Clear Airway Apneas TOO HIGH. ResMed AirCurve 10

[Amitaba]

        Hello I have only been on CPAP therapy for 45 days or so.  I started with a ResMed Airsense 11 and have just begun using the ResMed AirCurve 10v.  I switched to the BiPAP because I hoped it would solve my problem.  When I am able to control my Obstructive Apneas, my Clear Airway Apneas rise making my total AHI too high.  In addition, my Large Leak score is high (but I do not detect any leak from my P10 mask or my heated tube).  I have played with the adjustments for many days and I just can't seem to get things under control.

When I raise my Insp pressure, my OSA goes down but my CSA goes up.  When I lower my Insp pressure, my OSA goes up but my CSA goes down - oftentimes to zero.  I also believe that I am fighting pressure to exhale and that my total breathing cycle gets into an unbalanced "loop".

In addition, every night, my apneas are low for the 1st half of the night, but very high for the 2nd half of the night.  This is EVERY night.

Please comment/suggest settings changes or any other remedy.  Thank you

[KeepSmiling]

Amitaba,

Do you have the clinician manual, if not request it. Link is on top of page.

Be patient. The AirCurve 10 VAuto has a lot of things that can be adjusted to get the best results for you. Which may still change with time.

Post the machine settings for the two days.

Can you post an AirSense OSCAR. What pressure was set before. Did you do a titration can you post that or results. Take name off.

OA -- Usually EPAP is increased.
H -- Usually IPAP is increased (Usually done by increasing PS)
CA --
may be increased by high pressure,
some people have CA, check sleep study
some people get CA when starting therapy
It is not uncommon to get a couple of CAs.

When I changed to the AirCurve 10, the CA jump to AHI 5+; it decreased by increasing the Trigger [control].

[KeepSmiling]

Forgot to include,

Do you sleep on your back or roll onto your back.

I am not seeing a clear indications of [In addition, every night, my apneas are low for the 1st half of the night, but very high for the 2nd half of the night. This is EVERY night]

It is common to see waves of events, positional (on back, neck tucking), deeper sleep, (more relax airways.)

For:
[I also believe that I am fighting pressure to exhale and that my total breathing cycle gets into an unbalanced "loop".]

I understand what you are saying, I am now getting help for that. On your AirCurve 10 if you have Plus marked for Essentials under Options, when you go to sleep report you will see sync cyc. check the numbers.

I don't know if the info was taken from the stats on OSCAR or the graphs that are not shown on yours like the Inspiration time and the Expiration time.

Are all your OSCAR scans fragmented?

Start taking notes of your settings.

I would start increasing EPAP by 1 cm and move trigger to one position higher then what you have it. If you did not change it it would be at Medium.

Sleep on your side. What happens? If you prefer back sleeping, slowly you will figure out if the pressure will clear airways without increasing CA

Figure out if you go on your back, tuck in your neck etc.

[Amitaba]

Thank you KeepSmiling for responding to my post. I do not have the "clinicians manual" for the AirCurve and I did not see any link to it in your post.  I hope you were able to see my settings in the 2 Oscar Reports that were attached.  In those same reports you should be able to see how my Apnea Events increased dramatically during the 2nd half of the night. Oscar will let me display those periods separately if it helps.  As for the Airsense Reports. I will send a few tomorrow.  I will check further, but I don't think that the Sleep Study reports that were generated have any stats on Central Apnea or Clear Airway events. I will check in the morning.  

I am unable to generate ResMed reports because there is zero cellular network where I am currently located.  My only option is to move the SD card back and forth from the BiPAP and the computer.  I haven't tried to use any ResMed software on the computer- but I'll look into it tomorrow.  You mentioned "trigger" I have no idea what that means, but I'll step it up one notch from Medium tonight. I'll also increase the EPAP minimum tonight.

I sleep on my back (supine) almost 100% of the time.  If I sleep on my side the numbers are off-the-chart worse.??  I've tried it a few times with poor results. 

So, I'll make a few changes in settings tonight and post results along with some historic reports tomorrow.

Thanks again and best wishes
Amitaba

[Gideon]

Press the home button and the Round selector button at the same time for several seconds to enter the clinician menu. Look in the black banner above for the "CPAP Steup" to request a manual. It is a manual process so it will take a while.

Two changes for right now to get your CA under control

Set
PS = 3
Trigger = High, make sure that the trigger setting is mentioned in your profile.

Trigger may help with central apneas but do note that the VAuto is not equipped to treat Central Apnea.

Post the results with charts so we can see where to go after this. and do tell us how you feel and perceive your therapy and the changes you feel. Be Critical, I feel fine means you do not need changes.

[Amitaba]

Thank you Gideon. I will make the suggested changes in Settings. Current pressure settings are 6.4-13. PS was 4.4, but I will change it to 3. Trigger was medium, but I will change it to High. I do not know how to get the Oscar to display "Trigger". I do not know what "Trigger" does.

[pholynyk]

I am working on an update to OSCAR that will show all the settings in vAuto mode, at least.

For now, you will have to mention your settings within your post.

[KeepSmiling]

Top of page where there is a black band.

https://www.apneaboard.com/adjust-cpap-p...tup-manual

OSCAR software is what most of us use on the board.

If sleeping on your back gives better numbers and you like sleeping on your back that is good.

[Gideon]

Higher values of trigger start your breath with less "Input" from your bodies breathing. It is not designed to treat central apneas but many members here find that it helps.
Add it to any field in your profile either your device or pressure settings, anywhere just so it is mentioned. As Phil said OSCAR doesn't currently report this setting.

[Amitaba]

        Hello Gideon, KeepSmiling and all others.  Good News. After receiving a couple of suggestions, I decided to try Gideon's recommendation.  Last night my sleep session was 7.5 hours and my total AHI dropped to 4.14.  This is the lowest AHI ever.  My pressure settings were unchanged from the previous night. 6.4-13.  My only changes were to drop PS to 3 from 4 and to change "Trigger" from MEDIUM to HIGH.  These two changes seem to have made a huge difference.  

The results for the entire 7.5hrs were: AHI 4.14; OA 1.34; CA 2.54
When I study the first 4hr 21min. vs the last 3hr 8min.  The results are as follows:  1st part of total session: AHI 2.3; OA 1.15; CA 0.92 - 2nd part of total session: AHI 6.7; OA 1.6; CA 4.79. The settings were the same for the entire session.  The entire session results were: AH

Obviously my experience can vary greatly from one night to another, but the settings changes seem to have had an enormously positive effect.

I slept supine the entire night. ResMed P10 mask, heated tube ResMed AirCurve 10vAuto. 

BTW, I do tape my mouth closed with surgical tape the entire night.  In addition, a couple of times air was trapped and formed a bubble behind my lips?? Its not a big deal, but a clue to what's going on.  No air trapped during the 1st part of the session.  I started using tape because I thought an open mouth might be causing LL - Large Leaks, which correlate to high CA numbers.

Thanks to everyone for being responsive to my "newbie" questions.  I look forward to consecutive nights of "low event" sleep.
Best wishes,

Amitaba