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Ready to go!! Please check my settings
#1
Ready to go!! Please check my settings
I will keep all info on this thread going forward. I’ve stopped and started with xPAP multiple times, but I’m 100 percent determined to make it work this time.

Here is a link to my current settings on my new machine, which is an AirCurve 10 VAuto.

https://imgur.com/a/NdGl7fV

Please note that I picked these settings on my own. In the past, I’ve  had trouble both with a) aerophagia and b) panicking with the mask on during the night. So I tried to start by choosing the “easiest” possible settings.

I chose the S mode because I don’t fully understand the VAuto mode.

I went with IPAP of 7 and EPAP of 3 simply because it seems easiest to breathe while awake. I’ve been practicing. I understand those might not be the most effective settings, but just getting thru a night using the bipap will be a great start for me!

I don’t understand the rest of the settings, so please advise if I need to change those … or the mode … or the pressure … or anything else!)!!

My most recent sleep study is attached. It looks nothing like the two studies I had in 2018, where my AHI was around 30 … I was at elevation then, so maybe that accounts for the difference. Not sure it matters at this point.

Thanks in advance for any and all help!


Attached Files
.pdf   Sleep Study Feb 2022 Pages 1 to 3.pdf (Size: 901.23 KB / Downloads: 10)
.pdf   Sleep Study Feb 2022 Pages 4 to 6.pdf (Size: 620.5 KB / Downloads: 8)
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#2
RE: Ready to go!! Please check my settings
I am curious about your election to start with IPAP at only7 cm.  That sounds low to me, but about six or eight.  Not that you'll need it, but if your nightly flow limit and pressure reports show you climbing up to 15, even briefly, your setting of 7 cm is much too low.  I may have missed what your ePAP pressure is, but it should be between 5 and 7, probably in the higher end of that range.

From there, you must set your humidification requirement, often by seeing what happens to you during the night and if your hose or mask have condensate in them (water).  Try a setting of 4 to begin with, and a hose temp of about 24 deg C (75 F), and see if that keeps you happy and the hose and mask free from water by morning, or worse, during the wee hours!

Depending on the mask you are going to settle on, your machine must know which type it is.  There's a setting for that.
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#3
RE: Ready to go!! Please check my settings
Vauto mode is like using an auto CPAP instead of fixed. Since you have not been titrated and are using an exceptionally low EPAP, I would rather see you in Vauto mode with EPAP min 4.0, IPAP max 10.0 and PS 3. This will give the machine some room to increase pressure to as much as 10/7 if needed for obstruction. I don't recall your past history so it will help to see some background on why you are selecting very low pressure and no humidification. I would suggest keeping water in the chamber and getting passive humidity at a minimum. What has your experience been with humidity? I'd like to get feedback from one night with these settings, then if aerophagia is a problem, we can look at fixed pressure or a pressure reduction.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Ready to go!! Please check my settings
(09-24-2022, 02:48 PM)Sleeprider Wrote: Vauto mode is like using an auto CPAP instead of fixed.  Since you have not been titrated and are using an exceptionally low EPAP, I would rather see you in Vauto mode with EPAP min 4.0, IPAP max 10.0 and PS 3.  This will give the machine some room to increase pressure to as much as 10/7 if needed for obstruction.  I don't recall your past history so it will help to see some background on why you are selecting very low pressure and no humidification.  I would suggest keeping water in the chamber and getting passive humidity at a minimum. What has your experience been with humidity?  I'd like to get feedback from one night with these settings, then if aerophagia is a problem, we can look at fixed pressure or a pressure reduction.

Hi Sleeprider,

1) I'm game to go with your recommendation of "Vauto mode with EPAP min 4.0, IPAP max 10.0 and PS 3" ... but I'm also a little scared.

I've been an abject failure with the AirSense I had before. That was partly because of waking up with a volleyball worth of air in my stomach. So, my initial goal was just to give myself some confidence by sleeping thru a night with this new machine and new mask, even if it doesn't do anything to treat my sleep apnea.

If I start with higher settings and I wake up an hour later with my stomach distended with air, I think I'll be super discouraged. Note that I do have a history of long term GERD and very possibly LES damage.

I looked at notes from the Sleep RN I was working with at the time and the last note (in 2018, when I was using a FFM and struggling with aerophagia) said "I lowered the pressure from 10 to 8 cm H2O."

I picked S mode and 7/3 because it seemed easiest for me to handle while watching TV.

Do you still want me to start with the VAuto settings you suggested?  ... or do you think it's worth going with my plan of trying to build some confidence at lower settings first?

2) You mentioned that I haven't been titrated, The sleep study report I attached was a 2 night in lab study. I thought it involved titration, but I don't know exactly how to read the study?

3) Re the humidifier: so far I've only used this ResMed AirCurve while awake, watching tv. It didn't seem worth using water for that ... but I can put water in it and turn humidification on before I go to sleep with it.


Please let me know your thoughts. Thx
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#5
Sad 
RE: Ready to go!! Please check my settings
Hey guys, I gave it a go a couple of nights ago. Oscar data is attached.

As you can see, I made it a bit over an hour. I woke up with a very dry mouth and a MONSTROUS migraine.  Sad Sad Sad  I had to take max dose of my migraine abortive and thought there was a decent chance I was headed to the ER (I've only ever had one migraine before that was bad enough to go to hospital. So, that's not good.

I'm in crisis mode right now with migraines (that's what's pushing me to finally treat SA) and I believe that sleep apnea is the main trigger for my migraines. I wake up almost every morning with a migraine.

But ... idk why a little over an hour on BiPAP triggered this monster migraine? I wonder if I was grinding my teeth? Is there a bite guard you'd recommend. It doesn't seem like using BiPAP would make the SA worse, so I don't get it.

The good news is no aerophagia!

I'm willing to try any settings you want at this point. I'm stocked up on migraine meds and maybe I need to just keep pushing. idk. help! Smile


Attached Files Thumbnail(s)
   
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#6
RE: Ready to go!! Please check my settings
I realized I used the "print screen" function on my Mac, rather than following the instructions to use the "print screen" function in the actual Oscar map.

The first Oscar chart may have been blurry, so I uploaded the Oscar chart the right way and it's attached to this post.


Attached Files Thumbnail(s)
   
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#7
RE: Ready to go!! Please check my settings
The charts are fine, and you're still at the original settings. If you find bilevel pressure to be a problem, just cut the pressure support. I don't think a 1-hour session dominated by anxiety is of much use for our purposes. So far, not much evidence that obstructive apnea is a problem at all.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Ready to go!! Please check my settings
Sleeprider,

I don't want to be the poster that goes all off the rails, but I wake up every single morning with a migraine. The neurologist says he believes it's sleep apnea. Something is going on beyond stress and anxiety with my sleep.

My neck is fused on side (I have Ankylosing Spondylitis, the "young man's arthritis") Maybe that is playing into it.

I also had two sleep studies in 2018 with AHI over 30 and plenty of obstructives on my side ... no f---g clue why that is so different than my study this year.

I'll see if I can get a night's sleep in with the BIPAP. I didn't have a chinstrap on ... so maybe that was also a factor.

I'm super discouraged if the migraines every morning aren't SA that can be treated.
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#9
RE: Ready to go!! Please check my settings
You are not treating your sleep apnea with 1-hour of attempted therapy. You have to get a full night of sleep in therapy, or your are just basically sleeping without CPAP/BPAP. The objective is to get you where you are comfortable enough that the therapy is not the source of sleep disruption. So far, I have not observed any flow limitation in your charts, and relatively low pressure is preventing obstructive sleep apnea. Have you tried CPAP pressure with little or no pressure support?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Ready to go!! Please check my settings
Sleeprider,

I read and re-read that. I don't think I understand why cutting the PS would make it easier. It seemed like a lower EPAP would be easier. It certainly feels that way when I'm awake. What am I missing?

 I am determined to sleep thru the night with it on. I'm not kidding when I said I woke up with a 10/10 migraine. Blew thru 200mg of sumatriptan (which I rarely need) and it resolved, thankfully. So, I need to be prepared for another monster migraine. Why I have no idea. I suppose it could have been stress, but I don't think so. I do have some structural abnormalities I don't want to take up space here detailing. I'm hopeful that maybe not wearing a chinstrap had something to do with it.

I'm posting my 2018 sleep study so you don't think I'm nuts about having SA. Why it changed so much by 2022, I don't understand. I was at altitude in 2018, but it still seems like a massive change.

Thanks for bearing with me. I promise I'll find a way to get through the night using the machine.


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