ResMed Airsense 10 Autoset for Her

[Sleeprider]

Your overall AHI was 16 events per hour, however, this was a split study, and the diagnostic portion lasted approximately 3-hours and contained most of the events. You never experienced REM sleep without CPAP in this study. Your untreated AHI is probably closer to 30, but, that may be where the 25 AHI on the prescription form came from.

Looking at your titration, you had virtually no events from a pressure of 6.0 to 8.0 cm pressure, your AHI was 0.0. At 9.0 it rose to 1.4 and at 12 cm it was 3.4 AHI. A large cluster of events as pressure was elevated above 12 to 16 produced one of the most significant oxygen desaturations of the night at about 04:00 and an AHI of 3.0 at the higher pressure. Based on the results of this titration, I disagree with the prescription, and would suggest Auto CPAP is called for with a minimum of 6.0 and maximum of 12.0. Based on my judgement and experience with these titrations, I think your apnea at the higher pressures was not the result of the pressure, but of position. You moved from your back to your front (prone), and probably had your head turned sharply to the side. This is why you have the clusters of apnea and desaturation.

CPAP clearly improved your sleep and minimized both respiratory and spontaneous arousals. You appear to be adequately treated at relatively low pressures, but your sleep position changes your needs, which justifies the auto CPAP which can respond to those needed increases of pressure.

[snord]

Sleeprider, thank you for reviewing the sleep study.  It is really helpful to see which pieces of information are more significant to an expert, and to get your overall impression.  Its still not clear to me why my untreated AHI is closer to 30, but that's ok - I mainly wanted to rule out some overt error by the doctor.

I'm still unclear on whether it is "safe" to make changes to my settings during the compliance period.  Safe meaning not jeopardizing my relationship with the doctor or DME.  I realize my settings won't be broadcast by cellular for compliance purposes.  But I thought I read that the DME and/or doctor, if they are actively looking, can see what the settings are and make changes and get upset about it.  After the compliance period, I can just turn on airplane mode.  Are the machine settings recorded on the SDcard I will be turning on at my next appointment?


So my plan is to use the APAP in CPAP mode at 12, as prescribed, and see how I do.
If I have problems, then I call up the sleep doctor and ask if a range of 6-12 might be helpful, and if I continue to have problems, suggest we try increase the pressure towards 9-20 w EPR 2.  Even if the doctor says fine and updates the changes, does he have to update the prescription so the DME doesn't have a fit?

Yes, I realize I am free and legally able to make the changes to the CPAP, my anxiety is in navigating the shark-filled waters between dealing with the sleep doctor and handling the DME.

Thanks again for your assessment!!!

[Sleeprider]

The SD card sees and knows all. Usually the doctor isn't concerned about anything other than use and whether you feel better. I am telling you that in APAP mode with a minimum pressure of 6.0 and maximum of 14.0 the machine will likely end up where you need to be. The titration did not pick out the pressure at which you achieved the best results (lowest AHI). If you are inclined to ask your doctor why a pressure was selected that results in higher AHI than the range from 6 to 9, I think he will get a puzzled look on his face as to why you actually read the report. Anyway, glad you got the autoset, and once you have used it and posted some data we can offer much more. That said, I would put my analysis of your sleep test ant titration against the recommendations without hesitation. The conclusions of your medical team are not supported by the data.

[Gideon]

Sadly I agree,  SR analysis is all to true.  It certainly is not the worst I have seen.  I agree with SR's suggestion and would implement them on night 2.

Your case is uniques because it is not often we see enough info to offer a recommendation before the user has actually used a machine.

[snord]

Thank you.  I will use the 6-14 range and let the machine auto-adjust, and see how it looks in Sleepyhead.

Now I just have to wait for the DME to come through on their "promise" of dispensing the APAP.

They are still waiting for medicaid pre-certification, day 20 and counting...

When will the waiting ever end!? 
I started this process last October.

[snord]

Ok, so I've stuck with my prescribed settings and stayed in CPAP Mode at 12cm.  And my AHI (average 2.25) has been pretty good, I think.  I don't feel well-rested though, and you can see I have a lot of flow limitations and snoring, even having turning EPR to 3 on day 8.  Please ignore my UF1/UF2 flags, I have them set to 20%/50% over 4 seconds

I will be meeting with the sleep doctor in 10 days, so I would appreciate any recommendations for what the settings should be, now that I have some data to show.  I can't be sure the doctor will even look at my data, so I want to go into the meeting with some idea of what I would like him to change the prescription to.

Thank you

[snord]

.....

[Sleeprider]

CPAP and EPR are helping, however you clearly need to be in Autoset mode so the pressure can rise above your pressure limit of 12 cm. Keep in mind that while EPR helps resolve flow limits and snoring, it also reduces your effective pressure when in CPAP mode. You need to be in Autoset mode to allow the machine to move to higher pressure that you clearly need. While you were prescribed a CPAP pressure of 12, with EPR your pressure is 12/9 instead of 12/12. In Autoset mode with a maximum pressure of 16.0, your machine could adjust between 12/9 to 16/13, and this is still consistent with your prescription and titration findings. 

In your graph of 3/23, there is strong clustering of the event periods and that would suggest using a soft cervical collar to avoid tucking your chin and occluding your airway; but most of the other charts show persistent flow limitation with accompanying snoring and a more moderate event rate for hypopnea and OA.  In fact, your AHI will not get your doctor's attention, and he is likely to overlook the abundant snoring and flow limitation that requires higher pressure to resolve. 

I do think you are near optimal pressure based on the low AHI, but if you want the rest to clear up, you either need to set CPAP pressure higher or go to Autoset mode with a maximum pressure of 16.  I see two choices. You can either just go ahead and make the changes yourself, or contact the doctors office to let him know you are still not sleeping well, and have intense snoring. Request that he authorize/prescribe use of the Autoset mode with a maximum pressure of 16 so you can both see if the situation is improved.  Most of us just DIY, and they are not going to take your machine away unless you don't use it. Compliance means use, not settings. If it makes you feel better to ask, then do so.  Show your doctor  this chart that shows the classic flow limitations with snore on inspiration.  If you do not change your settings, get a soft cervical collar and let's see if that helps.

[snord]

Thank you, SleepRider, your expertise is greatly appreciated!

[snord]

So I switched to APAP 12-20 EPR3 (from CPAP 12cm EPR3), and over the last 4 days, AHI, RERAs, snoring and flow limitations dropped dramatically.  I am happy with these results, but noticing that machine is briefly maxing out at 20cm.  I will see the sleep doctor in 4 days, and this is my one chance to set things for the next year.  Do you think this is grounds for getting an AirCurve 10 VAuto, not only to make it more comfortable to tolerate this high pressure but to make sure the max pressure is sufficient?