New CPAP user looking for OSCAR review (no DME)

[walkingdead]

It’d be a good idea to see your doctor about the shortness of breath and the irregular heartbeat.

Agreed, my first follow up appointment since the diagnosis is next week. I wanted to ask ya'll before the doctor scolds me for using a ASV machine when it wasn't prescribed, even if it's in CPAP only mode.

[walkingdead]

Hi Everyone,

As some of you already know from another thread, I switched to the ResMed AutoSet 10 For Her last week and the daytime breathing issues feel like they've already subsided. I'm hopeful that I'm finally on the right track. I just need to talk to the doc about the insomnia issues that I think are related to my ADHD medication. With that being said, I was able to sleep last night so I have a good chart to seek feedback on. 

I have attached the chart along with a 2-min waveform on a RERA event. I also included a few extra screenshots from my sleep tracker. It shows that I'm barely reaching a deep sleep and my heart rate appears to jump as I come out of it. There's one particular event around 04:45 where the heart rate chart shows a cluster of varying BPM for several minutes, ranging between 68-90 BPM. I've never seen that before. I attached a 30 minute waveform around this time as well to see if you see anything odd going on. Maybe I'm finally dreaming for once?

My prescribed pressure is 14 with an EPR of 2-3. I'm currently using Min 13 Max 20 cmH2O with EPR 2. I have not tried EPR 3 yet.

Daily Chart
   

2-minute waveform for RERA event
   

30 minute waveform for odd BPM
   

Sleep tracker
       

[WillSleep]

I was able to sleep last night so I have a good chart to seek feedback on. 

Welcome back!

1) Those charts already look pretty good so first question to help guide the groups response:  How can the group help? E.g.  Are there goals you would like the groups help to achieve next?

2) Next, the group will soon ask you if they are not enabled to enable all available "Event Flags" down in the lower left hand corner of OSCAR's charts column so that all occurring events will show up in the Event Flags chart.  
   

My prescribed pressure is 14 with an EPR of 2-3. I'm currently using Min 13 Max 20 cmH2O with EPR 2. I have not tried EPR 3 yet.

One way to improve the therapy experience IF YOU CAN can would be to reduce your Min EPAP.  We are not seeing events on your Event Flags chart to indicate you are close to as low as you can go with Min EPAP.  

If you are wanting to test for improvement possibilities and are not yet solid on really needing a starting level of Min EPAP set to 13 then titriating to see if a lower Min EPAP will work for you might be a good early next step.   A pretty low risk approach might be to just drop Min EPAP by 1.0cm H20 each night until negative events start showing up. 

WillSleep

[walkingdead]

1) Those charts already look pretty good so first question to help guide the groups response:  How can the group help? E.g.  Are there goals you would like the groups help to achieve next?

2) Next, the group will soon ask you if they are not enabled to enable all available "Event Flags" down in the lower left hand corner of OSCAR's charts column so that all occurring events will show up in the Event Flags chart. 

One way to improve the therapy experience IF YOU CAN can would be to reduce your Min EPAP.  We are not seeing events on your Event Flags chart to indicate you are close to as low as you can go with Min EPAP.  

If you are wanting to test for improvement possibilities and are not yet solid on really needing a starting level of Min EPAP set to 13 then titriating to see if a lower Min EPAP will work for you might be a good early next step.   A pretty low risk approach might be to just drop Min EPAP by 1.0cm H20 each night until negative events start showing up. 

WillSleep

You're right, I forgot to clarify what I was asking for!

I'd like to make sure that I show a good response to the APAP machine, especially after my issues with the ASV machine. Is there anything I can about the RERA event? I just really want to make sure that I'm setup for success on the therapy side of the things. Next up on my hit list is diet and exercise!

For a little experiment, it would also be neat if someone were able to compare my initial charts in the thread that were from the ASV in CPAP mode to my latest APAP charts to possibly identify any improvements that the APAP provides me. My events were always low with both machines so it's a mystery to me why I struggled with the ASV machine. My guess is the lack of EPR when the machine is in CPAP mode.

Thanks for the heads up on event flags, I somehow turned off UA and H flags in my profile.

[WillSleep]

You're right, I forgot to clarify what I was asking for!

I'd like to make sure that I show a good response to the APAP machine, especially after my issues with the ASV machine. Is there anything I can about the RERA event? 

Yes.  

Changing your Min EPAP might reset all that is above it so no use spending time on RERA until you really firm up your Min EPAP.  

At 26 years old, your first step is to find your new lowest Min EPAP.   


Since 2015 wide scale research that has taken place on "Ventilator Induced Lung Injury" (VILI) The research is in essence ~"fellow hospitals, ER rooms, ICUs and physicians, lets learn how to kill less patients with ventilators and xPAP by identifying and avoiding behaviors that are injuring patients.

Researchers are starting to question and assess the negative impact/injuries of 28 day - 5 year long term stable EPAP over 10cm H2O , total pressure (IMAP) over 12-15cm H2O, frequent pressure changes and a load of additional patient-xPAP asynchronicities people here talk about every day.  Our response is simple, where we can we should avoid these risks.   

You and your wife at 26 years old, are looking ahead to 60-70 years of nightly xPAP help that you will want to try and ensure does not also come at the cost nightly micro-injuries from xPAP nearly like really long-term smoking and long term High Blood Pressure bring daily injuries likely to create debilitating pulmonary and cardiovascular diseases that you are free from today.    

To bring that to a back down to a pragmatic level ... your first step is to find your new lowest Min EPAP, like in the quote below. 
 

...

One way to improve the therapy experience IF YOU CAN can would be to reduce your Min EPAP.  We are not seeing events on your Event Flags chart to indicate you are close to as low as you can go with Min EPAP.  

If you are wanting to test for improvement possibilities and are not yet solid on really needing a starting level of Min EPAP set to 13 then titriating to see if a lower Min EPAP will work for you might be a good early next step.   A pretty low risk approach might be to just drop Min EPAP by 1.0cm H20 each night until negative events start showing up. 

.... 
 

My events were always low with both machines so it's a mystery to me why I struggled with the ASV machine. My guess is the lack of EPR when the machine is in CPAP mode. 

 
Yes, this "My guess is the lack of EPR when the machine is in CPAP mode"
.. and at high pressures.  Ouch!   Few people here would have kept with that machine in straight CPAP at 14.0.   
You were configured to run in CPAP at 14.0 and showed CAs in each screenshot I saw.  We know you don't "need" the ASV but that does not mean it ASVAuto mode would not have made you smile, epscially for how many months you suffered with straight CPAP on that machine.  
You might have just loved the experience with the ASV running in ASVAuto mode at EPAP 6.0-12.0 and PS: 2.0-9.0.  

I have a pretty sober view of the ASV. I might be moving on to another machine.  I am not yet happy with the ASV as the right answer for me so this is not a "ASV fan-boy" talking.   Still I respect that in ASVAuto mode that machine has serious suave to sooth ASV CPAP mode pains.  

Not yet sure what your actual end-state best treatment is but I assume your AHI on ASVAuto would be higher than you are seeing now with the Autoset.  Still compared CPAP on the ASV at 14, the ASV in ASVauto would be such a better experience.    Like one of those shoulder massages that really hits the spot but is free from pain -- a PG-rated and wholesome "Oh, oh, ya .. this is good, really good, oh, oh, don't stop."  Lol.  

Maybe showing respect for true ASV strength areas is part of a mourning process to go through as I wrestle with the realization that is it probably time for me to thinking about 'dating other machines.'    Lol.

After respecting and gushing on that aspect of the ASV I should come back to "your first next step is to find your new lowest Min EPAP on the Autoset."

WillSleep

[Sleeprider]

This looks pretty good, although I might try EPR at 3. It appears CA and H events are not turned on.

[walkingdead]

Wow, I had no idea about the studies for xPAP related micro-injuries. I'll definitely start finding my lowest minimum EPAP. For the first two nights, I had set the min/max pressures to 12/14 and later increased it to 14/20 based on what I was learning about titration and accounting for EPR.

       

Your positivity about the ASV machine makes me apprehensive to trade it in right away since they're so hard to get and mine was free. I have 30 days to return the AutoSet 10 that I bought my wife earlier today. Due to the risks for patients with heart related issues with ASV, I do need to mention that I developed an irregular heartbeat right around the time my treatment started going downhill in mid September. The doctor thinks it's hypertension related that will go away with diet and exercise because I'm so young. I have a good 100 lbs to lose.

[walkingdead]

This looks pretty good, although I might try EPR at 3.  It appears CA and H events are not turned on.

My bad! There were 2 H events and no CA.

   

[Sleeprider]

Your positivity about the ASV machine makes me apprehensive to trade it in right away since they're so hard to get and mine was free. I have 30 days to return the AutoSet 10 that I bought my wife earlier today. Due to the risks for patients with heart related issues with ASV, I do need to mention that I developed an irregular heartbeat right around the time my treatment started going downhill in mid September. The doctor thinks it's hypertension related that will go away with diet and exercise because I'm so young. I have a good 100 lbs to lose.

If you do not need ASV, it makes no sense to retain one. It will work miracles for the right person and do nothing for you, or actually provide worse therapy.  I don't understand your concern here.  The Airsense 10 should work beautifully for your wife, and worst case, an Aircurve 10 Vauto will be even better.  The ASV has no place execpt for complex apnea.

I also could stand to lose substantial weight, although it helps to hold down the boat in a blow (see avatar).

[WillSleep]

Your positivity about the ASV machine makes me apprehensive to trade it in right away since they're so hard to get and mine was free. I have 30 days to return the AutoSet 10 that I bought my wife earlier today. 

I completely agree with Sleeprider you do not need the ASV.  Beyond that you have access now to a machine that better fits your therapy needs you specifically should not use the ASV.  

Those who have better therapy choices might find the ASV actually degrades the quality of their sleep.  

The ResMed Aircurve 10 ASV truly is amazing for those who need it (e.g. CSA, etc.), ... AND I agree with what Sheepless posted in August about the ASV's uber-responsiveness sometimes becoming frustrating over-responsiveness contributing to sleep disruption (and I will add cardiovascular stress and heart rate variability) when no action was really needed by the ASV.  So not the best machine to help you beat back hypertension and get deeper ongoing sleep unless the ASV's therapy approach is providing you more benefit than cost in comparison with your other machine options.  

We should always seek to sort out the machine that provides the best overall therapy and work toward that solution.  

Therefore I absolutely think you should hang on the ASV until your wife's therapy is looking 2-3 weeks solid on the Autoset.   If you want I can post a Powerpoint with markup and comments on one of the earlier screenshots to explain why.  Her screenshots already looked so good most likely the Autoset will work out great for her but I would just hold onto and forget about the ASV until you guys see the the Autoset nailing it for her.  Then sell or trade the ASV.  
 
 

Wow, I had no idea about the studies for xPAP related micro-injuries. I'll definitely start finding my lowest minimum EPAP. For the first two nights, I had set the min/max pressures to 12/14 and later increased it to 14/20 based on what I was learning about titration and accounting for EPR.

 

One way to improve the therapy experience IF YOU CAN can would be to reduce your Min EPAP.  We are not seeing events on your Event Flags chart to indicate you are close to as low as you can go with Min EPAP.  

If you are wanting to test for improvement possibilities and are not yet solid on really needing a starting level of Min EPAP set to 13 then titriating to see if a lower Min EPAP will work for you might be a good early next step.   A pretty low risk approach might be to just drop Min EPAP by 1.0cm H20 each night until negative events start showing up. 

Supersleeper has way, way more experience than I do at dialing in the Autoset so I would add his suggestion to try EPR at 3 to the top of list of test configurations to titration through and test.  



Have a great weekend!
WillSleep