[Treatment] Change to BIPAP vauto in hope for better therapy

[Dave Water]

Thank you Quiescence. 
I am still trying to learn how the attachment feature works. i hope this times it works. 

   
   
   

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these are remaining 3 days.

   
   
   

[Sleeprider]

The typical pattern in your charts consistently shows typical positional apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea

The solution may be a soft cervical collar. http://www.apneaboard.com/wiki/index.php...cal_Collar The alternative is to increase minimum EPAP and maximum IPAP pressure enough to keep your airway pried open even when you kink it with your sleep position. You normally get good effectie therapy with relatively low pressure, and you will eliminate most of these OA clusters with a properly fitted collar. You could try increasing your maximum IPAP pressure to around 20 and your machine will got there whenever you tuck your chin or whatever it is you're doing.

[Dave Water]

Thank you Sleeprider. 

I thought that the 1 in smaller SCC in size won't make a lot of difference as I couldn't get the medium since they only have small in stock.
I will shop for a proper size and I will also increase the IPAP gradually as I feel my body don't tolerate well with high CPAP pressure.

Do you think I need to change anything else or take small change at a time for the time being.

Thank you for your help.

[Sleeprider]

Conventional titration protocols would suggest increasing EPAP when obstructive apnea is present, and to use more pressure support for flow limits, snores and hypopnea. Your Vauto uses the increase in pressure whenever it encounters obstruction or flow limitation which is why we see your pressure rising on each apnea and often residing at the maximum 11.0/8.0 pressure. Based on your results so far, you could stand to have higher minimum and maximum pressure, however the pattern of apnea clusters also suggest a positional element. I have seen some members successfully use higher pressure rather than the soft cervical collar to reduce or eliminate the OA. It depends on whether you are comfortable with higher pressure, or wearing a collar. It is a choice, especially when EPAP pressure are generally under 10.0 like yours are. Can you tolerate higher pressure? If so, you may be able to address this obstruction using higher minimum EPAP, and you will have to also raise the max IPAP to make room. My minimum EPAP is 9.0 with PS 4, and others use much higher pressure. I'm sure I would have many more events if I was using pressure as low as yours. So you have a choice...pressure or collar. If we can address the OA with EPAP pressure increases, then if there are residual flow limits or hypopnea we might increase pressure support. The use of PS is mostly limited by the onset of CA events. What do you think would work best for you?

[Dave Water]

Thank you for the information and it really helps me to understand about my issue.

Base on your advice, I think the immediate solution for me would be to increase the IPAP while I shop for the correct size SCC.
I assume with the increase of IPAP and PS remain at 3, my EPAP will  automatically increase to address the OA. 
I will post my OSCAR graphs in a few days with the gradual IPAP pressure increase.

Thanks Again.

[Dave Water]

I have set the max IPAP to 13 on Feb-20 and 21 but found the pressure seems to cause high leak, so I change the max IPAP to 12 and test the differences on Feb-22. But it seems that there is not a lot of improvements so I set the MAX IPAP to 20. The followings are the Feb 20, 21 and 22 OSCAR charts. 

Can you please let me know if my leak rate is acceptable. if OSCAR indicated that my leak rate is 99.5% at 15.3, is that mean 99.5% of my night sleep is leaking air at 15.3% ? That does not sound good for me. But somehow the OSCAR leak rate chart doesn't seems like that 99.5% leaks which should look like a straight line? I know I am missing something here or do not know to read OSCAR stats? Please help me understand.

     
   
   

[Dave Water]

The following are the remaining 3 days of OSCAR charts with the IPAP set to 20. I change my mask on all 3 days. But the AHI seems good on only day 3 Feb25.
But on Feb 25, I did change my eating pattern to avoid reflux. This is so that I can sleep on my side. 
All 6 days I have been using SCC but I am still shopping for a correct size SCC to replace the current one.

Thank you for all your advice. 

 
   
   
   

[Sleeprider]

The 24th looks promising. Except for leaks the 23rd is okay. On 2/21 you can see a strong positional element on 2/21.

[Dave Water]

Thank you Sleeprider. 

I will keep looking for a proper mask as the current one still gives me leak and I do have to frequently adjust the strapping.
I think it affects my squality of sleep.

Thanks again.

[Sleeprider]

Never had a problem with a P10, but if you have mouth leaks, then something like the F30 might be the ticket.