[CPAP] ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Printable Version +- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums) +-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area) +--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum) +--- Thread: [CPAP] ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) (/Thread-CPAP-%E2%80%98Sleepki%E2%80%99-starting-Need-%E2%80%9Cfirst-time-advice%E2%80%9D-on-machine-type-settings-2020-Nov) Pages:
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‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Sleepki - 11-15-2020 Hi, as per the title -- I’ve come to realize I need a CPAP (together with my pulmonologist & ENT doctor of course), so I need advice from you pro’s before purchasing my machine. Questions:
Context & background: References: Consolidated in a PDF I can't upload to this post nor link to due to forum rules, given my extensive post, I hope I've proven I'm not a spammer and I'll take the liberty to post it in plain text -- ge.tt/5UCb2s83 [size=x-large][font=apple color emoji]?
What I’ve tried so far (to reduce my AHI): Listed in order
Misc things I’ve tried… Tried at various points in the last 3y based on advice found on various forums and websites. General result for below: Not feeling rested after sleep (not validated with sleep test).
About me & my condition:
** WatchPat 300 *** TAP-T Many thanks for your time, I do appreciate it! RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Dormeo - 11-15-2020 Hello, Sleepki. I'm sorry to hear about the multiple problems you've been facing. Could you scan and post your most recent sleep study with your personal information blanked out? That would be enormously helpful to everyone who would like to offer you advice about the type of machine that would work best for you and the initial settings that would make sense to try. If that's not possible, it would be especially helpful to know the breakdown of your AHI into these three kinds of events: obstructive apneas, central apneas, and hypopneas. (Hypopneas are events of 10 seconds or longer involving a reduction of airflow of at least 30% along with a drop in O2 saturation levels. They can be obstructive or central in nature.) RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Sleepki - 11-15-2020 Thanks for the reply Dormeo! ge.tt/5UCb2s83 is the link to the pdf, but I'll post them as plain images as soon as I hit 4posts on this forum (can't post images before I have 4 posts) 2 more to go... RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - jaswilliams - 11-15-2020 You should be able to attach the pdf here without any more posts RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Sleepki - 11-15-2020 Still not possible. Trying again (sorry for the spam -- using this post as a workaround) RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Dormeo - 11-15-2020 Thanks, Sleepki. I was able to view the documents using the link. (Great job labeling everything, by the way.) Your overall AHI in the most recent study was 15.4, including a CA index of .7. There isn't a separate breakout of hypopneas vs. obstructive apneas. Your RDI was 21.3, so you averaged 5.9 RERAs (respiratory-effort-related arousals) per hour. Your percentages of REM and deep sleep were very good, which means that this was a possibly more representative night than people tend to see with even home tests. Your CA index was negligible, so you don't need a special machine like an ASV. Given the earlier study in which hypopneas predominated, plus the evidence of flow limitations in the CPAP titration, plus the RERAs in the most recent study, I think you would benefit from a machine that can offer bilevel treatment. Bilevel treatment provides a higher pressure on inhalation and a lower pressure during exhalation. The pressure boost on inhalation can be quite helpful in resolving FLs, hypopneas, and RERAs. There are two machines I would suggest you consider. One is the ResMed Airsense 10 Autoset, which can offer a pressure difference of 1, 2, or 3 cm H2O. The big market competitor for this machine is the Phillips Respironics Dreamstation, which you tried earlier. The PR machine provides something called Flex, but this is not true bilevel therapy. In addition, many people find that the algorithm for Flex leaves them with the feeling they are being rushed to inhale before they are ready. The other machine I think you might consider is the ResMed Aircurve VAuto. This offers a larger range of pressure differences than the Autoset, plus some other settings adjustments that you might not need but are there if you want them. PR also make a bilevel machine, but I believe most people here believe the ResMed bilevel is superior. I don't know how insurance works in Poland, or how open your doctors would be to prescribing a VAuto, but that's what I'd ask for in your place. It does everything the Airsense machine does, plus lots more. But it is about twice as expensive. RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Sleepki - 11-15-2020 Awesome, thanks for the reply! I'll call next week to see availability of that "vAuto" machine. Because w/ the dreamstation I had exactly that feeling you mentioned -- it was like suffocating by excessive air coming in. Insurance should not be a problem, in PL you get some reduction in price (I think it's 50%), so that'll be less than 1000USD for that machine paid out of pocket, that's a lot of money, but it's peanuts compared to how much I've plowed into my health issues. If no more posts I'll sign-up for a trial and post back how it goes. Thank you! RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Sleepki - 12-29-2020 Update: I had another sinus surgery in November (opening up the paths to maxillary sinuses and rinsing all sinuses with an hydrodebrider and some antibiotics rinsing on that), didn’t help. After that I realized I have to continue on the CPAP-path. So, I have now also had 18d+ test-run with a ‘ResMed AirCurve 10 VAuto’ at home and daily pulmonologist check-ups along with remote adjustments to the settings on the machine. I’m now ready for the next step, and need some advice on choosing the right machine based on the data. Questions:
Next steps: Based on responses from experts on this forum I will purchase the right machine and start using it and use OSCAR to upload and analyze my data. Note: In the meantime I’ve ordered an INAP (that’s an WINX replacement that creates a vacuum in the mouth to pull the soft palate and tongue base forward -- waiting for it to clear customs), I just got sick and tired of everything after surgery and tilted while looking for options to feel better, so I will try that machine as well, however I have no way of validating the AHI with that machine unless I take another sleep test at home I also ordered an iqoro (yes I tilted badly ), and decided to start training with that device too (doctors are still trying to rule out GERD and those kinds of things). ------------------------------------------------------------------------------------------------ Summary of 18d+ ResMed AirCurve 10 VAuto test-run:
Oscar data: Note: I started w/ different mask experimentation and the last ~10d I was using the N20 medium only. I sampled two detailed ones that I believe are representative, but can extract more if needed. We had some auto pressure in the beginning but despite good AHI numbers it didn’t feel good at all, so the pulmonologist shifted to fixed pressure and reduced it, which felt much better. Summary: [attachment=28945] [attachment=28946] [attachment=28947] RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Sleepki - 12-29-2020 PS! Let me know if more charts are needed. 26th of December, detailed view: [attachment=28948] [attachment=28949] [attachment=28950] 28th of December, detailed view: [attachment=28951] [attachment=28952] [attachment=28953] RE: ‘Sleepki’ starting! Need “first-time advice” on machine type & settings (2020-Nov) - Crimson Nape - 12-29-2020 The Elite is a static pressure treatment model with full data reporting. The "static", means that you will only be able to set the inhale pressure to a single pressure setting. The next step up is the AirSense 10 Autoset (or the "For Her" model), which allows for a variable pressure treatment range. The AirCurve VAuto that you mention, is a big step up. It allows for a variable pressure range (like the Autoset), but also allows for a wide range of exhale pressure differences from the inhale pressure. The Elite and Autoset only allow up to a 3 cm pressure difference (in 1 cm steps only) between the inhale/exhale pressures. The VAuto allows steps in .2 cm increments and can go as high as 8 cm in pressure difference. Note: Most users only use a maximum of 5 cm difference in real life. Do you have any sleep data that you can provide to see if that may help in determining a recommendation? Edit: You added additional charts since I posted this. Good luck! |