New Aircurve 10 Vauto Assistance Please

[Bandit0594]

Good morning. After a ton of reading and a brief recommendation from Deborah K, I just picked up a slightly used Aircurve 10 Vauto. Her concerns were that I was bouncing against the 20cm pressure limits that also corresponded with my flow limits. My history of mild sleep apnea has been going for 6 years with minimal (if any) improvement, so I am looking at all possibilities. I feel that my low AHI scores which are typically always sub 1 and never over 2, are sneaky because I continuously wake up feeling my battery is lower than when I went to bed! 

All of that to say that after averaging 5-6hrs of sleep per night for seemingly forever, I got over 7hrs my first night on the Aircurve 10! I scoured the forum for beginning settings since I am making this switch on my own and came up with the following:
Min EPAP 5.00 cmH2O
Max IPAP 15.00 cmH2O
PS 4.00 cmH2O

With that, I was bumping up against the max pressure but had respectable scores and I definitley feel better this morning. With the flow limits still spiking, are there any suggestions on what I can move around in order to limit, or eliminate those flow limits? 

On an unrelated/related note, I am still getting crazy pulse swings throughout the night. They appear to be tied to respiratory arousals and movement but it appears to be a chicken vs the egg matter. Are the arousals causing the movement or is the movement causing the arousals? Either way, my pulse is routinely swinging 40-50bpm within 20-30sec and that is what I suspect is causing alot of my fatigue the following day. Is this normal? I have tried every search term I can come up with and I am not having much luck on the interwebs.

I attached last nights maiden voyage with the Aircurve 10 and the last years stats with the Airsense 10, that was prescribed 6 years ago. I have been tinkering for the last 1-2 months trying to fine tune the APAP but it had been set mostly at 8/15 before that.

Thanks in advance for any recommendations/advice!

[SarcasticDave94]

I don't know that this will address your pulse changes, in fact I'd rather say it probably won't affect it much. Anyway I think you'll need a higher Max IPAP than 15. Evidence? Your pressure chart line hits the top (15 in your case) and bounces off that ceiling. This is like a manual transmission car redlining in 1st. The RPM limiter is stopping further increases to the revs.

This 15 IPAP Max would go against what you said Deborah K mentioned, 20 wasn't high enough, so 15 can't be high enough either unfortunately. Maybe try 20 IPAP Max, see what you get.

[Bandit0594]

Understood on moving the max pressure up. Truth be told, there was a little anxiety starting with a new machine last night. Although aware of her initial recommendations, I hedged that recommendation with a post where Sleeprider said the Aircurve 10 will most likely allow lower pressures once dialed in. Susprisingly, I am not there yet after the 1st night!

With the IPAP Max set to 20, where would you recommend the EPAP Min? Would that get set near the pressure median of 9.6?

[SarcasticDave94]

The chart you included didn't indicate much for the low end. However I don't think I would go up to 9. Between 5 and 7 would likely be suitable.

Do you feel any air starvation? This indicates EPAP needs to go up. Events can indicate the same when present.

[Bandit0594]

Nope, I felt the low end was sufficient. I will move the EPAP Min up to 7 tonight, just to minimize the ramp up to 20, if it is needed. Any opinion on the PS? Trigger or Cycle sensitivity?

[SarcasticDave94]

For now I'd leave the other settings as they are.

[Bandit0594]

Sounds good, I will get some results and post back. Thank you.

[Bandit0594]

I lost an hour plus of sleep from the previous night and paid for it with a hit to the overall restfulness. No changes during the day that should have effected last night. I hit the 20cm ceiling twice but relatively smooth the rest of the night. Outside of the 2 quick OA events around 22:23 and the large leak window, everything else looks relatively better.  My SpO2 drops were down immensely from the previous night (18.87/hr to 1.62/hr) while the Pulse Changes were up abit (50.90/hr to 52.77/hr). 

Anything worth monkeying with for tonight or sit tight for a few days and see what comes of it?

[Sleeprider]

In both charts, flow limits are intermittent and clustered. While you generally do not have any apena with these episodes, they are an indication of chin-tucking or positional obstruction. It may also be sleep stage related. I don't think there is any benefit to increasing the maximum pressure, and aside from those clusters of flow limitation, your pressure stays near baseline, even with the lower EPAP min of 5.0. The higher EPAP min of 7.0 did result in a lower 95% flow limit and fewer episodes of pressure increase. Overall, therapy is excellent in both cases. I'm certain any residual events are more related to your sleep position, pillows and other transient factors, and you could probably limit maximum pressure to 18 as leaks start to appear at higher pressures. Read the positional apena article, but I don't think this requires a soft cervical collar. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[Bandit0594]

Based on the differences between last night and the previous night, would it make sense to keep the EPAP Min at 7 since it knocked down the 95% flow limit? It is a tiny difference but the higher pressure remained comfortable while also helping with the SpO2. I will come down to 18cm on the IPAP max to help control leaks and possible arrousals. 
I would love to duplicate the first night on the Aircurve 10 in terms of quality and duration of sleep but I also like seeing my saturation beong more stable. Either way, the outlook is positive with just fine tuning needed at his point!

Positionally speaking, I started focussing on my right side as multiple articles list that as being easier on my heart. I have been having so may spikes throughout the night, I have become hyper focussed since getting the Wellue ring. I have only had it for a little over a month so I don't know what my pulse looked like before. That being said, when I wake up thoughout the night, I am often on my back. I will go searching for a pillow today and see how that works and maybe revisit sleep aids to keep me on my side. 



On a side note, I believe I was able to breathe through my nose for the bulk of the night. This is super rare as I have a severly deviated septum but will be meeting with the surgeon to discuss a septoplasty next Monday. I have been a mouth breather since a broken nose over 30 years ago. Every night, I make a conscious effort to breath through my nose but that goes out the window once I fall asleep. 

Anyway, thank you for chiming in and helping me get this dialed in!