01-26-2025, 02:04 PM
Tom Henry BPAP thread - need suggestions please to dial in settings
Relative newbie to PAP therapy. I have had and been using my ResMed Aircurve 11 VAuto since 12/21/24.
I have been “lurking” here since before I got my machine, and have tried to participate in a couple of threads before posting about my situation.
First of all: huge thanks to the moderators and other contributors for the time and effort spent in trying to help others.
Per request of one of the Moderators to “keep our stuff together”, I am starting this as a separate thread, rather than hijacking anyone else’s.
Short version of the backstory as to me: 68 y/o white male, , 6 foot tall, 175 lbs, generally good health and very active in multiple strenuous outdoor activities until August of 2022, when Covid and Paxlovid absolutely kicked my ass and damaged my heart and lungs.
It took a year of heart specialists to get the “voltage regulator” portion of my heart back to working normally. During that whole time, I had pronounced fatigue, brain fog, and SPO2 fluctuations, but was told that it was related to my heart rate fluctuations. However, when the fatigue and SPO2 issues continued after my heart rate stabilized, and the heart docs “released” me, my PCP spent the next year getting full blood workups done, which were all normal, and having me do two at-home and then two different in-lab sleep studies, which were the usual disasters. Although they showed numerous “arousals”, and some CA, OA and H events, the AHI number was less than 5, so neither met the threshold for me to get OSA treatment through Medicare. So, my fatigue and SPO2 issues continued with no resolution.
Fortunately, an ENT to whom I had been referred during this process, and to whom I am grateful, confirmed that there were no throat issues, opined that the deviated septum of which I was aware was not enough to be causing the issues I was having, and was willing to go “outside the box” and prescribe for me an APAP machine. When Medicare predictably refused to cover it, he then suggested that if I was going to have to self-pay, I just get a bilevel machine, which is what I did. Unfortunately, the ENT was not and is not able to provide ongoing consulting with regard to the use of the machine, since insurance was denied.
I spent HOURS on this and other forums, trying to get a feel for what my settings needed to be.
On 12/21 and 22 I started out using a RM P30I. Both nights were a disaster of mask leaks, and inaccurate readings of multiple events.
I switched to the RM F40 on 12/23, and since then have for the most part gotten good control of mask leaks, and have AHI numbers of 1 or less, BUT, am still having multiple arousals per night, and the persistent fatigue and brain fog during the day.
Over the last six weeks, I have slowly ramped up my EPAP number to where I am now at EPAP 8, and PS of 1 or 2, and IPAP max of 12.
The good news is that I seem to have “tamed” the OA and H events, with very rare exceptions. I do have random nights with AHI scores of Zero - yay, but do still have other nights where I have one or two flagged CA events. My biggest concern, and where I need some “adult supervision”, is that although I am now at 8/2/12, I am still seeing some really ugly “junk” breathing in my waveforms, which is NOT being flagged by the RM AC 11 Vauto, but which I assume to be manifestations of RERA’s or UARS. I have not been able to get the RM AC11 to flag them.
Last night for the first time ever, my max pressure actually hit 12, and the RM F40 did not handle it well. I had more leaks that I have had in weeks, which of course threw everything else off.
I have attached the last two nights, both of which were at 8/PS1/12.
1/24/25 was not a bad night, with an AHI of zero, minimal Flow limitations, and minimal leaks, but some junk.
Last night, 1/25/25, felt like a disaster. AHI was low, but leaks, flow limitations, arousals, etc….
I have attached the overview and a detail as to each night, and a detail area as to last night since the attachment limit is 3
My only goal in continuing to raise the EPAP base, was to see if I could clean out some of the “junk”.
Since I, like so many of you, are “on my own”, I am hoping that someone can please suggest whether I need to make changes to the EPAP, PS, or IPAP numbers, to get me dialed in better.
I apologize for the length of the post, but am trying to provide a context, and I thank you in advance for any thoughts or suggestions.
Gratefully,
Tom Henry
I have been “lurking” here since before I got my machine, and have tried to participate in a couple of threads before posting about my situation.
First of all: huge thanks to the moderators and other contributors for the time and effort spent in trying to help others.
Per request of one of the Moderators to “keep our stuff together”, I am starting this as a separate thread, rather than hijacking anyone else’s.
Short version of the backstory as to me: 68 y/o white male, , 6 foot tall, 175 lbs, generally good health and very active in multiple strenuous outdoor activities until August of 2022, when Covid and Paxlovid absolutely kicked my ass and damaged my heart and lungs.
It took a year of heart specialists to get the “voltage regulator” portion of my heart back to working normally. During that whole time, I had pronounced fatigue, brain fog, and SPO2 fluctuations, but was told that it was related to my heart rate fluctuations. However, when the fatigue and SPO2 issues continued after my heart rate stabilized, and the heart docs “released” me, my PCP spent the next year getting full blood workups done, which were all normal, and having me do two at-home and then two different in-lab sleep studies, which were the usual disasters. Although they showed numerous “arousals”, and some CA, OA and H events, the AHI number was less than 5, so neither met the threshold for me to get OSA treatment through Medicare. So, my fatigue and SPO2 issues continued with no resolution.
Fortunately, an ENT to whom I had been referred during this process, and to whom I am grateful, confirmed that there were no throat issues, opined that the deviated septum of which I was aware was not enough to be causing the issues I was having, and was willing to go “outside the box” and prescribe for me an APAP machine. When Medicare predictably refused to cover it, he then suggested that if I was going to have to self-pay, I just get a bilevel machine, which is what I did. Unfortunately, the ENT was not and is not able to provide ongoing consulting with regard to the use of the machine, since insurance was denied.
I spent HOURS on this and other forums, trying to get a feel for what my settings needed to be.
On 12/21 and 22 I started out using a RM P30I. Both nights were a disaster of mask leaks, and inaccurate readings of multiple events.
I switched to the RM F40 on 12/23, and since then have for the most part gotten good control of mask leaks, and have AHI numbers of 1 or less, BUT, am still having multiple arousals per night, and the persistent fatigue and brain fog during the day.
Over the last six weeks, I have slowly ramped up my EPAP number to where I am now at EPAP 8, and PS of 1 or 2, and IPAP max of 12.
The good news is that I seem to have “tamed” the OA and H events, with very rare exceptions. I do have random nights with AHI scores of Zero - yay, but do still have other nights where I have one or two flagged CA events. My biggest concern, and where I need some “adult supervision”, is that although I am now at 8/2/12, I am still seeing some really ugly “junk” breathing in my waveforms, which is NOT being flagged by the RM AC 11 Vauto, but which I assume to be manifestations of RERA’s or UARS. I have not been able to get the RM AC11 to flag them.
Last night for the first time ever, my max pressure actually hit 12, and the RM F40 did not handle it well. I had more leaks that I have had in weeks, which of course threw everything else off.
I have attached the last two nights, both of which were at 8/PS1/12.
1/24/25 was not a bad night, with an AHI of zero, minimal Flow limitations, and minimal leaks, but some junk.
Last night, 1/25/25, felt like a disaster. AHI was low, but leaks, flow limitations, arousals, etc….
I have attached the overview and a detail as to each night, and a detail area as to last night since the attachment limit is 3
My only goal in continuing to raise the EPAP base, was to see if I could clean out some of the “junk”.
Since I, like so many of you, are “on my own”, I am hoping that someone can please suggest whether I need to make changes to the EPAP, PS, or IPAP numbers, to get me dialed in better.
I apologize for the length of the post, but am trying to provide a context, and I thank you in advance for any thoughts or suggestions.
Gratefully,
Tom Henry