APAP vs Air Curve VAuto

WW4B · Post by **WW4B** » Fri Mar 20, 2020 9:29 am

Hello all, was able to download the Oscar software and post some results. I have read the "newbie" post so i hope i have understood and followed all requirements for posting results. My apologies if not correct but will learn from my mistakes. Will someone please look at the results from the past three nights and offer their opinions on my sleep therapy. Still not feeling refreshed as I would hope to be but that could also be due to life's changes as we all cope with the current pandemic. Would you recommend any changres or tweaking or leave thungs as they are. Thanks to all in advance.

Pugsy · Post by **Pugsy** » Fri Mar 20, 2020 10:05 am

Looking good on paper anyway. I don't see any reason to change anything.

Your hours of use (and I assume sleep) are all over the place. I have learned that a lot of how I feel directly relates to simply hours of sleep and quality of sleep.

Are you waking often during the night for some reason or other?

Are you averaging around 8 hours or actual sleep?

Spend much time tossing and turning?

Finally the most common reason for not feeling good numbers...
Do you take any medications of any kind? If so, what?
Do you have any other physical or mental health issues that might impact how you feel.
Medication side effects is a prime culprit in not feeling so great. My BP medication is known to cause fatigue....my pain medication (so I have a physical condition that affects sleep quality) causes insomnia. Damed if I do and damned if I don't.

Everyone is different but I have learned that I need 8 hours of sleep with minimal sleep disruptions to feel my best.
Anything less than 7 hours I can expect to feel lack of energy and a strong need for a nap. Each person has to learn what it is that they might need and try to attain it.

Dog Slobber · Post by **Dog Slobber** » Fri Mar 20, 2020 11:26 am

Your charts look good to me, and I don't think there's any obvious setting changes that will improve your sleep.

On a slightly different area, the pattern of your Flow Limitations with the corresponding pressure increase, is similar to my own, where my Apnea is greater during REM. Do you know if your apnea is worsened while in REM?

I'm not suggesting this will require any setting changes, just an informational consideration.

WW4B · Post by **WW4B** » Fri Mar 20, 2020 1:26 pm

Thanks for the replies. Yes, I do toss and turn at night numerous times. On meds (BP, cholesterol, pain meds for my hip ) but do not think they are the underlining reason for the tossing and turning. I do try to avg 6-8 hrs per night of sleep and my sleep times and hrs of use do vary each night. I do wake up at times during the night due to the constant tossing and turning and for the occasional bathroom visit. Sometimes the wife will wake me up during the night as well as she says at times I make "gurgling sounds" which I assume could be attributed to possibly mouth breathing.
The past week or so I have fallen asleep in my chair during the day at the drop of a hat. Just trying to eliminate my sleep therapy as the main culprit for my fatigue.
In regards to my flow limitations and corresponding pressure increase how can I determine if my Apnea worsens while in REM. And, if so, what changes if any would be recommended.
Is my AHI good? Would a lower minimum pressure and/or pressure setting be of any help or leave as is. I am very open to experimenting with my settings with the direction from experienced forum members. My old settings with an older responics cpap machine where set at 10 with the sleep study I participated in about 5 years ago before I graduated to the AirCurve 10. The current AirCurve 10 settings were default settings with a few tweaks on the advice from the forum. I have also included two additional results from nights were I was asleep for 8 hrs or more if the additional information is of any relevance. Looking forward to replies and advice.
Thanks and may all be safe and healthy.

Pugsy · Post by **Pugsy** » Fri Mar 20, 2020 1:41 pm

We have no control over REM stage sleep and other than maybe being more pre emptive with minimum pressure settings (if needed) there's really nothing we can do and your FL graph really isn't bad enough if those are REM clusters to urgently need anything be done with them.

You could try more Minimum EPAP just to see if anything changes in terms of your sleep quality and how you feel but there's nothing on these reports just standing out screaming "fix me and you will feel better".

Your AHI is well within acceptable numbers...nothing alarming there at all. It's rare to get a 0.0 AHI and even when we do it doesn't guarantee that we feel like superman or superwoman.

Based on these reports...your AHI is nice a low and there's probably room to maybe reduce your pressures as an experiment as well to see if it changes how you feel or sleep.

Not all our problems are related to airway issues and machine tweaking only fixes airway related problems. It can't fix bad sleep caused by anything other than airway issues no matter how much we might want it to. Believe me...I have been there myself.

WW4B · Post by **WW4B** » Fri Mar 20, 2020 1:54 pm

Thanks. So, for experimentation purposes to see if different results whether better or worse would occur would you recommend based on my charts that I lower or higher the epap minimum setting. Should I lower the max ipap as well if experimenting. What about pressure support...lower as well or leave alone ? Can the "gurgling noises" the wife hears be attributed to the occasional mouth breathing.
Would very much appreciate your further input. Also looking into more root causes of the constant tossing and turning.

Pugsy · Post by **Pugsy** » Fri Mar 20, 2020 2:04 pm

When I do experiments I do planned documented trials and I give it X amount of time and I only change one thing at a time.

I once decided to increase my minimum pressure (using apap at the time) of 10 cm to a point somewhere higher to see if it changed anything. So I increased the minimum 0.5 cm for a week at a time until I got to 13 cm for a week...took me about 6 weeks I guess.
Nothing changed...AHI never really changed...hours slept never really changed and how I felt never really changed.
I had already done the experiments at the lower pressures where I worked up to determine that below 10 cm minimum I wasn't getting good enough results (started with 8 cm minimum).

I wouldn't go changing PS because that's mainly for comfort and if you go screwing around with comfort you risk not sleeping so great just because you messed with comfort.

The gurgling sound....without being there I have no idea but gurgling to me is more of a descriptive term for water in the hose or mask...and it only takes a couple of little drops of condensation in the mask or hose to make some really annoying noise.

WW4B · Post by **WW4B** » Sun Mar 22, 2020 11:54 am

Thanks to all for the replies and insight gained. I have been experimenting with my settings basically for the month of March. I have attached 3 different results with min settings of each between 8-12.
Based on the results of the graphs attached which minimum setting, in the opinion of the forum, is showing overall best results. Realize the sample size is small but based on results what would be the better option to stick with for the long run at this point. Should I still explore increasing the minimum pressure setting further to see how the results will turn out. There was really not an "OMG I feel wonderful" result noticed the next morning on any one setting. What does the forum recommend?

zonker · Post by **zonker** » Sun Mar 22, 2020 12:01 pm

WW4B wrote: ↑
Sun Mar 22, 2020 11:54 am
There was really not an "OMG I feel wonderful" result noticed the next morning on any one setting. What does the forum recommend?

stay the course. i NEVER got an "OMG I feel wonderful" result. in fact, when pugsy replies, look at what she has written in her signature!

this isn't to say i've never gotten good results. my results-

not getting up multiple times per night to pee

no morning headaches

no more general feeling of malaise

my mood improved. no more grumpiness or rush to anger in social situations

i'm sure there are others that i haven't listed or have just plain forgotten. but believe me, i've never once jumped out of bed with a song in my heart or a smile on my lips.

and this takes time. it doesn't happen at once. be patient and hang in there. soon it will start getting better for you as well.

good luck!

Pugsy · Post by **Pugsy** » Sun Mar 22, 2020 12:13 pm

Looks like as you increase the minimum EPAP your leak issues also increased. Did those leaks wake you up?

If it were me I would use the 8 cm minimum EPAP...it's doing a good job and you didn't notice any marked improvement anywhere at the higher EPAP.

WW4B · Post by **WW4B** » Sun Mar 22, 2020 6:20 pm

Hi, i believe my tossing and turning is most likely causing the mask leaks and they do not wake me up. Just curious if increased minimum pressure presents better overall performance in the other category graphs posted besides mask leak. Will heed your advice and stay at the 8 cm minimum unless its advantageous to my overall therapy to increase and give it a longer trial sample.

Pugsy · Post by **Pugsy** » Sun Mar 22, 2020 6:35 pm

If you didn't notice any change in how you feel or how you sleep with the changes in pressure then I see no reason to use more pressure.
I long ago quit looking at AHI only as a marker. For me how I sleep and how I feel is a much better marker.
Unless you just like higher pressures for some reason or other...there's no reason to use higher pressures from what is shown on the reports or from what you are reporting on how you sleep or feel.

You didn't include the flow limitation graphs but I can make a fairly educated guess that it isn't very remarkable just by looking at the maximum FL statistic....it's fairly low.
It also didn't really change much no matter what minimum EPAP you used.

WW4B · Post by **WW4B** » Sat Mar 28, 2020 1:05 pm

First I would like to express my sincerest gratitude to all who have read and replied to my post in hopes of improving my quality of sleep. As I have mentioned earlier I have been experimenting with my settings in hopes of finding the right "tweak" for optimizing performance. I have included several results with various settings and using nasal and/or nasal pillow masks. Nasal pillows do hurt my nose leaving it red and sore but can continue to do so if advised and will so learn to get use to the pillows. Nasal masks are the most comfortable but seem to be more mask leak prone. I cannot tolerate face masks, however I do have and will try soon the dreamware nasal/mouth hybrid if you may that fits on the dreamware frame. Anyway can I please receive feedback on my graphs with advice on which mask & settings seem to provide the best results statistically speaking. Small sample size on the nights in use and I really do not notice any significant improvement on any one setting. I believe I am a mouth breather at times and do seem to toss and turn a lot which could result in major mask leaks. What course would the forum advise and is there any other mask recommended to try.
Appreciate any and all advise...be safe and healthy to all.
3.21 graph: 7 min setting with nasal mask
3.22 graph:10 min setting with nasal mask
3.25 graph:8.2 min setting with nasal mask

WW4B · Post by **WW4B** » Sat Mar 28, 2020 1:09 pm

In regards to previous post reply...including 2 graphs using nasal pillows. Aslo included the flow limitations graph which I have previously left out in earlier replies.
Again, my thanks to all. Looking forward as to what the forum advises on settings and mask. As noted as well, any advise on mask alternatives ?

Pugsy · Post by **Pugsy** » Sat Mar 28, 2020 1:34 pm

Any of those settings will work just fine. This doesn't surprise me. Often most of us probably have a range that we could use and they produce acceptable results.

Decide on a mask that let's you sleep the best and feel the best......that's the very first thing I would be working on.
Use whatever settings you think feel more comfortable to you...they are all treating your apnea very effectively.
Your flow limitation graphs are essentially unremarkable...a little bit of activity and to be expected and if those were mine...wouldn't get a second thought.

You didn't mention how you slept or felt the day after these results....that's more important than the numbers.

Large leaks that are brief and don't wake you up....don't worry about them.

APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto

Re: APAP vs Air Curve VAuto