Getting AHI lower

Flex is just a little exhale relief adding in. More of a timing thing between inhale and exhale than anything else.
You see it more on EPAP...very slight little dips. EPAP drops a little and the timing for when EPAP ends and inhale begins is mainly what it does.

Dog Slobber wrote: ↑

Mon Feb 03, 2020 10:14 am

I think we are approaching the point where you might want to consider switching to a BiLevel machine, such as the AirCurve 10 VAuto.

• You are approaching your machine's maximum of 20 cm, the VAuto has a maximum of 25cm
• The responsiveness of ResMed's algorithm might do a better job of treating your events.
• Even if your events get controlled in the 17-20 cm we have left to adjust your minimum to, the better pressure support might increase your comfort level.

Say it comes to that. My insurance changed and any sleep disorders are no longer covered. I have my original prescription and I checked around. Apparently, your prescription has to say BiPAP/BPAP on it for them to sell one to me. I could ask my primary care physician to write me a prescription for a BPAP, but he would likely order another sleep study which would put me in a bind.

Any advice on a potential plan?

Just buy a bilevel machine privately.
LSAT just had a couple...both are sold now but he probably will find some others later.
Watch craigslist. I bought an AirCurve 10 VAuto locally with 80 hours on it for $350. Everything included even a new sealed heated hose.

mgundy wrote: ↑

Mon Feb 03, 2020 12:41 pm

Any advice on a potential plan?

used, peer to peer. forum member lsat often has machines for sale. i haven't purchased any myself, but other forum members HAVE and swear by the experience. you may want to pm him to see what he has.

this is all, of course, if your current machine and pressures don't work out!

EDIT: pugsy has mentioned same.

Thank you both!

I just did a test run at 17 and then at 16. Even with chin strap (and tape) I couldn't exhale out my nose fully. I set a-flex to 3. As I relaxed and would start to fall asleep my lips would vibrate like when kids make fart noises. Sorry, it's the only way I know how to describe it.

I have a full face mask arriving on Wednesday. Will that fix this problem created at higher pressure?

Just wanted to update. Still can't get a good nights sleep with a minimum pressure of 17. My two nasal mask result in my mouth being blown open (even when taped) once the pressure rises. The Dreamwear full face mask won't create a good seal at that pressure. I ordered an AirTouch F20. It creates a great seal at that pressure. However, I'm getting what I call a "chipmunk" effect. When my mouth falls open when I fall asleep air fills my mouth and blows my cheeks out waking me up. I'm right in between a Medium and Large and went with the Large. I've ordered a Medium cushion to see if that's the problem. The saga continues...

I have a MAD that is in the process of being fixed at the lab (I kept cracking it with the stress of my jaw pulling back on it). If I can't get a higher pressure to work (17+), I think I'll give that a try when it gets back at a lower pressure and see what happens.

About six months into my treatment, I started sleeping with a firm foam cervical collar I purchase on line. This has really help keep my mouth closed, even though I use a full face mask. My wife also uses a firm foam cervical collar with her machine. I still have the chipmunk cheeks quite often, but I have learned to accept them as a normal part of my treatment.

I had a decent night sleep, or at least I thought I did last night. It was with a full face mask where I felt like the pressure and mouth breathing didn't wake me up. Here's my chart. Pretty blown away. I'll try and bump the min up to 17 tonight now that I finally have a system where I'm more comfortable at the higher minimum pressure.

LSAT thinks he has a line on an Aircuve 10 Vauto! Once I get it should I start another thread on asking how to set it up or keep it in this thread? Here's my plot from last night with min at 17. Why I think I need a machine with a higher max. Am I right about that?

mgundy wrote: ↑

Mon Feb 10, 2020 6:11 am

LSAT thinks he has a line on an Aircuve 10 Vauto! Once I get it should I start another thread on asking how to set it up

No

mgundy wrote: ↑

Mon Feb 10, 2020 6:11 am

or keep it in this thread?

Yes.

Get the machine LSAT has available.
Probably the AIrCurve 10 VAuto....you won't regret it.
We can help you set it up. Easy peasy....and a very sweet little machine.
provider manual can be requested here....
https://www.apneaboard.com/adjust-cpap- ... tup-manual

The ResMed machine from LSAT is scheduled to arrive tomorrow!

I've downloaded the clinical manual per Pugsy's suggestion. I've gone through it and understand where the menus are.

Right now my DreamStation settings right now are:

min pressure - 18
max pressure - 20
aflex - 3
humidity - 5 (max)
heated tube - 4 (out of 5)

Suggestions are where to start with my new Aircurve 10 Vauto?

mode - vauto?
max IPAP - 25?
min EPAP - ?
epr - on?
epr - 3?

mgundy wrote: ↑

Fri Feb 14, 2020 7:25 am

Right now my DreamStation settings right now are:

min pressure - 18
max pressure - 20
aflex - 3
humidity - 5 (max)
heated tube - 4 (out of 5)

Equivalent BiLevel settings:
Mode: VAuto
Min EPAP: 15
Max IPAP: 25
PS: 3 (though not the same as A Flex)

Initially, I would just set the Climate CTRL and Tube Temp to Auto and then see how you do.

When I switched to the AirCurve 10 VAuto, Pugsy suggested to try out PS of 4. I did, really liked it.

PS and EPR and Flex confuses a lot of people even at the same number. Even though they essentially do the same thing they go about it a bit differently. Flex and EPR are both exhale relief but not exactly the same.

EPR or Flex comes off IPAP (inhale) to give you EPAP (exhale).

PS is added to EPAP to give you IPAP.

So with your current machine and setting of the minimum of 18 with Flex at 3...that gives you roughly 18 IPAP and 16 EPAP.
Flex machines don't do a full cm drop with each setting. The drop depends on how forcefully one breathes and the most it can ever give is a 2 cm drop.

So DogSlobber's suggestion of 15 EPAP PS of 3 will give you IPAP of 18 which is essentially what you are getting now when you inhale at the beginning of the night and then if you set max IPAP to 25 the machine could take IPAP to 25 if it needed to and if it does it drags EPAP up with it always with EPAP being 3 cm below whatever the IPAP goes to.

You may notice a difference in exhale and you may not notice...with PS at 3 and that's 1 cm more than the 2 cm you were probably getting. Doesn't matter ....as long as whatever you use is comfortable for you and PS of 3 should be very comfortable.
I do suggest starting with it and maybe later give PS of 4 a try....from my own personal experience I find 3 comfortable but 4 even more comfortable.
PS of 4 is the setting that is most commonly used in bilevel titrations as a starting point for PS and the majority of people will end up with PS of 4 or maybe 5 when on bilevel.

So the settings I would suggest mimic DogSlobber's.
Mode....Vauto
Minimum EPAP 15
PS 3 or 4
Max IPAP 25
Not a lot of room to roam but some room and will allow the machine to go past 20 cm if it needs to and I am reasonably certain it will want to. Those pressures are a bit high of course and exhaling against them can be difficult and PS should help you out.
We want you to be comfortable because we have to be comfortable to be able to fall asleep.
EPAP is going to be the setting that does the bulk of the work preventing OAs. IPAP helps out some but EPAP is the main critical setting.

I took a nap with my new ResMed machine. Am I doing something wrong with the mask? It's the same mask I was using w/ my DreamStation (Resmed AirTouch F20). I did the "check mask fit" test and it said how I had it fit was fine. Also, I looked at the manual for the mask and where it is reporting a large leak (over 16 L/min) is for a pressure of 4. At a pressure of 22 the leak rate of the mask in in the 50's.

Also, is it normal that it's reporting the apnea events as "unknown"? Is the machine messed up?