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Therapy-Airsense 10 Autoset to Aircurve 10 Vauto
#41
RE: First night with CPAP: Suggestions?
Hi,

Tonight I had a good sleep. I practically copied the settings from the day where I had the best AHI (6-20 cmH2O with an EPR of 2). No mouth taping. Also, I used the mask fit option on the device to make sure that the mask was firmly seated (I normally don't use this option but I think it is helpful, because I had to make it tighter than I regularly do. Normally it is recommended that the mask shouldn't be very tight but no leaks at mask fit mode (which I assume blows at maximum pressure) requires a tight fit). The mask was still comfortable despite being tighter. I remember waking up only 2 times and for very brief periods. At these periods I was mouth leaking. Also my leak amount is worse than the days I used taping but I assume this is a manageable leak rate and doesn't really decrease therapy efficiency. 

   

I had very few centrals (first time in 2 weeks where centrals were lower than obstructive events and all of them are 10-11 seconds). 6 Obstructive events, nearly all of them between 10-15 seconds, except the one at 1.26 a.m which is 21 seconds but it didn't create a serious desaturation. Also probably the best saturation chart since I started recording saturations, with only 1 brief episode where saturation is at 87%. Interestingly tidal volume is lower (480 vs 400 ml) with a slightly higher respiratory rate.

Any recommendations? Shall I increase EPAP slightly to fight the OAs? Maybe I shouldn't increase a whole cm H2O and experiment with smaller denominations.
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#42
RE: First night with CPAP: Suggestions?
Numbers are good, no complaints, ride these settings for now
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#43
RE: First night with CPAP: Suggestions?
Thanks. Had a good night today too. A very good AHI (and I was awake at the last central so even better in reality). I haven't changed the CPAP's settings but made 2 modifications. The soft collar that you've suggested previously (Eliminator) arrived yesterday and I've used it. It is much more comfortable than the previous neck collar I had used (which had neck support at the back side, interfering with the pillow), so no problems sleeping.  I assume its impact is mostly visible on flow limitations. I was awoken at around 5 a.m. and I've found that the collar was a little bit tight and my neck was slightly sweaty so I widened it a little bit, and I think that's why the flow limitations after that point in time were slighlty higher. So probably, the tighter the collar is, the better its effect but we probably have to find a balance between comfort and effectivity.

   

The second change I made was to try the N30i, which I've also received yesterday, instead of the Dreamware nasal cradle. They of course look quite similar but have some noticeable differences. The N30i has plastic parts at the cushion, while Dreamwear is mostly silicone, so softer. This makes N30i firmer and it can preserve its shape easier compared to Dreamwear. This had a huge impact for me, because for the first time I was able to side-sleep without worrying about the nasal cradle flexing and starting to leak. I didn't feel the pressure and/or pain due to the plastic parts that some people mentioned on their reviews. I only had a problem when I had to wake up at 5 a.m., because I was having difficulty in breathing in as one of my nostrils was stuffed. I didn't have this feeling with the Dreamwear before, so maybe that's a problem with N30i's design, where the nasal part has 2 separate holes, instead of 1 large hole on Dreamwear (maybe Dreamwear is better at providing oxygen at these situations, but it is to early to say something definitive).
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#44
RE: First night with CPAP: Suggestions?
Hi,

Yesterday I had the opportunity to try VAuto for the first time:

   

It might be subjective, I am not sure, but it was easier and more pleasurable to breath in and especially out. I thought a range of 6-20 with EPR of 2 would feel similar to an EPAP of 4 (4.6 to be exact) with a PS of 2,  but it doesn't. I didn't have any centrals, which is a first for me, however I had some obstructive events (between 11 and 19 seconds, with the exception of one of 30 secs), so I assume I should increase the EPAP. Shall I keep the PS of 2? 

I had no desaturation events, which also is a first for me. It is interesting to note that the pressure graph is very symmetrical to the saturation graph. Whenever there was an increase, the saturation also increased. Does it mean my IPAP is not ideal? Shall I increase it? I now have the opportunity to experiment with different PS values, so I might experiment on that.

No mouth taping yesterday, which explains the mouth leaks. Also no neck collar, it probably creates more chin tucking than it is supposed to solve.
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#45
RE: First night with CPAP: Suggestions?
Hi,

I keep on experimenting with various options. Yesterday night I wanted to try again the full face mask that I had tried previously. That previous attempt was problematic. Here's the OSCAR chart for my previous full face experience:

     

And here's yesterday's results:

   

A few changes that I've made had a lot of influence at the end result. I am using a VAuto and I find it more comfortable compared to Airsense but the settings are quite similar, so I don't think it is the main reason. I am probably getting used to the treatment emergent centrals, despite the fact that I have a PS of 3, they are less frequent now. The other major difference was the use of a soft neck collar (Sleeprider mentioned that my events were clustered, so probably due to chin tucking, and I think the actual results prove that). The collar, combined with the full face mask, practically prevent any leaks, and also it is nearly impossible to open my mouth in this setting, so I assume the therapy is more effective. I wish the collar that I've used (Carex Cervical Collar) was more comfortable, as it feels very restrictive (with the addition of the full face mask, it is nearly claustrophobic) but I prefer it to mouth taping, which is a more disturbing sensation for me.

It is also interesting to note the effect of chin tucking on the pressure levels. I assume it is practically impossible for the device to combat with a physical phenomenon, where the airway is bent and no amount of pressure is going to fix it unless you correct your posture. As a result, the device increases the pressure to very high levels, which disturbs the sleep. I think Resmed should add an algorithm to recognize clustered events due to chin tucking and not to respond to those as aggressively as it is doing right now. It probably isn't preventing anything and is messing with the therapy.

And a question: Do pulse change events matter? I have 75-250 PC events each night. I don't have a cardiac problem, except some low grade hypertension, so I assume these are normal??
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#46
RE: First night with CPAP: Suggestions?
I like your results at PS 3 and EPAP min 5.0. The soft cervical collar really helps to clean some things up. I'd really appreciate if you would review your Carex collar in the Review forum. I am trying to get more collar reviews so members can compare and see the experience of others.
Sleeprider
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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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#47
RE: First night with CPAP: Suggestions?
"I wish the collar that I've used (Carex Cervical Collar) was more comfortable, as it feels very restrictive (with the addition of the full face mask, it is nearly claustrophobic) but I prefer it to mouth taping,"

my sentiments as well. I wish I didn't have to wear a collar, especially as summer arrives here, but it works. I choose the 'pain in the neck' as a price to pay for more restful sleep. nothing is more important than that. fortunately, we can adapt to most anything if we feel the result is worth the effort.

idk the answer to your pulse question but glad to hear you're making progress.
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#48
RE: First night with CPAP: Suggestions?
(06-21-2020, 11:09 AM)Sleeprider Wrote:  I'd really appreciate if you would review your Carex collar in the Review forum.  

I just did: http://www.apneaboard.com/forums/Thread-...cal-Collar
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#49
RE: First night with CPAP: Suggestions?
Hi,

I want to talk about my experience with the VAuto with the Dreamwear Full Face mask and the Carex collar. I think I've found the combination which gives me minimal or practically 0 AHI (I haven't been able to get a 0 yet, but the last night, which I've posted the chart below, probably counts as 0). 

The full face mask decreased leak rates to 0. It is interesting because people generally tend to have larger leaks with larger masks as there is more surface area that is prone to leak but this one works. I normally have a standart sized face, so generally use M size on every type of mask but here I use MW size, which has wider nasal holes which makes breathing more comfortable. With nasal masks, I had zero leaks only if I used mouth taping (not a big fan). Otherwise there are some consistent leaks (rarely over the leak red line) due to mouth breathing. A cervical collar didn't really help with leaks, as it won't prevent you mouth from opening. Another advantage of the Dreamwear's full face mask is its ability to keep your nasal passage open. I used to put Breathright strips sometimes, but here the air pressure performs the same function naturally, as it doesn't cover your nose the pressure acts outwards only. Very clever design!

The collare decreased flow limitations. No more chin-tucking. Still trying to getting used to it though, as it is quite a restrictive feeling and it keeps your neck too warm in these summer months.

The VAuto feels more natural to breath compared to the Airsense. A PS of 3.4 seems to be my sweet spot for now. I also started to have larger tidal volume and minute ventilation, so I assume my oxygenation is slightly improved.

My only complaint is the occasional centrals that I might get when transitioning from awake to asleep phases. Here's the example from last night:

     

As you can see, the only events from yesterday were 2 centrals, and I remember them exactly. I've felt I was hypoxic 2 times and needed to take a deep breath conciously. I know they are SWJ however it is interesting to see that I can get heavily desaturated while still being awake. Do you think there is a way to prevent them? The only way I see is if there was a way to put the machine in ASV mode during the transitional phase and then revert back to VAuto mode afterwards, but it isn't a real possibility. Are there other ways to ease the transition phase? I don't think a very short desaturation period will make any sense in the grand scheme of things but it slightly bothers me.

Thanks....
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#50
RE: First night with CPAP: Suggestions?
Thanks for the review on Carex. Your results are outstanding, and I hope you continue to increase your comfort and sleep quality. I don't think it is practical or possible to put a machine in ASV mode during transition to sleep. This is just a normal or common problem as the respiratory system hands off from a mostly voluntary to autonomic sleep respiration. For me, it is much worse without PAP therapy and a common source of arousal from early sleep. Ramp is a personal decision and fine if you need it for comfort, but that would make sleep onset events much worse for me.
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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