Need Some Advice

I have only posted on this board a couple of times. Do these numbers look OK? My Respironics ASV machine doesn't usually work with Oscar and I have been using encore. I did turn off the auto start function. It took a couple of days, but I was able to get and Oscar export last night. The time stamps are off, but the total time in therapy is correct. I have severe sinus issues. ENT Doctor has said I need sinus surgery. Hesitant because of cost. I also have severe dust allergies. So, I am forced to breathe through my mouth. Cannot find a mask that doesn't leak at the pressures I have. Usually about 1 to 2 hours into sleep, my nasal passages become blocked and I think the pressure has nowhere to go except leak out. Would the sinus surgery possibly help me? My concerns here are the leaks, the snoring and the timed breaths. Is this too high of leakage, too much snoring and is this 46 timed breath something to be concerned about. It says I had 289 timed breaths. I am getting severe sinus headaches now with using CPAP. My Hypopnea is much lower than usual for last night, average is like 3.0

What humidity setting are you using? Have you ever tried different settings? If so, what and what were the results in terms of maybe helping with congestion or headaches?

Is the OSCAR reported timed breaths matching up with what Encore says?

Are the settings being reported under the AHI bar actually the settings that are on the machine itself? I ask this because sometimes OSCAR doesn't report the settings accurately. If your minimum PS is really 7...that's quite a big starting point and I wonder why that was chosen.

Would you be okay with changing a setting yourself?

Have you tried sinus irrigation?
Ask your doctor first.

Pugsy, I have the humidity at 2 right now. I have tried having it off and all the way up to 5. I don't really see much help either way with the humidity. I do not have a heated hose. I might have even had a better night with the humidity off. I usually have it on 4 just because I mouth breathe and hope the extra humidity helps with the dry mouth, but I changed it to 2 a few days ago. Not sure if it really helps or not. The settings listed on oscar are what is on my machine. These settings were adjusted by me and I have been on these settings for 6 months. I do not go through medical insurance and do not have any doctor changing my settings. I do have a sleep doctor and I brought the encore reports with me 6 months ago with these settings and they were happy with the results. I really think they are just looking at the AHI being under 5 and not really looking at everything else and have me only coming once every year.

What do you mean when you say "sinus headache"? What are your symptoms specifically?

How did you come by using this machine? Meaning what was your original diagnosis prior to ever starting some sort of cpap therapy? Did you have obstructive sleep apnea without any central apneas initially and the centrals came about after starting cpap or did you have central apnea from the beginning and no obstructive apneas or did you have a mixture right from the very beginning?

I know a lot of questions but I am trying to figure out what is being treated so that we can think of better ideas.

The snores...More EPAP is usually needed which is more minimum EPAP but with your current EPAP and minimum PS your pressures as you well know...awfully high.

If you were sleeping soundly and feeling good I don't know that I would worry about the snores at this point right now. At least until I know if your original diagnosis was obstructive apnea related. Snores point to the airway trying to close up but your AHI is low so they aren't progressing to full closure bad enough to earn a flag.

Did you ever have a formal in lab sleep titration study where they tried to find the optimal pressure settings with this or any machine?

Pugsy. The sinus headache is just a guess by me. It feels like a sinus headache. Pressure behind my eyes. I have not talked to a dr about it. I was diagnosed about 1.5 years ago with severe obstructive apnea. I could not sleep during the sleep study. But, they were able to diagnose me. They said 100 events an hour. They didn't say anything about clear airway apneas. I was given a respironics dream station auto cpap. Evidently the DME was not in my network and I had to return it after a month. Then I found out that even if I go through in network DME, it would be subject to deductible. I do not want to deal with insurance. The Cpap did not go well. I could not handle the constant pressure. I was given an old resmed S9 auto bipap by a friend that i used for about 6 months. Much better than cpap but I was still taking off the mask at night. The same friend who gifted me the resmed is on ASV, so I took a chance and bought this used ASV off ebay and it has been much better than either of the other machines I have used. My sleep doctor said they can write me a prescription for a bipap. I think they said a resmed aircurve 10 vauto. But since I am going out of pocket, I am using this ASV machine until it dies. It works for me now. I am willing to go back to bipap, but I would hate to spend large sums of money to realize the ASV works best. I have had severe snoring issues since my early 20's. Wife told me not only was I snoring but that i was stopping breathing too. I rarely have obstructions while on current machine. If I have any, usually just 1 or 2 in a night. I only have 1 or 2 CA as well.

Ahhh....we don't even know if you have a central apnea issue.

Let me think on this for just a few minutes and I will get back with you in a bit. In the middle of cooking supper at the moment.

Let's back way up and just proceed like we are only dealing with obstructive apnea issues because at this point that is what we know for sure.

Your PS minimum of 7...that's higher than I would like to see someone be using unless there is some sort of special reason or need behind it.
It can actually be a trigger for central apneas at that setting. It very well could be causing the need for the machine to administer those timed breaths.

Let's try configuring the machine in a bilevel mode that should be comfortable for you and take out the risk of the PS being a central apnea trigger (clear airway apnea events are central apneas....the airway is open but no air is moving because there is no effort to breath).

Minimum EPAP 10
Minimum PS 4
Maximum PS 4
Maximum EPAP 15 if that's as high as it will go. More if it will go higher. I am unsure of what that max might be with PS essentially fixed.
Maximum IPAP 25

I don't remember all the other setting options available on the Respironics ASV....any that have factory default settings just use the factory default. Any that don't....tell me what they are and what your options are and I will try to come up with something suitable.

In all honesty I don't know what to make of the headaches. At first I thought related to humidity setting and the nasal congestion issues but now I am not so sure. It wouldn't be impossible for them to be related to some hyperventilation going on because of the high minimum PS of 7. Unstable gas exchange because of the PS being so high and consistently high. Let's try these settings and see if we get lucky and maybe have the headache diminish.

Pugsy. Thanks. I have not tried using the machine with a fixed PS yet. I have had the minimum at 4 before and looking at the reports from that timeframe, the timed breaths were about one third. So, you may be on to something. So, I will try a fixed PS tonight. I hope oscar keeps being able to report for me. It has been hit or miss with Oscar and this machine. Encore does not give a timed breath #. It just shows them on a graph, but in any event I could attempt to count them on the encore report. Maybe this will help with my headaches. These could be pressure related as well.

Chunky Frog. I thought I responded already but I must not have hit submit. I have used saline in a squeeze bottle as well as a pressurized can. I have not tried a netty pot or a navage. The saline hasn't helped much. It only helps for an hour or so. I really think my sinus issue is more of a swelling and not a lot of room issue. Doesn't seem like a lot of mucus. Plus, I usually only have one nostril at at a time that i can even get the saline wash into. The other nostril is nearly totally blocked most of the time. If the sinus irrigation helps to wash out allergens too, it really only seems to be a temporary solution. I use nasal strips as well that help only a little bit.

Question.....does a hot steamy shower make any difference in your nasal congestion issues in either nostril?
Better, worse, no change that you can tell?

I don't know what is going to happen with these changes but I wanted to get back to settings that are more appropriate for the for sure known problem of OSA....worry about dealing with central apneas only if we see evidence of them being a problem.
We all have a few centrals here and there but they aren't a problem unless present in large numbers or keeping a person from progressing into normal sleep stages.
Let's not be trying to fix them unless we know for sure they need to be fixed.

Pugsy. Yes, hot showers do tend to clear up sinuses a bit and so does vapor rub. But both of these are just temporary. Usually within an hour or so I am back to at least one nostril being closed. I was diagnosed with deviated septum. Also, this ASV machine does not have different modes like the 60 series does. This is the old model that was replaced by the 60 series years ago which had bipap, cpap & ASV modes. This one doesn't have modes. I have the EPAP min = 10, max = 18, PS min/max at 4. IPAP Max is at 25. Breathing Rate is on auto. Flex at 1. So, will this act like a BIPAP. The only values I changed where the PS & Min EPAP. The max EPAP can still go up to 25 even with a fixed PS.

Got it...I didn't read the comments and see that you were using the 50 series ASV.
Your settings are good to go.

I would like to see you try a lot more humidity and you can't use a heated hose with the 50 series...and the setting of 4 is almost as high as you can go but it really isn't all that much moisture on a 50 series machine in the new humidification mode.
There is Classic Mode though......

If a steamy shower helps for about an hour....wonder what would happen if you could be sort of breathing that steamy shower all night long?
Classic Mode on max is like a steamy shower all night long. Comes with its own set of problems though in terms of condensation.
Let's talk about it later...remind me. I don't want to make too many changes at one time tonight.

Pugsy. Oscar did not work with last nights sleep. But I attached encore report. I had some leaks as one of my straps came loose. My AHI is way up. Mostly HI. Encore does not score timed breath, but there were quite a bit. Over 50. I did not have near as bad of headache today and I actually felt much better. I also bumped humidity up to 5. I will try another night with these settings. Many of the issues may have been due to the leaks. Snoring is way up too, but it appears that they are more during the large leak.