[Pressure] jonny7100 - Therapy Thread

[jonny7100]

After 200 days of unsuccesful CPAP use, I went ahead and bought a used Aircurve 10 Vauto online for $350 CAD. I asked my sleep doctor for advice and he gave me a shrug, telling me again that according to resmed, my apnea is controlled. It appears I'm on my own, like many of us. I wanted to show him my OSCAR data, and he hadn't even heard of the software before....  

On CPAP, I was using a pressure of 7 with EPR of 3. My AHI was always very low but I believe the continuous pressure was constantly waking up due to my low arousal threshold and narrow nasal passages. 

I read online via Barry Krakow that many find Bi-pap (And ASV) for comfortable and it may work better for sensitive patients. For reference, I am slim. A recent watchpat study gave me an AHI of 12 and an RDI of 24. 

For reference too, I've tested CPAP at low pressures like 5 and also came back with low AHI, but higher flow limitations. 

I did my initial air curve settings based off some reading online. I did Vauto mode 5-11 with a PS of 4. 

I came back with an AHI of 5, but almost entirely central apneas. Some very long. I imagine I need to lower the pressures. I never had Centrals like this on CPAP or APAP. 

Attached below some screenshots. Also, why does OSCAR still say airsense 11? Even though I'm now using an Aircurve 10 Bi-pap. Do I need a new SD card? 

Any ideas of what to lower my settings to? Thank you SO much in advanced. I am incredibly grateful to find this forum. 

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[jonny7100]

After 200 days of unsuccesful CPAP use, I went ahead and bought a used Aircurve 10 Vauto online for $350 CAD. I asked my sleep doctor for advice and he gave me a shrug, telling me over and over that according to resmed, my apnea is controlled. It appears I'm on my own, like many of us. I wanted to show him my OSCAR data, and he hadn't even heard of the software before....

On CPAP, I was using a pressure of 7 with EPR of 3. My AHI was always very low but I believe the continuous pressure was constantly waking up due to my low arousal threshold. 

I read online that many find Bi-pap (And ASV) for comfortable and it may work better for sensitive patients. For reference, I am slim. A recent watchpat study gave me an AHI of 12 and an RDI of 24. 

For reference too, I've tested CPAP at low pressures like 5 and also came back with low AHI, but higher flow limitations. 

I put my initial air curve settings based off some reading online. I did Vauto mode 5-11 with a PS of 4. 

I came back with an AHI of 5, but almost entirely central apneas. Some very long. I imagine I need to lower the pressures. 

Attached below some screenshots. Also, why does OSCAR still say airsense 11? Even though I'm now using an Aircurve 10 Bi-pap. Do I need a new SD card? 

Any ideas of what to lower my settings to? 

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[Crimson Nape]

jonny7100  -  Both of your threads were related to your therapy.  For this reason, I have merged them.  This provides the reader a history of your past settings and results.  Having the ability to see past attempts and their results will help to form better recommendations.  Additionally, it eliminates cross posting.  Please use this thread for all your therapy related posts. I have changed the thread title to, jonny7100 - Therapy Thread to be more inclusive.
- Red

[UnicornRider]

Your OSCAR Report does state "(Mode and pressure settings missing; yesterday's shown)" I colored it red to match the OSCAR Report.

That is probably why it still shows your old machine with old settings.. a new SD card would be recommended.

I could not provide any new settings, until you post additional OSCAR Reports with current AirCurve 10 VAuto settings.

Do you have a current Clinicians Manual? Get one here:   https://www.apneaboard.com/adjust-cpap-p...tup-manual

There is a setting for "Response" in the VAuto, that if you increase it, could possibly reduce your CA events. The Clinician's manual will help navigate the menu, to enable you to set Response.

Post back with current information on your OSCAR Report. We will guide you in optimization of your therapy sessions on the VAuto.

When posting OSCAR Reports, follow these guide lines.   OSCAR Chart Organization

[jonny7100]

Thanks for getting back to me! I figured out the SD card issue.

I moved to S mode and lowered the pressures significantly. I still have some lingering central apneas, plus a few hypopneas. I'm nervous to lower the pressures further as it will probably cause more hypopneas/obstructive events. 

I have some questions to any willing expert. 

1. How does increasing/decreasing PS affect central apnea.

2. Does epap or ipap cause central apnea? 

3. Should I play with Trigger? It's set to medium right now. 

Would love thoughts . Thanks so much

[UnicornRider]

Jonny7100, I will answer your questions and assist you in understanding PAP therapy meanwhile assisting you to dial in your therapy for optimization. We will have other forum members looking at your thread also.

We need a copy of your Sleep Studies or Sleep Lab reports which ever you had. Redact all personal information, name, address, phone number, anything else that may identify you. Knowing your sleep & health background assist us to assist you.

Do you use any medications for your turbinate's, Many of use utilize FloNase, or other steroidal medications to shrink the inflamed tissues, ~1hr before bedtime. Do you use any other medications or herbal supplements prior to sleep?

We will need you to post your OSCAR Reports in a standardized format so members can readily extract needed information most efficiently. My previous post I provided a link to:  
 
OSCAR Chart Organization

From your OSCAR Reports you are posting, Please refer to that link and hide the calendar, widen the left hand side panel to get single row entries in your Statistics area,  That will allow addition information about your machine to come into view. 

Then I need you to provide a zoomed in view from 2338 to 2344 of the night of the 14th March OSCAR Report you provided.

To answer your questions:  1. How does increasing/decreasing PS affect central apnea.

                                   2. Does epap or ipap cause central apnea? 

                                   3. Should I play with Trigger? It's set to medium right now. 


The spread between IPAP and EPAP will determine how much CO2 is flushed from your lungs, The body will normally monitor hormone levels, blood pH, and others signals from the body to respond and maintain it's desired level of CO2. That includes signaling when to breathe or not to breathe. Therefore an increase pressure support may cause an increase of CA as the increase of Tidal Volume will flush out more of the body's CO2. 

Now, it is never that simple in real life, because there is TECSA, which many of us have experience, even after 10 years of PAP therapy I experienced TECSA when an increase of all my PAP therapy pressures became necessary. Sometimes you have to utilize additional monitoring equipment to optimize your sleep therapy. Sometimes you have to compromise between treating UARS and addressing CA.

Before you play with trigger, Post some usable OSCAR Reports. 

We need to know what internet discovery, inspired you to start using S mode. What effects you were seeking from that change.

Post the requested views and we will do some more.

As always, any questions, concerns or comments, please post back.

[jonny7100]

Thank you so much for the thorough response Unicorn Rider. I apologize for the late reply. 


I have attached my sleep studies below but will give you a thorough breakdown of my sleep journey so far 

March 2024 - Initial PSG sleep study came back with 89 AHI. I do not believe this number as I was quite sick and congested that night and had an ear infection the next day. Mouth breathed during that test. Mostly Hypopneas.

July 2024 - Had sinus and septum surgery. Helped with nasal breathing. I currently do sinus rinse at nights and in the mornings with pulmicort steroid capsules. This lets me use my p30i mask comfortably enough. I have tried a number of other steroid spray and this works the best. I also take an anti-histamine before bed.

March 2025 - Watchpat study came back with 12 AHI and 24 RDI. I had a ton of insomnia that night, during which I think the test thought I was sleeping. I think my AHI is somewhere in the moderate/low severe range. Will add in a separate reply. 

I take Dayvigo sleeping pills before bed and have for a couple of weeks. Can't tell if they help....I never have had an issue falling asleep. I think I just have a low arousal threshold. I have taken Clonazepam in the past but am off it for obvious reasons. 

I got in Bipap because after 200 days with CPAP, I felt worse and knew something was wrong. I could wear the mask all night long but kept getting woken up. My sleep doctor told me my data looks good. I found Barry Krakow online and he says that for many patients, cpap makes things worse. And my Watchpat data suggests maybe UARS, which I read online bipap can help with. 

So far with Bipap I have felt some improvement. 

I am using a climate tube and use mouth tape every night. I have lowered my pressure to 4-7 which has seemed to solve the Central apnea problem, still have some obstructive and Hypopneas. I have posted more OSCAR nights 

Things I've noticed: 

1. Flow limitations are completely zero according to OSCAR. I had more with CPAP. 
2. I am not waking up throughout the night. Or knowingly. 
3. My leaks are worse with Bi-pap? I am using a climate tube for the first time. Maybe that's why? I notice there is a constantly leak of 1.20/2.40 and then spikes (I assume are mouth leaks) 

I will post more nights on OSCAR.

As requested, I've included 23:38 to 23:44 on March 14th.

Thank you so much again.

---

Here is my wabtchpat Study

[jonny7100]

Attached is one image from last night.

[jonny7100]

Two nights ago. March 16, 2025

[UnicornRider]

Thanks for the reply, I have to digest this information this evening and post back.