Advice on adjusting my settings needed

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Advice on adjusting my settings needed

Post by Conrad » Mon Nov 22, 2021 8:56 am

I'm having some real issues with my new Resmed AirCurve 10 Vauto. I can't get consistent results and the average pressure is too high and it causes lots of mask leaks and/or it blows my mouth open and of course this shows up as leaks.

Before this machine I was using a DS1 auto BiPAP with the following settings


First Thu Dec 3 2020
Last Sat Jul 24 2021
Days 234
AHI 2.38
FL 0.42
Machine DreamStation Auto BiPAP (700X110)
Pressure Relief Bi-Flex 1
Mode AutoBiLevel
Pressure Settings Min EPAP 6.5 Max IPAP 15.0 PS 2.0-7.0
Average pressure 7.72


Here's the current setting on my AirCurve (settings when the machine arrived from DME before I changed the numbers. PS 5.0 over 6.4-15.0)


First Thu Nov 18 2021
Last Sun Nov 21 2021
Days 4
AHI 6.60
FL 0.00
Machine AirCurve 10 VAuto (37094)
Pressure Relief None
Mode VPAPauto
Pressure Settings PS 5.0 over 6.6-13.0 (cmH2O)
Average pressure 12.31

And here's my report from last night.
screenshot-20211122-083525.png
screenshot-20211122-083525.png (115.45 KiB) Viewed 248 times
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...

User avatar
Pugsy
Posts: 59521
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Advice on adjusting my settings needed

Post by Pugsy » Mon Nov 22, 2021 9:16 am

Try one change only....change PS of 5 to PS of 3 and see what happens.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Re: Advice on adjusting my settings needed

Post by Conrad » Tue Nov 23, 2021 7:24 am

Thanks so much for the reply and advice Pugsy! I really do appreciate it.

I saw your post yesterday when I checked from my phone. I wasn't logged in (forgot my password) so I wasn't able to reply then. I did make the change that you advised, one change only.

I just now looked at my numbers from the My Air app. Not good. It showed a high leak rate of 23L/min and an event count of 7.4 events/hour. I'm going to give it another night before I look at my Oscar data and post it here. I felt good about the way I slept last night, till I saw the numbers at least...
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...

User avatar
Pugsy
Posts: 59521
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Advice on adjusting my settings needed

Post by Pugsy » Tue Nov 23, 2021 8:10 am

Conrad wrote:
Tue Nov 23, 2021 7:24 am
I just now looked at my numbers from the My Air app. Not good. It showed a high leak rate of 23L/min and an even count of 7.4 events/hour.
Please understand what the numbers you see on the MyAir app actually reflect before going into panic mode.
The leak number is what we call a 95% leak number and all that means was the leak was AT OR BELOW 23 L/min for 95% of the night. That "or below" part of the definition is critical. This number seen does NOT mean an overall average leak number nor does it mean where a person was at in terms of leak for 95% of the night.
I would wager that when you can finally see the actual leak graph itself that for the bulk of the night the leak line was well below 23 L/min.

I have a good visual explanation here in this thread where the "numbers" look horrible but in reality the leak itself was only really bad for a short period of time.
https://www.cpaptalk.com/viewtopic.php? ... t#p1036669
Numbers don't tell the whole story.

So 23 L/min isn't all that horrible and most likely the bulk of the night the leak was below that and certainly well within the limits of the machine's ability to compensate for.
Now if the leaks are causing wake ups that is a different story but in terms of therapy effectiveness alone...it's not an issue.

Something to think about though is whether those leaks...even if small...could be causing arousals and with the arousals come the chance of false positive flagged central apneas. You may or may not remember arousals....it doesn't have to be a full awakening happening to get false positives.

You are having a worrisome number of centrals...so we wonder why.
First thing to check is are those flagged centrals real asleep centrals or are they post arousal centrals. If we aren't asleep when something gets flagged then it doesn't count in terms of apnea but can matter in terms of overall sleep quality itself.
Meaning the false positive flagged events could be a symptom of poor sleep quality and not necessarily the cause of poor sleep (arousals).
Second thing is what might have changed to cause the increase in centrals (assuming real asleep centrals)....medication side effects and altitude are prime thoughts in that area. Any medication changes or dosages????
Has your altitude changed? Higher altitude can certainly cause centrals. If temporary change in altitude then that will usually resolve once a person goes back to primary lower altitude.

To check for asleep vs arousal flagged events...watch the videos here to learn to spot the difference.
http://freecpapadvice.com/sleepyhead-free-software
If you see lots of arousals you can also look to see if the leak maybe increased prior to the arousal which might indicate that the leaks caused the arousal and the arousal may have caused the false positive flagged event.

Obviously you have to be able to utilize the SD card and computer software to evaluate any of this so I don't know how much evaluation you can do now.

But relying on just the MyAir data (which is the same data as the machine's LCD screen will show) the change in PS didn't really reduce the number of centrals....I assume though you didn't really give us a breakdown of the AHI when you reported last night's AHI of 7.4.....it's really important to know the breakdown into each category..
Was the 7.4 shown composed of primarily centrals????

It was something to try that might or might not have helped but would depend on if those centrals are for sure asleep centrals to even stand a chance of helping reduce the numbers. Zero chance of reducing the number of centrals if those centrals are arousal related flagged centrals. This is why it is so important to know what those centrals reflect....either a real asleep central or a false positive arousal related central. Gotta know exactly what we are fighting first.

Now...assuming for sure real asleep centrals the only thing you can really do is try altering PS to see if it helps or not.
Sometimes PS actually can cause centrals. It's a small number of people for sure but it can happen so that's why we try either reducing PS or even totally eliminating PS to see if it changes the centrals or not. It's a quick easy, cheap experiment to try. I have a friend who gets about 15 centrals per hour consistently with PS of 4 but essentially none with PS of 3. Go figure that one as being weird but it can happen.
Are your centrals a product of the PS??? We don't know for sure if they are or aren't but it's something to try that is within our control and about the only machine tweak we can try given this type of machine being used.

Given that you only have the data from the machine to evaluate at the present time and can't look at the flow rate right now....sort of flying blind but if the centrals didn't reduce with a reduction of PS....the next step is try simply turning PS off or setting to 0 (or maybe 1) and see if that makes a change.
If it doesn't then you are just going to have to wait until you are able to use OSCAR to get a better idea what is going on.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Re: Advice on adjusting my settings needed

Post by Conrad » Tue Nov 23, 2021 8:41 am

I decided that it would be best to post my data from last night after reading your post above.
screenshot-20211123-083819.png
screenshot-20211123-083819.png (115.88 KiB) Viewed 166 times
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...

User avatar
Pugsy
Posts: 59521
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Advice on adjusting my settings needed

Post by Pugsy » Tue Nov 23, 2021 8:56 am

As suspected....for the majority of the night leaks were well below LL threshold.
Now it is entirely possible that the large leaks could have caused arousals.
Did the LLs allow OA/hyponeas??? Not sure but there aren't any UAs flagged which usually get flagged when leaks are starting to impact the machine's ability to do anything.

First thing I would do is evaluate each flagged event for it being a real asleep event or an arousal related event...and that includes the OAs/hyponeas flagged. We can have false positives in OAs/hyponeas...it's not limited to centrals.

If the OAs/hyponeas are for sure asleep....the machine is hitting the max of 13...wants to go higher but can't.
If this is a common occurrence then more max IPAP is the appropriate change.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Re: Advice on adjusting my settings needed

Post by Conrad » Wed Nov 24, 2021 7:12 am

Pugsy,

You asked me a couple of questions in your previous post that I neglected to answer.

No changes in my meds, Luckly I don't require any. No change in elevation.

I increased the IPAP setting from 13 to 14 last night before bed. I left the PS at 3. Here's last nights data.

The break at around 1:45a was from me turning my machine off then right back on. I woke and it felt as if the pressure was way high.

The increase in pressure at around 4:30a was when I woke up and laid there for a while hoping to fall back asleep, no luck.

As always, thank you for your help.
screenshot-20211124-065838.png
screenshot-20211124-065838.png (109.15 KiB) Viewed 133 times
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...

User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Re: Advice on adjusting my settings needed

Post by Conrad » Wed Nov 24, 2021 7:32 am

What I don't understand is how with my DS1, and similar settings, how my AHIs could be so low when compared to the AirCurve?

Is it because the DS1 has more adjustable settings that the AirCurve does not? Adjustable PS ranges with IPAP and EPAP (PS 2.0-7.0) and Pressure Relief Bi-Flex 1?

Would it be helpful if I posted data from my DS1 for comparison?
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...

User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Re: Advice on adjusting my settings needed

Post by Conrad » Wed Nov 24, 2021 8:01 am

And here's the data from back in October. Same settings on the AirCurve only with fantastic numbers.
screenshot-20211124-075828.png
screenshot-20211124-075828.png (97.17 KiB) Viewed 123 times
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...

User avatar
Pugsy
Posts: 59521
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Advice on adjusting my settings needed

Post by Pugsy » Wed Nov 24, 2021 8:26 am

I think it probably is that you just aren't sleeping as well and the bulk of your flagged events are false positives.
The 2:00 AM cluster of centrals I would bet my last dollar you weren't totally asleep...maybe false positives or remote chance of some sleep onset centrals repeating themselves because you couldn't quite transition to asleep.
You know yourself you didn't sleep from about 4:30 on and the machine was wanting to kill something with more pressure.
I don't think it is so much that you don't have variable PS available itself because I suspect with the DS bilevel even though there was a variable available it never really varied all that much. While it could range from 2 to 7....I bet it went to something around 2 or 3 and pretty much stayed there.

Go ahead and post a typical DS bilevel report and let me look to see if I spot anything though. Never hurts to look.

The ResMed auto adjusting algorithm is simply different from the Respironics auto adjusting algorithm.
I have never been able to figure out the most accurate politically correct way of describing the differences. I used to use the term "more aggressive" as an adjective and then decided that maybe "more responsive" was a better term.

I have personally used both a Respironics auto bilevel and the ResMed auto bilevel so I do have some experience.
I never could see that a PS that ranged did much...at least for me.
And while BiFlex was nice...it really was such a small drop that I couldn't tell it was doing anything even when trying really hard to feel it.

Here's the deal though...our bodies and brain get used to one way of doing things and then we go upset the apple cart by switching brands and go to a new way of doing things and the body/brain has time adjusting to the new way of doing things and our sleep quality suffers. ResMed will flag awake/semi awake breathing irregularities as some sort of apnea event and it isn't limited to centrals. It doesn't know if we are asleep or not and when it thinks we are having OAs or hyponeas it will increase the pressure and it doesn't matter if we are awake or not...like your 4:30 pressure increase and a few OAs and hyponeas and you know you weren't asleep. I have seen it happen myself.

I had a night a while back where my AHI was 9.4...holy crap...way bad for me. It was a nice normal mix of centrals, OAs and hyponeas...not just centrals. I had the normal pressure increases as well. Extremely unusual high AHI number for me though so I took the time to look at each flagged event to see if I was actually asleep or not when they were flagged.
95% of the flagged events were arousal/awake related flagged events. Almost all of them.
Then I remembered I had a really bad night in terms of sleep that night....lots of tossing and turning and back pain was the culprit. I had over done it with my gardening that day and my back reminded me that I wasn't a spring chicken anymore and it made me pay for it. I always have had about 75% of my AHI be awake related (back pain crap) but hadn't ever had THAT many in one night. My usual AHI runs 1 to 3 with maybe 75% not real asleep events due to the back stuff. I never sleep all that great because of the pain.

So I know from personal experience the ResMed flags false positives and responds to false positives. Most of the time it is centrals that get the false positive and the pressure never increases for centrals but on occasion we can get false positive OAs/hyponeas and if we have enough of them the machine will crank out more pressure.
Is that a pro or con??? I haven't decided. :lol: My dream wish for a machine is one that can know for sure if we are asleep or not. That's a big dream.

So first thing though...lets confirm or not whether my suspicions are correct and the bulk of what you are seeing is false positives or not.
Can you get me a zoomed in picture of the flow rate for the cluster of centrals at around 2:00 AM?
Looks like the first central was flagged some where around 01:48 or so....give me a 4 minute segment with the first couple of flagged centrals on the right side and the flow rate preceding the first flagged central on the left.
Do you know how to do that?

Let me get some more coffee...as I have a couple more thoughts as well. More in a bit.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

User avatar
Pugsy
Posts: 59521
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Advice on adjusting my settings needed

Post by Pugsy » Wed Nov 24, 2021 8:28 am

Hmmmm....I wonder what has changed from that good Oct report to now????
Something changed....now to figure out what.
Need to check for false positives first....
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Re: Advice on adjusting my settings needed

Post by Conrad » Wed Nov 24, 2021 8:35 am

Here's the data from a typical night with the DS. I'll work on the zoomed section now, if I can figure it out that is.

DS1 screenshot-20211124-083036.png
DS1 screenshot-20211124-083036.png (104.47 KiB) Viewed 115 times
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...

User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Re: Advice on adjusting my settings needed

Post by Conrad » Wed Nov 24, 2021 8:46 am

I'm not sure if I have this zoomed section right. Do I?
screenshot-20211124-084529.png
screenshot-20211124-084529.png (93.92 KiB) Viewed 111 times
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...

User avatar
Pugsy
Posts: 59521
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Advice on adjusting my settings needed

Post by Pugsy » Wed Nov 24, 2021 8:49 am

Thanks for the DS report...as expected...you really were pretty much at PS of 2 for the bulk of the night.

That's it....now do the same thing starting at the 01:56 flagged CA so it is at the far left.

You weren't asleep when these 3 flagged events got flagged...they are false positives.

I suspect the others are false positives as well.

Hard work is figuring out why your sleep quality turned to crap but I don't think it is related to the machine or settings.
If it was the machine you wouldn't have such good reports from October.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

User avatar
Conrad
Posts: 205
Joined: Mon Jul 30, 2012 9:10 am
Location: Northern Illinois

Re: Advice on adjusting my settings needed

Post by Conrad » Wed Nov 24, 2021 9:05 am

How's this?
screenshot-20211124-090419.png
screenshot-20211124-090419.png (95.48 KiB) Viewed 108 times
ResMed AirCurve 10 Vauto Swift FX

Do not regret growing older. It is a privilege denied to many...