APAP experiment without official OSA/UARS

Hi slowriter, I use it in auto mode and tie its hands. I get all the FL data that way. BTW, LSAT has a lightly used VAuto for sale....

Miss Emerita wrote: ↑

Sat Dec 07, 2019 11:41 am

Hi slowriter, I use it in auto mode and tie its hands. I get all the FL data that way. BTW, LSAT has a lightly used VAuto for sale....

Ah, great!

slowriter wrote: ↑

Sat Dec 07, 2019 11:13 am

rosie1231 wrote: ↑

Sat Dec 07, 2019 9:12 am

.... the Autoset "for her" algorithm or the extra PS from the Aircurve Vauto.

Just to clarify, beyond the additional pressure support, there are two other benefits to the VAuto:

1. EPR can only be set at integers (1, 2, 3); PS on the VAuto can be set more precisely (like, 3.4)

I have doubts about that being a tangible benefit.

So I sprang for the VAuto and love it! I think the "feel" is quite different from the AutoSet, and more natural. I started with settings to best mimic my Autoset settings and noticed that the VAuto applies pressures ~1 cm lower than Autoset yet does a better job at squashing flow limitations. I still experienced my usual half dozen OA in the second half of the night, so my question is: with the Autoset, you guys recommended raising min pressure...now that I've switched to VAuto, should I raise PS or min EPAP? In other words is it more important to raise inhale or exhale pressure?

Thanks!

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

So I sprang for the VAuto and love it! I think the "feel" is quite different from the AutoSet, and more natural.

Great!

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

... my question is: with the Autoset, you guys recommended raising min pressure...now that I've switched to VAuto, should I raise PS or min EPAP? In other words is it more important to raise inhale or exhale pressure?

You raise min EPAP to resolve OAs, and you raise PS to basically address everything else related to UARS; namely, in your case, reducing the FL further so that you also reduce or eliminate any RERAs.

Normally, one starts at PS of 4 on bilevel.

So I would suggest ...

• raise min EPAP to 5 or (maybe better) 6
• raise PS to 4
• make sure to set your max IPAP so the machine has some room to maneuver at the top; so if you have 6 and 4 respectively, that means it starts with an IPAP or 10, and so maybe do a max IPAP of 11

... and see what happens.

Make sense?

I would just raise EPAP 1 cm and see what happens.
Then try increasing PS to 4 and see what happens.
But that's me...I like 1 change at a time. I like to see what happens or doesn't happen.
Probably isn't a critical issue with that AHI one way or the other though.

You might also just need more time.
This was the first night.
I suspect those wee hours of the morning OAs are REM stage sleep related. Those wee hours are when we typically get more REM.

Geer1 wrote: ↑

Thu Nov 14, 2019 10:24 am

Palerider, a simple explanation as to why something is a bad idea and maybe a good reference would suffice... My "stupid" comment just made her aware that the same idea she she was having may be a bad idea... Easiest way to stop uninformed opinions is to teach

I'd be happy to teach you, I charge $125 an hour, two hour minimum, payment in advance., I expect you to take notes because I charge extra if I have to repeat myself.

This isn't a teaching forum. However most people are quite capable of learning on their own by reading, not posting their overthought but incorrect "advice".

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

So I sprang for the VAuto and love it! I think the "feel" is quite different from the AutoSet, and more natural.

Both the Autoset and the VAuto use the same EasyBreathe(tm) algorithm, and deliver the pressure change on inspiration in virtually identical manners, I've charted this with both machines. (Easy to do with Oscar)

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

I started with settings to best mimic my Autoset settings and noticed that the VAuto applies pressures ~1 cm lower than Autoset

What does that even mean?

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

does a better job at squashing flow limitations.

Not with your settings the way they are.

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

I still experienced my usual half dozen OA in the second half of the night, so my question is: with the Autoset, you guys recommended raising min pressure...now that I've switched to VAuto, should I raise PS or min EPAP? In other words is it more important to raise inhale or exhale pressure?

For FL, raise the PS, which means you need to raise the maxipap, it really should be at 25. You're preventing the machine from being able to treat your breathing problems, and those are what most likely disturb your sleep, then you wake up and blame the pressure.

It is proven that breathing problems disturb sleep, that's the whole reason we have cpaps, "the pressure wakes me up"... As far as I know, not one legitimate study has concluded that.

Thanks to all for the input, I will plan to raise all of the above...min EPAP, max IPAP, and PS...one at a time, and slowwwwly.

palerider wrote: ↑

Sat Dec 14, 2019 10:00 am

Both the Autoset and the VAuto use the same EasyBreathe(tm) algorithm, and deliver the pressure change on inspiration in virtually identical manners, I've charted this with both machines. (Easy to do with Oscar)

Really?! Interesting. My (apparently poor) perception was that IPAP descends towards EPAP much more rapidly on VAuto compared to Autoset. I'm not talking about sensitivity to START the transition from IPAP to EPAP, which I believe pertains to "cycle" parameter - I mean the speed at which the transition occurs. I bumped Ti max to 4 seconds so I don't believe I'm timing out the inhale.

palerider wrote: ↑

Sat Dec 14, 2019 10:00 am

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

I started with settings to best mimic my Autoset settings and noticed that the VAuto applies pressures ~1 cm lower than Autoset

What does that even mean?

Over the last 3 weeks or so, median IPAP on Autoset has consistently clocked in at 9 cm for me, yet median IPAP on VAuto was only 8 cm. Since the machines deliver pressure change identically, this outcome seems unexpected...but maybe I just coincidentally had a "good" night last night and didn't need as much pressure, who knows.

palerider wrote: ↑

Sat Dec 14, 2019 10:00 am

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

does a better job at squashing flow limitations.

Not with your settings the way they are.

I was looking at 95% flow limitation value, which has consistently been 0.13-0.17 for me on Autoset, yet was cut in half to 0.07 on VAuto. Is that a significant improvement? I assumed so but I guess I don't know for sure since the values are normalized between 0 and 1. Is the flow limitation scoring algorithm proprietary?

palerider wrote: ↑

Sat Dec 14, 2019 10:00 am

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

I still experienced my usual half dozen OA in the second half of the night, so my question is: with the Autoset, you guys recommended raising min pressure...now that I've switched to VAuto, should I raise PS or min EPAP? In other words is it more important to raise inhale or exhale pressure?

For FL, raise the PS, which means you need to raise the maxipap, it really should be at 25. You're preventing the machine from being able to treat your breathing problems, and those are what most likely disturb your sleep, then you wake up and blame the pressure.
It is proven that breathing problems disturb sleep, that's the whole reason we have cpaps, "the pressure wakes me up"... As far as I know, not one legitimate study has concluded that.

Yup, you nailed it - I once woke up in a panic at IPAP 12 and then blamed the wake up on "not being used to high pressure." Thanks for the very needed nudge to try again!

rosie1231 wrote: ↑

Sat Dec 14, 2019 11:36 am

I was looking at 95% flow limitation value, which has consistently been 0.13-0.17 for me on Autoset, yet was cut in half to 0.07 on VAuto. Is that a significant improvement?

That's a good number to look at. My opinion: you want to reduce it to 0.

Raising the PS should help with that.

95% number of anything (pressure or leak) don't really mean much of anything.
They are just numbers that are easily skewed to the higher side by a relatively low period at a higher whatever.
You can't really compare them with much of anything on a night to night basis because we don't sleep the same each night.
Now long term...4 to 6 months maybe...then you can maybe compare them.
Long term they will most likely come in very close to a median average.

rosie1231 wrote: ↑

Sat Dec 14, 2019 11:36 am

Thanks to all for the input, I will plan to raise all of the above...min EPAP, max IPAP, and PS...one at a time, and slowwwwly.

palerider wrote: ↑

Sat Dec 14, 2019 10:00 am

Both the Autoset and the VAuto use the same EasyBreathe(tm) algorithm, and deliver the pressure change on inspiration in virtually identical manners, I've charted this with both machines. (Easy to do with Oscar)

Really?! Interesting. My (apparently poor) perception was that IPAP descends towards EPAP much more rapidly on VAuto compared to Autoset. I'm not talking about sensitivity to START the transition from IPAP to EPAP, which I believe pertains to "cycle" parameter - I mean the speed at which the transition occurs. I bumped Ti max to 4 seconds so I don't believe I'm timing out the inhale.

Yup, really, I can post a comparison later. There's no setting to affect the transition speed of ipap to epap. You can zoom in and look at the waveform on the mask pressure trace, if you still have your autoset data.

rosie1231 wrote: ↑

Sat Dec 14, 2019 11:36 am

palerider wrote: ↑

Sat Dec 14, 2019 10:00 am

rosie1231 wrote: ↑

Sat Dec 14, 2019 6:47 am

I started with settings to best mimic my Autoset settings and noticed that the VAuto applies pressures ~1 cm lower than Autoset

What does that even mean?

Over the last 3 weeks or so, median IPAP on Autoset has consistently clocked in at 9 cm for me, yet median IPAP on VAuto was only 8 cm. Since the machines deliver pressure change identically, this outcome seems unexpected...but maybe I just coincidentally had a "good" night last night and didn't need as much pressure, who knows.

Yes, sleep does vary from night to night

rosie1231 wrote: ↑

Sat Dec 14, 2019 11:36 am

palerider wrote: ↑

Sat Dec 14, 2019 10:00 am

It is proven that breathing problems disturb sleep, that's the whole reason we have cpaps, "the pressure wakes me up"... As far as I know, not one legitimate study has concluded that.

Yup, you nailed it - I once woke up in a panic at IPAP 12 and then blamed the wake up on "not being used to high pressure." Thanks for the very needed nudge to try again!

You have to go back to that and look at the breathing that was happening prior to the wakeup. There was *something* that caused the pressure to go up, and that is almost certainly what woke you up, knocking you out of whatever sleep stage you were in... Then the extra stimulus of the hose and mask caused you to wake up enough to become aware of what was going on....

Pugsy wrote: ↑

Sat Dec 14, 2019 11:47 am

95% number of anything (pressure or leak) don't really mean much of anything.
They are just numbers that are easily skewed to the higher side by a relatively low period at a higher whatever.
You can't really compare them with much of anything on a night to night basis because we don't sleep the same each night.
Now long term...4 to 6 months maybe...then you can maybe compare them.
Long term they will most likely come in very close to a median average.

But with UARS, those numbers are really the only ones that we have that might correlate with RERAs.

And just comparing my own numbers over many months, across autoset vs vauto (and being titrated in a lab at PS 6):

• median FL is always 0, so clearly that number is not helpful
• 95% FL now is always zero, but at times in the past has been above 0
• max FL is now 0.10 or below, at times in the past it's been as high as 0.35 or so

That tells me anecdotally the 95% (and max) FL number is likely to be helpful in self-titrating UARS.

All the 95% number is just max with some of the brief peaks cut off, like in the Olympics where they ignore the high and low scores.

But some ignorant people put a lot of stock in the 95% number as if it is magical or something.

Like any statistic, it means something, but is easily misconstrued into something significant.

What is important is the graphs, which can't be summarised into a simple easy number.

You could have FL of 0 for 94% of the night and 1.0 for 6% of the night, and what would your 95% number be? 1.0

You could have a FL of of 1.0 for the entire night and you'd have a 95% number the exact same as before, but those two nights are hugely different.

slowriter wrote: ↑

Sat Dec 14, 2019 12:04 pm

Pugsy wrote: ↑

Sat Dec 14, 2019 11:47 am

95% number of anything (pressure or leak) don't really mean much of anything.
They are just numbers that are easily skewed to the higher side by a relatively low period at a higher whatever.
You can't really compare them with much of anything on a night to night basis because we don't sleep the same each night.
Now long term...4 to 6 months maybe...then you can maybe compare them.
Long term they will most likely come in very close to a median average.

But with UARS, those numbers are really the only ones that we have that might correlate with RERAs.

And just comparing my own numbers over many months, across autoset vs vauto (and being titrated in a lab at PS 6):

• median FL is always 0, so clearly that number is not helpful
• 95% FL now is always zero, but at times in the past has been above 0
• max FL is now 0.10 or below, at times in the past it's been as high as 0.35 or so

That tells me anecdotally the 95% (and max) FL number is likely to be helpful in self-titrating UARS.

Could just be a coincidence too. It fits your needs to think of it that way but it's still the law of numbers being applied and you can't change it.

And all this is assuming that the FLs seen are UARS at work and it's not necessarily the case....but it is all that people have to go on in this situation with UARS. People forget that the FLs that the machine cares about are related to OSA stuff and not some other stuff.
With UARS it's the arousal that is associated with a airway disturbance that is the key. A person can have that happen and no FL be flagged at all.
And then there's the whole thing about the machine's not being able to tell if we are asleep or not.

We want the machine to provide data to fit our unique situations and the machine was never designed for that unique situation and no amount of making the situation fit the data seen is going to change that fact.

If it were me and I had UARS going on I would be learning how to spot arousal breathing and counting that arousal breathing manually to best judge my overall sleep quality. I wouldn't be counting FLs or really even bothering to look at them.
For it to be UARS it has to have an arousal associated with it....and then there's the whole idea of spontaneous arousals mucking up the waters. CPAP won't do anything for spontaneous arousals.

But that's just me.