back it down some. When I used my ASV I sometimes hit PS of 9 as my machine was set for a PS range of 3-13, but I have Complex Apnea and COPD.

[Gideon]

Let's see if we can bring you down to more normal settings.

Set PS = 6, I don't want to go all the way down at once
Set EPAP min =9, need to raise it for the OSA
Set IPAP max =20, to give the auto more room.

Try that and post your charts after 1 night.

[Dormeo]

Black Sheep, good to see you on this site. You're in good hands with Bonjour.

Let me add a few details that you provided elsewhere: your doctor has not continued providing you with the O2 bleed. I believe you are considering getting an oximeter that would be compatible with Oscar. In your night-time breathing, your tidal volume is somewhat low and your respiration rate somewhat high.

[Black Sheep]

Black Sheep, good to see you on this site.  You're in good hands with Bonjour.

Let me add a few details that you provided elsewhere: your doctor has not continued providing you with the O2 bleed.  I believe you are considering getting an oximeter that would be compatible with Oscar.  In your night-time breathing, your tidal volume is somewhat low and your respiration rate somewhat high.

Hey, thanks Dormeo. You are spot on with me wanting oximeter. To tell you the truth I have a contec CMS50E, but sleeping with a probe is way more comfortable than sleeping with a bulky oximeter taped to your finger, don't you agree?
As with my discountinued O2 bleed, I'm sorry that I forgot. About low tidal volume and high respiration rate, besides losing weight can anyone suggest any other way( I have gastric bypass on my mind, but because of COVID-19 I postponed it for now)?

[Keithp1960]

a stupid question....

how do I post a new question?

[Crimson Nape]

Read this thread in the Member Account Help Forum: http://www.apneaboard.com/forums/Thread-...New-Thread

[Black Sheep]

Been busy, sorry not to post earlier. Here are my screenshots.
   
   

[Dormeo]

I see that the increase in your minimum pressure has reduced your OAs. It's interesting to me that despite the decrease in PS, your FLs are improved as well.

I hope that Bonjour can swing by. With the decrease in PS, your TV is lower, and despite an increase in your RR, your MV is down too. The median RR of 24.8/min is fairly high. You are working hard to move enough air during the night.

Would you consider wearing the Contec oximeter a few nights to see how your O2 looks now that your O2 bleed has been discontinued? I think that could provide valuable information.

How do you feel you slept with the new settings? How are you feeling during the day?

[Gideon]

Please scale your Flow Rate chart to +/- 60 (Closer to what your values are) and provide a 2-minute view of your flowrate.  I looking at normal flow not a trouble flow.

And let's try a PS = 4 and that is a 'normal' PS for a biLevel.  We may yet try lower, we will see.  Note that how you feel is important so please report that from a critical point of view.