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Yet another new user needing advice!
#1
Yet another new user needing advice!
Sorry for the length!!!  Wanted to give history… 

Posting on this board is a BIG step for me!!  I am a private person, who does not like to "put himself out there".  I don't do social media, and am generally wary of putting any personal information on the web.  But quite frankly I need help, and this board seems willing to give advice, so here goes… 

I have been on CPAP therapy for about 3 months now, and despite GREAT numbers -- 
 - 6-8+ hours of sleep each night
     (wake up 1-3 times to hit the head) 
 - Day-to-day AHI averages 0.9, and is rarely above 2
I feel worse than when I started!!  I wake up feeling exhausted, like I haven't slept at all (frequently with headaches), and struggle to stay focused during the day.

I am committed to staying with it, because I'm already being treated for high BP, and worry about long-term effects of apnea, but something has to change!!

I never rec'd a copy of my sleep study (I'm working on that, but I'm wading through bureaucracy, when it should be a straight forward request?!?!), but I know from emails with my sleep doctor that my AHI was 41, 115 during REM sleep, at one point my O2 level dropped to 80%, and for 25 minutes my oxygen level was <88%.  He was sure all this would resolve by going on CPAP.

Started out at pressures of 8-20.  

About a month into therapy, I started to search the Internet for help.  I found lots of tips(!), but few boards are willing to give practical advice (like machine settings) -- "we're not doctors"…  

Based on a tip from one site, I did purchase a pulse-ox sleep tracker.  It proved somewhat helpful in that I realized my headaches coincided with nights that my O2 levels dropped <88%, usually for 5-15 minutes early morning, within an hour or 2 of waking up, but I will have 3-4 good nights >90%, then have 1-3 bad nights with no other changes.

At my 2 month followup, early august, I raised my concerns with my sleep doctor.  He said my pressures were consistently above 10, and raised it to 10-20, but overall was very happy with my numbers/progress and said "you just have to hang in there, it will get better…"

I found this board about 2 weeks ago, and have been reading through a lot of posts.  I downloaded OSCAR, bought an SD card (wasn't one in machine) and started looking at my data.  Based on advice from similar sounding stories I kind of focused in on increased flow limits, and over the last 10 days, I raised my pressure in several steps from 10 --> 13.  I removed the pressure ramp up, and increased EPR from 1 (that my doctor had apparently set), to 3.

It's a very subtle (but improved) change, but I'm still waking up exhausted!  One observation that I'm moving in the right direction, I haven't woken up with a headache in over a week!!

I think I've reached the point where I'm comfortable tweaking things (somewhat blindly!), and I need to ask for help.  OSCAR data is a little over whelming, and I'm just not sure what to look at.

Attached are PDF's of OSCAR screen shots.  I only included 2 screens out of 4 to conserve space.  One is from 8/22, after I had made 1 change - min pressure from 10 --> 11.  It was the first night I broke max pressure of 19, and the first time I noticed an apparent pattern between flow limits and pressure.  The 2nd is from last night.  I also included 2 zoom ins of flow rate where it coincided with increased flow limits.  I went with zoom ins, to conserve file size.

I can post other info as requested.

Thanks for reading!  Any/all help would be appreciated!!!!


.pdf   2020-08-22.pdf (Size: 493.21 KB / Downloads: 30)


.pdf   2020-09-01.pdf (Size: 570.77 KB / Downloads: 19)
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#2
RE: Yet another new user needing advice!
Hi there.  If you look at the stats at left, under the 'Med' heading, and in the line for pressure, you see that you're median pressure is about 13.  That should probably be your low number for minimum pressure, certainly not less than 12, and then let the machine to the rest by bumping up to what you need in order to overcome flow restrictions.  Your EPR could probably suffice at 2 or even 1, but you can play with those to see what feels most comfortable.  What you don't want is leaks or anything so strong that it arouses you, so whatever changes you elect to make, try them for three successive nights to get a 'grouping' like you do at the firing range.  You probably understand that you should NEVER make two changes concurrently and then expect to be able to tell which of the two caused a deleterious and unwelcome change if that should happen.

Please stand by for more minds to contribute.  I am still not fledged, and have a way to go before I can be considered a guru.  Like, another year at least.  Smile
Serial Tapist
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#3
RE: Yet another new user needing advice!
I think the flow limits are causing the poor sleep and to get rod of them also to raise the low number. 13 ok adjust after a couple of days.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar  
Mask Primer 
Dealing w DME
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#4
RE: Yet another new user needing advice!
In response to mesenteria, I have been making changes gradually, waiting at least 3-4 days before changing something.  
Changed minimum pressure to 13 on 8/26.  Experienced some of my highest pressures - actually hit 19.7 one night.  On 8/31 changed EPR from 1 to 3.  Max pressures have been 15-16-ish the last 4 nights.

Still concerned about pulse-ox readings.  Hoping that adjusting settings even further will help!  I am spending less time below 90% since raising pressure to 13, but still experiencing a lot of SpO2 drops (event flags marked SD). 

This is where I'm stuck --
When my min pressure was 8, my doctor says my pressure was usually above 10, don't have any more detail than that.

Started using OSCAR, with minimum pressure of 10, 95% pressure around 14-15, maxed out above 17.

After raising minimum pressure to 12-13 (left EPR at 1), 95% pressure around 17, maxed out above 19.

So raising min pressure just pushed pressure up further.

Raising EPR helped @ min pressure of 13, max pressures went down to 15-16.  Will raising minimum pressure help or just push pressure up higher??

Dumb question -- would lowering min pressure (with higher EPR) help?  I doubt it, but generally speaking sometimes the best changes are counter-intuitive.
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#5
RE: Yet another new user needing advice!
stayed away from Mac over holiday weekend!

bumped min pressure up to 14 last week.  Can't say it did too much.  My untrained eye doesn't see too much difference in OSCAR graphs.  Still waking up more tired than when I went to bed.

Last night was a bad night!  Tossed/turned A LOT.  In bed/on CPAP for 6+ hours, but I know I slept less than 2.  

I attached a screen shot from the night before.

Open to suggestions!!

Was talking with someone at church whose husband passed away last year.  She said she still had his "barely used" aircurve vauto.  She would give me a good deal on it.  We didn't talk figures.

2 questions: 1) would it help?  
I've wondered about my consistent flow limits.

2) IF, it would help, what's the going rate for a used aircurve?  
Don't want to be taken by paying too much, but she's on a fixed income, don't want to cheat her either by paying too little.




.pdf   OSCAR-2020-09-06.pdf (Size: 280.16 KB / Downloads: 17)
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#6
RE: Yet another new user needing advice!
You will benefit from using an Aircurve 10 Vauto or even the VPAP S. You can also consider the Resmed S9 VPAP auto or S machine. I have seen pretty good deals on Dotmed (see respiratory devices/bilevel), Craigslist, Offerup, Facebook Marketplace, and of course Supplier #2 sells lightly used machines with a warranty.

Your flow limitations are high and contribute to the hypopnea and respiratory effort related arousals indicated by the big spikes in flow rate. Using pressure support will help support your inspiratory effort and overcome the airway resistance.
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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#7
RE: Yet another new user needing advice!
Supplier #2 on the supplier list at the top of the page.  $799.  Dotmed has used ones, I have not purchased one there but be sure to check the hours on the machine.  I bought from suppler #2 a used VAUTO and it had 250 hours (1 month) and it is a great machine.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar  
Mask Primer 
Dealing w DME
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#8
RE: Yet another new user needing advice!
Went with aircurve from supplier 2.  Will be here Tuesday or Wednesday.

What should my initial settings be?

Currently running 14-20, epr 3 on my airsense.  Attached is most recent report.  Still waking up exhausted!

Assume pressure support will be at least 4(??).

Should I adjust other pressure settings, or leave the same?

Please help/advise.

Thank you.


.pdf   Oscar 2020-09-13.pdf (Size: 960.45 KB / Downloads: 5)
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#9
RE: Yet another new user needing advice!
Start with EPAP min 9.0, PS 4.0, max pressure 18. We can observe results and make recommendations. This is lower than current pressure but the idea is to work up rather than the other direction. Go now leave trigger and cycle sensitivity at medium and Ti min and max at 0.3 and 2.0 respectively.
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: Yet another new user needing advice!
Epr is PS on your new machine and 3 is your max setting now wile the VAUTO has a much larger number and settings can be raised by .2. I’m not sure what your best setting will be but I would start at 5 and see if that helps your flow limits. The top and bottom number seems ok to me
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar  
Mask Primer 
Dealing w DME
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