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Pretty Dialled in but minor tweak help please
#1
Pretty Dialled in but minor tweak help please
Hi everybody!

I have, over a long process, gotten pretty dialled in with my machine and settings, thanks in large part to the help pf forum members here. I actually feel quite a bit better, and I know I'm pretty much there.

i thought I'd check in again, and see if there are any other lingering tweaks I can make. I often feel sleepy mid afternoon, and usually succumb to a nap, but set an alarm and keep i to 30min. I know that's not a bad thing, but it does control my schedule more than I'd like. Granted,i work from home, and my work is often un-inspiring, so I'm sure that doesn't help. I certainly don't want to nap when I'm out fishing - so that's a flag for me.

I attached last night's graphs, and it shows my current machine settings. I'm a mild apnea sufferer (ahi=8) but am treating because of debilitating fatigue pre treatment. 

I'd like to see if I can get at the flow limits just a little more. I know they are far less than most people would find problematic. The Vauto is a newer to me machine, and I have left it alone for a couple months, and though I should check in again just to see what else I can do and if it would help.

Attached is a full graph and also a zoom in in the area where I saw some flow limits go see curves. 

This is all about how I feel at this point, but i think I'd like to still feel like I don't want to go back to bed 4 hours after I wake up. 

thanks for everything!!


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#2
RE: Pretty Dialled in but minor tweak help please
Keeping one eye on the time-line for all charts you show, you'll soon notice that your tidal volume rises are commensurate with rises in flow rates, almost one-for-one.  I can't be sure, but my money is on arousals.  It might be due to dreaming, noises, sagging and that twitching thing that automatically comes with a sudden change in muscle tone or head attitude....something...

You show a bit of 'clear airway', which Resmed uses as a catch-all term for 'central apnea'.  These are often quite spurious.  They become more considerable when their length exceeds about 10-12 seconds, and happen more frequently.  They often happen during arousals, such as when we turn from one side to the other, or sit up to adjust something momentarily...that kind of thing.  So, maybe they are commensurate, but I can't tell.

With an AHI as low as this, and if it's rather typical to be less than an AHI of '01", you should probably turn your energy elsewhere...frankly.
Serial Tapist
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#3
RE: Pretty Dialled in but minor tweak help please
(Small request: could you change your profile to reflect the VAuto?)

As Mesenteria says, it's pretty unlikely that FLs are a big problem for you at this point, but you might take a zoomed-in look at some flow rates that aren't flagged to see whether they, too, show signs of FL (inhalation curve is dented, flat, or pointy).

If you do see signs of FL that the machine's algorithm doesn't flag, you could gradually increase your PS and see what happens. You want to watch out for increases in CAs or leaks or other disruptions.

The other things to think about are side-effects of medications, adherence to sleep "hygiene" guidelines, and levels of daytime activity and exposure to sunlight, especially given that you are working from home doing work you describe as kind of boring.

It'd be great if you could feel less daytime sleepiness. Good luck with that!
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#4
RE: Pretty Dialled in but minor tweak help please
(02-20-2020, 01:43 PM)mesenteria Wrote: With an AHI as low as this, and if it's rather typical to be less than an AHI of '01", you should probably turn your energy elsewhere...frankly.

Thanks for that. I will continue to do so.
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#5
RE: Pretty Dialled in but minor tweak help please
(02-20-2020, 02:04 PM)Dormeo Wrote: (Small request: could you change your profile to reflect the VAuto?)

As Mesenteria says, it's pretty unlikely that FLs are a big problem for you at this point, but you might take a zoomed-in look at some flow rates that aren't flagged to see whether they, too, show signs of FL (inhalation curve is dented, flat, or pointy).  

If you do see signs of FL that the machine's algorithm doesn't flag, you could gradually increase your PS and see what happens.  You want to watch out for increases in CAs or leaks or other disruptions.

Thanks for this info Dormeo. I think with my settings as they are, I'm maxed out at PS of 3, correct? otherwise I would try to raise it. Also, I actually thought the Vauto would respond to FL by increasing pressure, but it seems the pressures on this machine are static. Do I have it set properly? (and yes, I edited my profile to update machine - thanks)
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#6
RE: Pretty Dialled in but minor tweak help please
If you go into the clinical settings, first make sure you're in VAuto mode. You'll see options for min EPAP and max IPAP pressures and for PS. Just be sure that your max is equal to or great than the sum of your min and your PS.

Myself, I'm disrupted by pressure ranges and don't really need them. So in VAuto mode, I set min EPAP at 5 (works for me, maybe not for you), then max IPAP at 9.8, and PS at 4.8 (again, works for me, maybe not for you).

If you google "VAuto pressure settings," the top hit is a clinical manual that has lots of information. You can also get the manual emailed to you by using the link at the top of the page here.
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#7
RE: Pretty Dialled in but minor tweak help please
I’m not familiar with an AirCurve VAuto, but I believe you can increase the PS past 3. The clinical manual, or even going into the clinical menu, will let you know.

My only observation that is a concern is the afternoon nap. While your numbers are great, IPAP/EPAP of 7/4 seems incredibly low.

John
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#8
RE: Pretty Dialled in but minor tweak help please
I'm dialed in with help here too.

Along the way, I bought a Garmin watch that records heartbeat. It gives me a crude sleep report. The part that really helps me is that I have a record of how long I slept. I wasn't very good at that before this watch. I felt I got adequate sleep; however, I didn't sleep long enough.

The watch tells me how long I have "deep sleep" and how long I have "light sleep" I find that reassuring.
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#9
RE: Pretty Dialled in but minor tweak help please
(02-20-2020, 02:57 PM)Dormeo Wrote: If you go into the clinical settings, first make sure you're in VAuto mode.  You'll see options for min EPAP and max IPAP pressures and for PS.  Just be sure that your max is equal to or great than the sum of your min and your PS.

Myself, I'm disrupted by pressure ranges and don't really need them.  So in VAuto mode, I set min EPAP at 5 (works for me, maybe not for you), then max IPAP at 9.8, and PS at 4.8 (again, works for me, maybe not for you).  

If you google "VAuto pressure settings," the top hit is a clinical manual that has lots of information.  You can also get the manual emailed to you by using the link at the top of the page here.

Thanks - I downloaded the manual. 

So because I'm at 4 on the low side and 7 on the high, and PS of 3, that's why i wouldn't be seeing any rise in pressure during a FL, correct?
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#10
RE: Pretty Dialled in but minor tweak help please
(02-20-2020, 03:49 PM)DaveL Wrote: Along the way, I bought a Garmin watch that records heartbeat. It gives me a crude sleep report.  The part that really helps me is that I have a record of how long I slept. I wasn't very good at that before this watch. I felt I got adequate sleep; however, I didn't sleep long enough.

The watch tells me how long I have "deep sleep" and how long I have "light sleep" I find that reassuring.

Can you recommend which watch I should get? How reliable is the data from your experience? Thanks!!
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