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Therapy-Airsense 10 Autoset to Aircurve 10 Vauto
#1
Therapy-Airsense 10 Autoset to Aircurve 10 Vauto
Hi,

Today I have been able to try mt S10 Autoset for the first time. Last year I went through a sleep test, which resulted in with me getting fiagnosed with mild/moderate OSA (AHI:15). I have only been able to start using a CPAP device yesterday night (except 2 titration tests). I am using a Philips Dreamwear nasal mask (the one which is like a cradle) but normally I am a mouth breather, however my doctor suggested using a nasal mask first, to see if it helps with mouth breathing so here are my results.

First, I want to show the difference it made about my snoring. Here is a comparison with SnoreLab results:
   

I think it makes a huge difference, but I got a better result when I used a mask which covered my mouth during the titration test.

Here's my Oscar chart:
   

How do you find the results? I apparently had 2 central events, do you think they are important?

The sleep itself was not very comfortable. I woke up a lot.  I didn't have any problems breathing through the mask, which was very light and comfortable to wear but I am a side sleeper, so the mask tends to move a little bit if I turn and air can escape, which sometimes woke me up. Generally my nose and throat were ok but 3-4 times I woke up with my mouth open and with a dry throat. The  hose itself is alittle bit difficult to control. 

Do you have any recommendations for a more comfortable sleep? 

Thanks...
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#2
RE: First night with CPAP: Suggestions?
First, your numbers suggest you are well-controlled and are being well-served by your device.

If you put your cursor over any of the events in the chart, when it is being displayed in OSCAR, you'll see the duration of each event.  I think you'll find the CA events in purple are probably less than 15 seconds, but I could be guessing wrongly.  CA events get recorded at 10 seconds and on up.  If they are very low in duration, they can be caused by arousals, even if only to turn over.  Most of us hold our breaths when we turn during the night.

My main point is to say that the number and duration of the very few CA events are likely to be entirely innocuous. 

I settled on a nasal mask, but that first night was terrible, and for the reasons you specify.  Mostly it was my open mouth.  When I called the therapist next morning to report my problem, she said to use either a chin strap or to tape...the latter she could not recommend.  I have taped since Day Two, and have never looked back.  It's just a fact of my therapy now.  

However, some people find that a soft foam cervical collar can do a good job of keeping the jaw closed IF it is sufficiently high to do that.  If you decide to tape, use the Somnifix...I think that's what it is called, but I use 3M NexCare 1" wide white 'water resistant' tape that comes in a plastic spool encased in a plastic cylinder.  Look for it at drug stores.

As for mask deflection and deformation while you sleep, it happens to all of us.  You will eventually learn to half-wake and to reorient the tube near your face, or to massage your pillow edge to change its impact on your mask, or you'll learn how to orient your head while you sleep on your side.  I have done all of these.

Keeping a sense of calm and positive expectation will help.  This can, and does, work for 90% of all users of the various headgears, masks, cushions, and machines that put air through them.  It just takes some time, some thinking, some tinkering, and an open mind to try things that you might otherwise look at askance.

Good luck.
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#3
RE: First night with CPAP: Suggestions?
Your ramp is on for 45 minutes. Turn it off or change it to Auto. There should be absolutely no need for ramp with a minimum pressure of 6.0 and what that does is to keep you at minimum pressure for a long long time which is going to be very uncomfortable. Very few of us tolerate 4 cm pressure because it is not enough flow. You clearly should not be using ramp either.
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#4
RE: First night with CPAP: Suggestions?
Hi,

Thanks for the suggestions, they are very valuable for me.

First, I want to state that I apparently made an error yesterday with the Dreamwear nasal mask. I measured M size, but somehow used the L size, so it was probably easier to displace. I'll change to M today and try again. Also, as mask type I chose nasal but I have seen suggestions on choosing pillow. Shall I change the type to pillow?

For the centrals, yes, you are right, they are both 12 seconds long. I zoomed in to those 2 events:

   

   

I am not sure which graphs would be more helpful but I reordered them to show the ones with the highest variance. Apparently just before the apnea, I tend to take a breath with a larger amplitude, then stop breathing. Would it be due to a positional change? Also, do all of the central events end up by waking you up?

For the ramp I remember choosing auto, however it shows as 45 min, so it is probably my fault. I don't feel a sensation of missing air with the 4 cm H20 pressure so I thought it could be more comfortable to set it to auto, where it would start increasing pressure after I started sleeping. I can try with ramp off.
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#5
RE: First night with CPAP: Suggestions?
Those centrals are not worth worrying about. They show that you drew a deep breath just before the event, took a short break from breathing, and then returned to normal breathing.
That's mostly likely a sigh, probably while rolling over. You likely do it all the time during the day too. It shouldn't be disturbing your sleep.

Your results are great. No need to change to pillows unless there is some reason too. Give it a couple of weeks with the correct sized nasal mask so that you build up a proper view of what's happening, then decide if you need to change anything.
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#6
RE: First night with CPAP: Suggestions?
Hi,

I've realized that I haven't posted my sleep test results, so maybe you can provide a better insight for the appropriateness of the treatment. I've been diagnosed with obesity hypoventilation syndrome. Here are my results.  

           

Is obesity hypoventilation syndrome much different from OSA? Does it require a different approach (lweight loss is ,of course, required)? Is CPAP therapy enough for it?

Thanks
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#7
RE: First night with CPAP: Suggestions?
OHS is characterized by high Blood CO2 and Low Blood O2.
Have your CO2 levels been measured?

Treatment is typically with some form of CPAP. I would suggest a BiLevel because of its greater flexibility to adjust blood gasses with its greater range of PS/Pressure Support.
Thus the ResMed AirCurve 10 VAuto.
If they insist on a CPAP, the ResMedAirSense 10 AutoSet. The AutoSet offers a feature called EPR which can mimic a BiLevel but is limited to PS values of 1, 2, or 3.
I would also order an OTC Pulse Oximeter that is OSCAR compatible such as the Contec CMS50F.

On losing weight, very few of us don't need to do that. A few have done the Bariatric surgery. If interested ask.

If they offer any other machine check with us first.
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#8
RE: First night with CPAP: Suggestions?
Thanks for the comments.

Yes, my arterial blood gas levels have been measured in the morning, when I just woke up. My pH was 7.40, pO2:96 mmHg, pCO2:45 mmHg, and SaO2 96%. Do they support the diagnosis?

I have been given the S10 Autoset for now.

I also have ordereda CMS50I, I think it is the newer version of the CMS50 series, with the possibility to store more than 1 nights' worth of data (3-4 nights I think). I've read in the forums that the newer version of CMS50F could not be directly read by Oscar for now, maybe it will be similar for CMS50I too.
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#9
RE: First night with CPAP: Suggestions?
pCO2 30-45 is considered normal, you are at 45. A deeper review show that 45 qualifies for OHS
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#10
RE: First night with CPAP: Suggestions?
Hi,

Here's yesterday's chart:

     

I have a few questions. Please disregard the EPR being turned off, I was experimenting with it in the morning (as you can see from the pressure charts) and apparently it shows the latest setting on the machine when you removed the SD card. Normally EPR was at 2 for the majority of the session.

1)I had 3 obstructive and 1 central events. The 1 obstructive and 1 central event were very close to each other (about 10 breaths apart) and I think I was awake or about to wake up, so I don't consider them important. Do I need to modify my settings for the remaining 2 obstructive events? In other words, If you have obstructive events, does it mean you have to increase your minimum pressure (actually it is at 6 cm H20 with EPR of 2) or is it better to leave it to APAP's algorithm with the current settings?

2) How about flow limitations? There seems to be a concentration of these events between 4.00 a.m. and 5.15 a.m and the machine is actively trying to prevent them (quite sucessfully probably, as there are no recorded events). I used a tape for closing my lips but it got loose at around 4.00 a.m. and my mouth opened. Can this be a reason for the increased flow limitations? I removed the remaining tape at around 6 a.m. and didn't put any replacement. I ordered a soft collar and will try it when it arrives.

3)In the morning I woke up feeling a little bit less rested compared to yesterday. Could it be due to the taping? The tape prevents air from escaping from your mouth and that blows my cheeks. I remember waking up a few times, feeling confused about what to do with that air in my mouth.

Thanks...
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