New and confused

joshgreene9471 · Post by **joshgreene9471** » Thu Jul 01, 2021 6:56 pm

Hey guys, so I'm new to this whole thing. I've just got an Air sense 10 Autoset last month, and I'm trying to get it to work for me.
During my sleep study, they said I had 42 events an hour, and that that was pretty bad, and unusual for a guy my size in his early 30's.

So on to my question. Well, two questions actually.
1. When I got this machine, the doctor set it to CPAP mode, on a pressure of 9. That was ok sometimes, but I'm diabetic and on my bad blood sugar nights (200's and 300's), I would wake up feeling even more tired than before I got the machine.
So after digging around I found out that this machine has an auto mode. I turned it on that, which I guess means it's now an APAP. I've only tried it one night, but I'm kind of nervous. Is there anything I really should know? Like I say, I'm new to this, but I have to learn quickly. Walking around half asleep at work is gonna get me hurt.

As to the second question, I noticed the tube type seeing was set to "Slimline", but I've got a Climateline hose, so I changed that to standard. Is that ok?

Tl:Dr: Is there anything I need to know if I'm switching from CPAP to APAP mode on an Air sense 10,
and is a Climateline hose a Slimline?

Pugsy · Post by **Pugsy** » Thu Jul 01, 2021 7:16 pm

The ClimateLine heated hose is a slimline hose.
It has to do with the hose diameter...slimline is like 15 mm and standard is like 22 mm....your machine won't function properly with it set to standard
plus I think that when you plug the climateline hose back in that it will default to slimline because the machine recognizes the heated hose.
Now if you were using some other hose non heated...then you might need to select hose diameter depending on what hose you were using.
There are slimline hoses that aren't heated and standard size hoses that aren't heated either.

Julie · Post by **Julie** » Thu Jul 01, 2021 8:18 pm

If you're set to Auto, have you set two pressures, or still stayed with just one?

GrumpyHere · Post by **GrumpyHere** » Thu Jul 01, 2021 8:30 pm

In auto mode, you might want to raise the minimum pressure to 6 or 7.
Lots of people feel air starved at the default min pressure of 4.

Leave the max pressure at 20 to let the machine adjust the pressure as needed.

Please download Oscar so that the experts here can help you with therapy optimization.
https://www.sleepfiles.com/OSCAR/

Format the graph before uploading screenshots as requested in the following thread.
Oscar replaced Sleepyhead so substitute "Sleepyhead" references in the posts to "Oscar"

viewtopic/t158560/How-to-post-images-for-review.html

zonker · Post by **zonker** » Thu Jul 01, 2021 9:47 pm

joshgreene9471 wrote: ↑
Thu Jul 01, 2021 6:56 pm
Hey guys, so I'm new to this whole thing.

welcome to the zoo! please follow grumpyhere's advice. in order to help you get the very best out of your therapy, we'll need to get to the data that oscar software will provide.

we are none of us the same. and how we setup the machine is very much an individual thing. this seems to be something that most sleep docs and dmes just don't understand.

once we get the info that oscar provides, we'll be able to help provide you with suggestions to get your therapy optimized.

good luck!

joshgreene9471 · Post by **joshgreene9471** » Fri Jul 02, 2021 10:42 am

Wow, lots of quick replies. Thanks guys.

I set the lower and upper limits at 6 and 20 respectively. Like you said, I couldn't breathe at 4. I can't use the ramp for that reason either. I don't know how to start it higher than 4, or even if it's possible. I woke up twice the first night and saw it at 16 at one point and 7 at another.
I'll try to download the software tonight. I'm at work at the moment.

zonker · Post by **zonker** » Fri Jul 02, 2021 11:03 am

joshgreene9471 wrote: ↑
Fri Jul 02, 2021 10:42 am
Wow, lots of quick replies. Thanks guys.

can't speak for others, but i seem to have plenty of time to come to this forum and meddle in the affairs of new cpap users!

joshgreene9471 wrote: ↑
Fri Jul 02, 2021 10:42 am
I set the lower and upper limits at 6 and 20 respectively. Like you said, I couldn't breathe at 4. I can't use the ramp for that reason either. I don't know how to start it higher than 4, or even if it's possible. I woke up twice the first night and saw it at 16 at one point and 7 at another.
I'll try to download the software tonight. I'm at work at the moment.

let us know if you need help with that software and we'll meddle in that, as well!

good luck.

joshgreene9471 · Post by **joshgreene9471** » Sun Jul 04, 2021 7:56 am

I think I did that right. I'm very curious to hear what you guys think.

I did wake up around 2:30 with my blood sugar meter maxed out high, so i set the minimum to 9. I think the sleep apnea events were causing it to climb. I don't know if that'll help, but I thought i'd try.
So now, my min is 9 and my high is still 20.

Pugsy · Post by **Pugsy** » Sun Jul 04, 2021 8:06 am

Close but no cigar...missing some critical stuff on the left side.
See this
viewtopic/t158560/How-to-post-images-for-review.html

I am wondering if your OSA is worse in REM because the clustering of events loosely coincides with when we would expect REM to kick in.
It's common...my own OSA is 5 times worse in REM.
Same thing for some people with supine sleeping.

When there are rather wide changes in pressure needs do to worsening of the OSA either from REM or supine sleeping the minimum pressure used is the most critical setting.
The machine works best by preventing the collapse in the first place and often when a more optimal minimum is used the machine won't feel the need to increase the pressure as much.
You need more hours of sleep to verify things than just this one report with 3 hours at the higher minimum but I suspect that you needed the higher minimum to better hold the airway open and prevent the collapse from ever happening and thus the machine didn't have further need to increase the pressures so wildly.

GrumpyHere · Post by **GrumpyHere** » Sun Jul 04, 2021 8:16 am

Pugsy wrote: ↑
Sun Jul 04, 2021 8:06 am
I am wondering if your OSA is worse in REM because the clustering of events loosely coincides with when we would expect REM to kick in.
It's common...my own OSA is 5 times worse in REM.
Same thing for some people with supine sleeping.

Pugsy,

The cluster of events you're referring, are they the FLs around 23:20, 01:30, 05:00?

Pugsy · Post by **Pugsy** » Sun Jul 04, 2021 8:51 am

GrumpyHere wrote: ↑
Sun Jul 04, 2021 8:16 am

Pugsy wrote: ↑
Sun Jul 04, 2021 8:06 am
I am wondering if your OSA is worse in REM because the clustering of events loosely coincides with when we would expect REM to kick in.
It's common...my own OSA is 5 times worse in REM.
Same thing for some people with supine sleeping.
Pugsy,

The cluster of events you're referring, are they the FLs around 23:20, 01:30, 05:00?

No...not FLs but the OAs...especially the 23:20 OAs.
I don't count FLs in terms of "events"....his FL graph isn't horrible and if you look at the pressure line it doesn't really seem to react all that much to the FLs.
If you note the FL line after the increase in the minimum to 9 cm (where the pressure obviously stabilized markedly) the FLs didn't really change all that much. Maybe a slight reduction but it's not like it totally killed all the FLs.
In this situation I think that the FLs play a small part in the pressure ranges and the main cause were actual OA events or whatever else is going on to cause the wildly reactive pressures. Snores may or may not be a factor.

I have no idea as to whatever was going on the first half of the night with the wide pressure changes was the cause of the blood sugar issues but if it were me I would keep the 9 minimum for now and maybe later visit a slightly lower minimum.
We know that 9 cm minimum does a good job...we don't know if maybe 8 cm would have done just as good of a job but I don't like making changes all over the place based on 3 hours of data.
I like to make a choice and stick with it (assuming the choice gives good results) for a period of time and see if a pattern develops.
We know that 9 cm minimum at least worked for 3 hours. It's not an unrealistically high pressure to deal with especial with EPR engaged....I would say continue using it for a week and see what happens both in terms of blood sugar levels and event flagging.
The actual AHI with the lower minimum wasn't horrible but those wild pressure variations could have impacted sleep quality or whatever the pressure was wanting to kill with the higher pressures could have also impacted things.

I don't think that the pressure went crazy just because of the 2 OA events (23:20) themselves though....it was whatever was going on in conjunction of those events that drove the pressures. We can't see what that might have been with any certainty.
I have my doubts that we can blame all of that on the FLs though. It's just not that bad of a FL graph. I have seen much, much worse.

joshgreene9471 · Post by **joshgreene9471** » Sun Jul 04, 2021 11:37 am

Thanks guys, I'll try to post again Saturday. I'll see what happens throughout the week. In the meantime, have I got the right screenshot this time?

Pugsy · Post by **Pugsy** » Sun Jul 04, 2021 1:13 pm

Very close on the screen shot. No need to redo this one but next time try to squeeze the Flow Limitation graph into the image.

Miss Emerita · Post by **Miss Emerita** » Sun Jul 04, 2021 6:55 pm

Just wanted to say you have an excellent machine, excellent numbers, and an excellent approach to PAP therapy. (Evidence-based and experimental.)

It’d be useful to know how you’re feeling during the day. Any better yet? It can be gradual, so see if you can track how that’s going.

Janknitz · Post by **Janknitz** » Sun Jul 04, 2021 9:02 pm

1. When I got this machine, the doctor set it to CPAP mode, on a pressure of 9. That was ok sometimes, but I'm diabetic and on my bad blood sugar nights (200's and 300's), I would wake up feeling even more tired than before I got the machine.

I know you're not asking for help on your diabetes, but you can't be running blood sugars of 200 -300 and expect to feel good, CPAP or not.

Take a look at Dr. Richard K. Bernstein's Diabetes Solution book. Start here: http://www.diabetes-book.com/ Parts of the book are online for free. Save your limbs, and save your life.

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