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Please Help Optimize Aircurve 10 VPap Settings
#1
Please Help Optimize Aircurve 10 VPap Settings
   
   

Hi. I'm looking to optimize my aircurve 10 vpap settings. Had aircurve 10 vpap for 6 days after a few months with airsense 11. My sleeping is massively improved. Attached two graphs. 

Looks like I have problems at the same time as there are leaks.

History is here:

I'm 53, 190#, athletic. Rock climbing, mountain biking, jiujitsu. I have had what seems like 'cheyene stokes' breathing since I was 19. Not diagnosed by anyone I just know from what other people have described: I'll hold my breath for 30-45 seconds, then puff out air and pant. Over and over at night. Never minded it, didn't know it was happening, no perceived consequences. Sorry if its the wrong term, I just know the term from altitude first aid.

2015: My dentist mentioned this thing called 'sleep apnea' said she'd just seen a talk and it was an extremely unhealthy thing. I'm like: "huh... whats apnea", she said its breathing trouble when sleeping. "Oh... I have that. I've stopped breathing while I sleep since at least age 19.

Well... went to sleep dr, got home test, ahi of 15. He wanted to put me on some absurd sleep machine, guy seemed like a kook that wanted money from insurance. No way. I'm fine, I'm not going to participate in a scam.

2018: start waking up feeling like I've been clocked in the head with a brick. Groggy and dazed, seriously concussed. Spinny things in front of my eyes. Gets better/worse but feel bad most mornings.

2019-2020: Over 2 years I spent 5 months living at 10-12k feet with a week or so > 14k. Seem to have some sort of altitude reaction where I wake with a half-pint of clear fluid in my lungs. Some mornings I wake feeling like someone is sitting on my chest. Its like pulmonary edema from first aid book but doesn't get better, I have it for 2.5 momths at a time, seems to get worse at higher altitudes. Continuous cough but athletically I'm fine, just this pesky cough all the time. Both years the fluid is gone the moment I get out of plane at lower elevation, 30 minute plane ride and its gone.

2021: february: finally waking concussions are so bad I am periodically taking days off work. Zonkered. Arrange new visit with sleep dr. Because of covid everything takes forever to arrange. Another home sleep test, this time ahi is 39, dr says he thinks machine will help, I'm game because now there's a real problem I need fixed. Finally get machine in november 2021. Airsense 11 autoset. I've got restricted nose holes, dr wanted to know how often I'd broken my nose. Never, my sister and father have the same thing. Bottom line I'm a mouth breather and need a full face mask, what I call the "Chuck Yeager".

Dr sets machine in autopap. pressure range 5-15. My sleep is nicely improved, ahi is apparently 2-3. I have about 2 weeks of goodness even though facemask hurts. At some point I start having trouble with mask hovercrafting off my face. I can't get a seal no matter how hard I press. Dr drops pressure range to 5-10. Sleep is pretty awful because of mask pain.

At some point 40 days in I start swallowing air while sleeping, often wake up vomiting into my mask. Thats a really bad way to wake up. Make another dr appt because I'm totally miserable. Can't wear the mask more than 4 hours even at 4cm. It still seems to help but concussion feeling is bad again, i really need to wear it all night but I can't.

10 days ago saw different dr, says I seem to have some central sleep apnea. I tell him how I've held my breath while sleeping since I was 19. Dr suggests I 'try' bipap, borrow a machine I'll know right away if it helps. Loaner available 5 days ago, an aircurve 10 vauto set at 4/4-8. I'm renting this machine at $100/month. Want to know that this is the right machine!
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#2
RE: Please Help Optimize Aircurve 10 VPap Settings
Do you have a copy of your original sleep report? What breakdown of events did the study show (obstructive central hypopnea)?

The usual approach to reducing CAs is to lower pressure support. You might consider dropping it down to 3.6 or so to see what happens.

What is most striking to me about these two charts is that you are having clusters of hypopneas, snores, and flow limitations. This strongly suggests a positional element to your results. Do you sleep on your back, your sides, or some of each? In any of these positions, do you sometimes tuck your chin down toward your chest? And what kind of pillow do you have -- high or fluffy, or low and firm? Depending on your replies, we may be able to suggest some remedies.
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#3
RE: Please Help Optimize Aircurve 10 VPap Settings
(02-13-2022, 02:13 PM)Dormeo Wrote: Do you have a copy of your original sleep report?  What breakdown of events did the study show (obstructive central hypopnea)?

The usual approach to reducing CAs is to lower pressure support.  You might consider dropping it down to 3.6 or so to see what happens.

What is most striking to me about these two charts is that you are having clusters of hypopneas, snores, and flow limitations.  This strongly suggests a positional element to your results.  Do you sleep on your back, your sides, or some of each?  In any of these positions, do you sometimes tuck your chin down toward your chest?  And what kind of pillow do you have -- high or fluffy, or low and firm?  Depending on your replies, we may be able to suggest some remedies.

I'll need to ask to get a copy of the sleep report. I never saw precise results and never paid attention. The data was from a home report and they didn't seem to think the data was very good, it didn't show as being nearly as bad as I felt, it was good enough to prescribe a cpap.

The thing I'm noticing:
- since getting bipap I'm sleeping through the night and feeling relatively great in the morning. Some mornings are still bad though. The ahi 6.8 day I had spots in front of my eyes when I woke but still much better concentration than I've had for years.
- the AHI scores are always higher on days when I have high res data. Is ahi computed differently when high res data is present?
- There's some problem with high res recording, about half the time the high res data isn't recorded on the sd card. Yes I have the write protect off. I wish there was a status mark so I knew the data was being written.

I noticed that correlation between leaks and sleep problems. I sleep in all different ways. I sometimes wake with hose around my neck. I've got a pretty thick pillow.
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#4
RE: Please Help Optimize Aircurve 10 VPap Settings
The first thing that struck me was the clusters of hypopneas. These typically happen when you kink that hose we call a windpipe. It's important to realize that no amount of pressure will relieve this.

Fixes. Pillow modification, get a flatter/less firm pillow. This may or may not work. The next step is to try a soft Cervical collar, see the link in my signature. There are examples there from the same person, mask, and machine, one before the collar that looks horrid, and the next night with the collar looks like a completely different person.

Can you provide the same chart but click on the central apneas until only a 10 minute segment is showing (see duration on the top left of the flow rate chart). That will tell us something about the centrals.
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#5
RE: Please Help Optimize Aircurve 10 VPap Settings
Zoomed graph of day with AHI 6.06:

   

Two zoomed graphs from day with AHI 4.33:

   
   
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#6
RE: Please Help Optimize Aircurve 10 VPap Settings
Gideon beat me to it. Lower pillow, and if that doesn't work, try a collar.

But the zoomed-in views make me wonder whether instead the clusters are due more to periodic breathing than to a kinked windpipe. (Periodic breathing occurs when you alternate heavier breathing with attenuated breathing; it's a kind of respiratory instability that sorts itself out. To some extent, I wonder whether you're fully asleep during these stretches; both of them have some arousal breathing toward the far left. I'll be curious what Gideon thinks.

I'm not sure what you mean by "high res data." Could you clarify?
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#7
RE: Please Help Optimize Aircurve 10 VPap Settings
(02-13-2022, 07:16 PM)Dormeo Wrote: I'm not sure what you mean by "high res data."  Could you clarify?

Hi Res Data: There is high res data that is supposed to be stored to sd card when sd card is present (like the graphs I screenshotted), but I'm at about 50/50 getting the data written on the sd card. About half the time there's a directory there for the day but no data inside. Wondering if I should power-cycle the on/off just to make sure the files were flushed. Is there a protocol to be certain the data has been written before I eject the card?

With the zoomed images above: I'm quite sure I don't remember being awake. How would I tell? Wink

Since at least age 19 people have told me I hold my breath while I sleep and then gasp for air. Over and over apparently.
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#8
RE: Please Help Optimize Aircurve 10 VPap Settings
Others may be able to answer your questions about the data written to your SD card.

We often don’t remember short periods of arousal to wakefulness. Really, the only way to tell with a degree of confidence about brief awakenings is to have EEG data available.

For what it’s worth, I’ve used a Dreem headband, which has some EEG capability, and I saw a pretty good correlation between brief wake-ups (Dreem) and the deeper, more irregular breathing that typifies arousal breathing.
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#9
RE: Please Help Optimize Aircurve 10 VPap Settings
I have never had problems with data being written to the SD card, however the card must be inserted before a session begins, and should be left in place long enough for data to write. A good rule of thumb is to let your machine complete its cool-down cycle.
Sleeprider
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#10
RE: Please Help Optimize Aircurve 10 VPap Settings
I would buy a new data card. It's possible that there is something "off" with the write protect tab and it looks like it's engaged when it's not.

Another possibility is that the sd drive in the machine is defective in some way.

You do need to understand that the detailed data is written on the card in real time as the machine runs, and if anything goes wrong with the write you are simply out of luck -- the data is not saved anywhere else. (I've been a software developer for a lot of years, and the detailed data looks to me like a debugging tool for the engineers while they are engineering the machine.) As far as they are concerned, the logging of the data is NOT required for the device to function as designed. The data can be used to show whether or not the machine in fact functioned as designed, and can be used to show whether or not its functioning is providing effective therapy, is ineffective, or it's harmful.

But you should be aware that according to sleep medicine you shouldn't worry your little head about whether the therapy that goes on when you are unconscious is helping you or harming you. The machines have magical powers, and as long as you are obedient to their commands in using it, you will have wonderful outcomes.
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