3rd attempt at CPAP, Told I need a Bi-Level?
3rd attempt at CPAP in 4 years. Was recently told on another forum I need a Bi-level but may benefit even more from an ASV based on my Flow rate charts?
My sleep seems very very fragmented which is making me feel absolutely terrible all day.
Any advice?
Didn't want to add too much info and make this post a novel, so let me know if theres any other info you would like.
Full Night (9-12 EPR 3)
FL's leading to RERA?
Flow limitations in Flow Rate
03-13-2025, 05:49 PM
(This post was last modified: 03-13-2025, 05:50 PM by Deborah K.. Edited 1 time in total.)
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
Your flow limits are not too high, and are not causing any problems.
I suggest you raise your start pressure to 10. You might feel better there.
Did you have a lot of CAs in your sleep study? Have you posted a copy of your redacted sleep study? If so, post it again in this thread. It would help us determine if your CAs are anything to worry about. I don't think they are, but it's worth checking.
You have no leaks, which is terrific! 
One thing to keep in mind is that if you haven't used a machine for a long time, you may simply need time to adjust to therapy again. Don't give up!
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
The OSCAR flow limit chart does not seem to show any where near the amount shown in my flow rate chart. That is shown in the second two pics in my first post.
I have added my in-lab sleep study but my doctor did not believe this was very accurate as I only slept for 2, 2 hour blocks of time (at home study showed AHI of 29.7 while sleeping for 8 hours).
I do understand that patience is key and it will take time, but based on how choppy and messy my flow rate chart is, I dont feel like im close as far as settings.
Sleep study page 1
Sleepy study page 2
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
2 each Central and Obstructive Apnea, zero mixed Apnea, 39 Hypopnea events recorded. A bilevel, the ResMed AirCurve 10 or 11 VAuto, would be fine, but it's possible the current AutoSet may be fine. You have the EPR 3 active, which is the same effect to therapy as the bilevel with pressure support at 3.
Those test results negate the ASV.
Mask Primer
Positional Apnea
Attach OSCAR, etc.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
03-14-2025, 08:16 AM
(This post was last modified: 03-14-2025, 08:20 AM by justaguy26. Edited 1 time in total.)
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
SarcasticDave thank you for the response and help!
How am I to know if my current machine (resmed airsense 10) is sufficient enough? Does it come down to just increasing my min pressure until I don't see any FL's in my flow rate any more?
Or simply using it longer at the current settings to see if my flow rate "gets any better"?
Here is another full night from last night. It is wildly different from the initial full night i posted on here.
Thanks again
03-14-2025, 09:30 AM
(This post was last modified: 03-14-2025, 09:32 AM by SarcasticDave94. Edited 2 times in total.)
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
It seems whether to get VAuto or not depends in part if you're comfortable with what the AutoSet can provide, even as is now.
It's not that you can't try to make this better, but you're limited to what more you can do. Here on the AutoSet it's pressure edits and EPR.
If the somewhat elevated CA on your chart is an issue, but include wanting to keep FL down, they're opposite treatment actions. Now this combined with comfort will be a reason to move to VAuto.
With the AutoSet you're limited to a pressure support of 3, here it's called EPR. On the VAuto PS goes to 10 I'm thinking. I'd probably not advise using PS 10, but the point is there's more PS with VAuto to help your wanting control of FL.
Also on the VAuto with what's likely treatment emergent Central Apnea, you can time things a bit to help CA reduce a bit. Trigger to High or Very High will increase sensitivity to trigger the IPAP for inhale, reducing these CA some.
Mask Primer
Positional Apnea
Attach OSCAR, etc.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
03-14-2025, 03:44 PM
(This post was last modified: 03-14-2025, 03:46 PM by justaguy26. Edited 1 time in total.)
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
Im not sure what to do. My sleep is insanely fragmented and I have no clue if that can be fixed with this machine.
While im only a few weeks in on my 3rd attempt, my 2nd CPAP attempt at CPAP was for 7 months and my charts looked similar to how they do now.
If my FL's arent anything to worry about and I just need to get used to them, than I can deal with that, but I get mixed responses on whether or not they are an issue/causing problems. They seem to be much worse than what the 95% # or flow limit chart shows (that is shown in the attached pics of FL's from last night).
Do you think a bi-level would clean that all up and help in general? At this point, I will sell a limb and get a bi-level if it will help me. (thanks again for the help)
03-14-2025, 05:30 PM
(This post was last modified: 03-14-2025, 05:40 PM by Deborah K.. Edited 1 time in total.)
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
You seem to be mixing up flow limits with flow rate. Flow rate is second on your chart. This shows all your events through the night, including every type of apnea. Your flow rate is fine. Flow limits are further down on the chart, and are a record of apneas that are too short to record as an apnea, but which need to be kept low. EPR is keeping yours at an okay level, so your flow limits are fine. Don't worry about them.
As to getting a bilevel, they are overall better machines, but I don't see any indication that you need one. If you want one, and want to go through insurance, you might want to check out my long thread by clicking the link below. There may be something there that will help you get what you want. If you go that way, make sure you get the machine I have, also listed below. It's the best. If you decide to pay, get a new or used one, but get the same machine.
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
I am not mixing up flow limitations and flow rate. I am using my flow rate chart to find flow limitations because our machines absolutely suck at detecting flow limitations.
Flow limitations will be seen at the "peak" of ones breath with a flattened top or indented top within a flow rate chart.
This is why I have been saying ignore my flow limitations chart and look at the screenshots of my flow rate I have been sending because there are very clear FL's (that arent shown in my FL chart).
Maybe I don't need a bi-level or to worry about my FL's but ALL of the data needs to be looked at before making that assessment. Not just the very inaccurate flow limitations chart (just trying to get the best and most accurate answers from the community that i can).
Thank you for the bi-level info I will look into it!
RE: 3rd attempt at CPAP, Told I need a Bi-Level?
justaguy26, you are definitely not mixing up flow limitations and flow rate. I agree ResMed machines do many things well, but they are terrible at detecting flow limitations. This causes confusion.
If your sleep is fragmented and the disruptions are caused by these flow limitations, then you may need to try a bilevel as I do.
Can you post a zoomed in chart of your awakenings ?
Good luck .
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