New User - Mild to Moderate Apnea plus UARS (High RDI)

[sosotired]

Greetings,

I'm a new/ancient CPAP user. Just wanted to say I'm extremely impressed with the depth of knowledge amassed on this forum. You guys put my sleep doc and DME to shame. And I love the OSCAR software.

I've been viewing the forum since I got my Resmed 10 Apap a month and a half ago and just want to thanks everyone for all the excellent tips I've gleaned from the forum so far.

I was on a CPAP back in the 90's for 18 months so not having a lot of psychological issues adjusting to the CPAP and Mask. I'm very impressed with the advances in technology. My new vented mask and the integrated heated humidifier with heated cord are wonderful. With the vented N20 mask, I sometimes don't know if the CPAP is turned on or not. You should have seen the size of my original CPAP and humidifier. Would barely fit in a carry on bag. And it sounded like a vacuum cleaner. The new machines are really compact and even the tubing is slimline.

That said, it's been a bit of slog. I'm sleeping even less than before CPAP. 4-6 hours a night. The cervical collar tip was a breakthrough. Probably solved a combo of mouth leak and chin tucking and got my AHI down below 5. I discovered Resmed doesn't do a very good job of leak detection and was giving me a smiley face every morning even though I was leaking like a sieve. Gradually raising min pressure is also helping. Got some decent sleep last night at min pressure of 9. Over the month and a half I've had the machine my average pressure has mostly ranged in the 10 - 12 range so I don't think I'll have to go too much higher. And I am seeing some benefits of treatment since the morning headaches are almost gone.

Things I've tried based on member suggestions:

Soft cervical collar: dropped my AHI 6 points
Chin Strap for two nights: Drove pressure up to 18 so that one didn't quite pan out
Bumped pressure up from 5 min/10 max to 9/20 (I was pegging the max every night)
Set Response to Soft (aggressive Apap pressure seems to be tough on UARS)
Duct Tape for now (waiting on my soft tape order from Amazon)
Mouth scrunchie over tape
5mg extended release melatonin (Terrible hangover, will try low dose once my order arrives)
Got an SD card from Amazon and got OSCAR installed once I resolved my graphics driver issues
Watched all the videos on how to interpret OSCAR data

Got my AHI down to 1 or 2 per hour so far with the addition of the cervical collar, but still felt like crap. To resolve, I've been chasing clusters of flow limitations by upping min pressure. I made some real progress last night with the flow limitations by bumping the min pressure to 9 and felt like a human today. Going to bump it up to 10 tonight since I have no problem dealing with the pressure given my wonderful vented mask. Right now I only have 3 nights of OSCAR data and it's kind of fragmented. Once I get some decent data, I look forward to posting some screen shots and requesting your expert advice.

In the meantime, I'm debating the purchase of an AirCurve BiPap but was unable of instant message LSAT. I was wondering if someone could kindly activate my instant messaging.

Thanks in Advance and look forward to being a member of the Cpaptalk community.

Dave

[Julie]

Why do you want a bipap?

[zonker]

Mouth scrunchie over tape

welcome to the zoo! i hope you mean SCUNCI and not SCRUNCHIE.

In the meantime, I'm debating the purchase of an AirCurve BiPap but was unable of instant message LSAT. I was wondering if someone could kindly activate my instant messaging.

now that you've made your first post, you may indeed PM forum member lsat.

good luck!

oh and as julie asks, why do you think you'll need or want the bipap?

[sosotired]

Hi Julie and Zoo,

As for the Aircurve VAuto, I noticed all the cool members have them! Along with seep apnea, I also suffer from bipap envy!

Just kidding! My understanding is that bipaps provide the best treatment for UARS. Please correct me if I'm wrong.

SCUNCI it is. My area of expertise is not exactly women's fashion accessories.

Dave

[sosotired]

Ok .. now I have a question for the experts. I noticed some clipped jagged flow patterns in the flow rate graph. I want to confirm if they are flow limitations and if I need to address them with more pressure. Thanks Dave

Wondering if these flow patterns are normal?

flow1.jpg (413.96 KiB) Viewed 16554 times

[werther]

No doubt to me, hope one of the experts will give their opinion.

[Pugsy]

[Miss Emerita]

In the zoomed-in view, you do have clear flow limitations. It'd be nice to see a whole daily chart with the following in one screen shot:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

Do you have EPR turned on? I couldn't tell.

[slowriter]

Do you have EPR turned on? I couldn't tell.

I was going to ask this as well.

It looks from the statistics that you do have EPR set to 3 sosotired. Can you confirm?

Just kidding! My understanding is that bipaps provide the best treatment for UARS. Please correct me if I'm wrong.

You are correct. The VAuto is a great machine, and gives more flexibility to address UARS.

And the initial charts (per Miss Emerita, we do need more here) suggest it could be a good idea.

[sosotired]

Greetings,

Thanks everyone for all the great input.

I took your advice and purchased a vauto with 1 hour use for $500 off of craigslist. I checked the serial number and it was manufactured in May of last year so I think I got a good deal. It also came with a F20 mask and since my DME will not send me one without a fitting (think they want to be sure and charge the insurance) during the lockdown, I've had to manage with my N20 and duct tape. The mask came with a large cushion so I ordered a medium from Amazon and got it on Sunday night. So now I can give my lips a break from the duct tape.

I really like the pressure display on the vauto. During the day on Saturday I read the manual and the titration documentation and did some test runs. It felt like it was cutting off my exhale on long breaths and I verified it with the pressure display so I lowered the cycle sensitivity to low. Since EPR seemed to be missing some of my inhales, I set the trigger sensitivity to high. I set ti min to 1 based on a Resmed titration chart and set ti max to 3 based on some recommendations on the forum. Basically I set it up for a patient with low inspiratory drive. I got cocky and set the pressure support to 4 and used my N20 nasal mask.

Upon reviewing the data from Saturday, I noticed a lot of OA's but the flows were a lot more rounded. Based on the review, I lowered the pressure support to 3 in case I was getting CO2 washout. I set the trigger sensitivity to very high and the cycle to very low and the rate waveforms looked better than they have in the past. A couple of interesting things. My respiration rate went up a full point over my daily average and my tidal volume dropped from 420 to 380. Probably because of the lack of rescue breaths. Here's the 1000 foot shot.

first good night.jpg (459.61 KiB) Viewed 16458 times

Of course there's still a few funky flows but I slept through them. See a couple non flagged examples below:

funky1.jpg (429.64 KiB) Viewed 16458 times

Notice the pressure change almost woke me up on this one.

funky 3.jpg (451.21 KiB) Viewed 16458 times

It seems to me like the APAP algorithm goes after these flow limitations very aggressively, jacking up the pressure and often waking me up. Just a guess, please correct me if I'm wrong. Now that I can sleep a little, I'm going to start fine tuning one change at a time. Any suggestions will be greatly appreciated.

Thanks in Advance,

Dave

[sosotired]

Hi Guys,

Thought I would post an image of the OA's I got on Saturday night at Pressure Support 4. Looks kind of like cheyne stokes but I think I blew off a little too much CO2. At least I hope so. What do you guys think?

periodic breathing.jpg (430.71 KiB) Viewed 16451 times

I did a test Monday night with EPAP of 7 (up 1), pressure support of 4, and trigger sensitivity very high (previously high) and I didn't get any OAs this time. Going back to my Sunday night settings tonight.

[slowriter]

Min EPAP of 7 seems to work seems to work for you.

The increase in your reported CAs when you go from PS 3 to 4 is a typical example of treatment-emergent central apneas. They typically go away after a couple of months, as your body adjusts, but you need to decide what works best for you.

Maybe give PS 3 a bit of time without changing settings, and then see how you feel, and then slowly raise PS over time (like 0.2 every few days?) if there seems value there?

To check your waveforms, zero in on a two-minute section of your flow rate graph, during a period of normal breathing (not the events you focus on above).