CPAPtalk.com

Posted: **Thu Jul 11, 2024 2:50 pm**

robysue1 wrote: ↑
Thu Jul 11, 2024 2:04 pm
I think what Ozij is suggesting, and what I would concur with, is that a modest increase in your Min EPAP from 10 up to 11 or 12 might get rid of obstructive events while not aggravating the number of CAs being scored.

I agree with both of you.

Posted: **Thu Jul 11, 2024 3:29 pm**

ROBYSUE1, thank you very, very much for this detailed explanation of PS and pressure settings in relation to PS. Make more sense to me know.

I will be setting my EPAP to 11 or 12 tonight per your suggestion and what Ozij is suggesting.

Again, thank you very much for this level of detail so that I can better understand! I can't thank you enough.

Posted: **Thu Jul 11, 2024 3:30 pm**

Thanks Pugsy, going to EPAP of 12 tonight!

Posted: **Thu Jul 11, 2024 3:44 pm**

robysue1 wrote: ↑
Thu Jul 11, 2024 2:07 pm
I know it's a big ask, but I'll ask it anyway: Can you take a picture of your AirCurve's screen with this number and then upload the image to imgur and post the link over here so I can see exactly what you are seeing?

Not a big ask at all, I'm immensely grateful for the help. Here is link:

https://imgur.com/a/S3DE3qh

Is it normal practice for users here to use imgur and not upload direct to forum i.e. is it easier to manage with imgur?

Thanks!

Posted: **Thu Jul 11, 2024 3:58 pm**

Question for those who have been so helpful on this thread. I know this of course varies with each person, BUT is it expected to feel worse before feeling better when on good CPAP therapy (months and months of 60 AHI, now ~7 AHI for about 1 week).

If so, when can one expect to feel baseline, and then to feel better? Am I looking at several weeks? I would just at least like to be able to not feel like a zombie when I walk or drive and being barely able to function.

Thanks in advance!

Posted: **Thu Jul 11, 2024 4:00 pm**

chuck29 wrote: ↑
Thu Jul 11, 2024 3:44 pm
Is it normal practice for users here to use imgur and not upload direct to forum i.e. is it easier to manage with imgur?

It wasn't until just a couple of weeks ago that we were finally able to do forum attachments for image sharing.
Before that the forum attachment storage was full because so many people used the attachments and never came back here to clean out unneeded old images to free up the space.

It won't be long with the way people do things that we won't be able to use the attachment feature unless people clean out their storage.

I have moderator powers but they don't include my doing the cleaning from their account. I can't do anything about the storage once it gets full.

So.....for years the storage was full for attachments and imgur (or similar image hosting website) was all we could do.

BTW I have no idea what is going on with your I:E stat....your machine is different from my AirCurve 10 VAuto I guess but when I look at the I:E ratio thing on my machine it shows what shows on the OSCAR report....something like 1:1.7 I think it was.

Posted: **Thu Jul 11, 2024 4:11 pm**

I'm trying to cover all bases here. I saw my 95% and 99.% percentile results. My pressure settings are 18/10.
95% for one night is at 17.72, but 99.5% is at 18.

Unless I completely misunderstand this metric, is that saying 99.5% of the time IPAP is at 18, thus pegging my max setting? Does not make sense, as graph does not reflect this.

I just need clarification on this please.

Posted: **Thu Jul 11, 2024 4:45 pm**

Pugsy wrote: ↑
Thu Jul 11, 2024 4:00 pm

BTW I have no idea what is going on with your I:E stat....your machine is different from my AirCurve 10 VAuto I guess but when I look at the I:E ratio thing on my machine it shows what shows on the OSCAR report....something like 1:1.7 I think it was.

Thanks Pugsy for explaining why imgur has to be used, makes sense now!!

I'd like to see what my I:E is on OSCAR then, out of curiosity, but I can't find. Where could I find that please?

Posted: **Thu Jul 11, 2024 5:28 pm**

chuck29 wrote: ↑
Thu Jul 11, 2024 4:11 pm
Unless I completely misunderstand this metric, is that saying 99.5% of the time IPAP is at 18, thus pegging my max setting? Does not make sense, as graph does not reflect this.

No, that 99.5% number does NOT mean you were AT that number for 99.5% of the time. It just means that you hit that number for some period of time (probably a brief max) but the rest of the time you were below that number.

chuck29 wrote: ↑
Thu Jul 11, 2024 4:11 pm
My pressure settings are 18/10.

when you say 18/10 are your settings that information is incomplete and could be confusing because it makes it sound like your EPAP (Exhale) is 10 and your IPAP (Inhale is 18) which would make your PS at 8 and it's not at 8. You PS is 4 ...not 8.
Now if you happened to hit 18 then that means your EPAP was 14.

The correct and less confusing way to speak of your settings is this
EPAP minimum 10
IPAP maximum 18
PS 4

chuck29 wrote: ↑
Thu Jul 11, 2024 4:11 pm
95% for one night is at 17.72, but 99.5% is at 18.

There's a part of the definition for 95% and 99.5% numbers that you don't seem to understand despite Robysue explaining it
It means you were AT OR BELOW that number for 95/99.5% of the time.
That OR BELOW part of the definition is of critical importance. Both those numbers are easily skewed to the high side making it look like you were higher for a large part of the night when you really weren't.

I have an excellent example in this thread below where I talk about 95% leak numbers. Same definition....AT OR BELOW.
viewtopic.php?f=1&t=108724&p=1036669&hi ... t#p1036669

chuck29 wrote: ↑
Thu Jul 11, 2024 3:58 pm
when can one expect to feel baseline, and then to feel better? Am I looking at several weeks?

You asked a question that no one can answer because there are way to many variables involved.
Are you saying you actually feel WORSE since starting cpap?

chuck29 wrote: ↑
Thu Jul 11, 2024 4:45 pm
I'd like to see what my I:E is on OSCAR then, out of curiosity, but I can't find. Where could I find that please?

Not sure with your AirCurve 11 VAuto....but look for something on the left side under statistics that mentions inspiration time and expiration time. On your report above it is right above the tidal volume statistic at the bottom.
I am wondering if there is supposed to be a decimal point on the sleep report from the machine.
You can see it below from my report from last night. Bear in mind that you are using the AirCurve 11 and I am using the AirCurve 10.

Posted: **Thu Jul 11, 2024 8:49 pm**

robysue1 wrote: ↑
Thu Jul 11, 2024 2:04 pm
by robysue1 » Thu Jul 11, 2024 23:04

chuck29 wrote: ↑Thu Jul 11, 2024 20:45
I appreciate this input! How can you tell that when the pressure goes down, I get OSA?
By looking carefully at when the tick marks for the OAs occur and comparing them to the pressure curve. Here's a marked up version of your data:

Thanks, robysue!

chuck29 wrote: ↑
Thu Jul 11, 2024 4:11 pm
My pressure settings are 18/10.

Where do you that number from?
That is not what your pressure settings are on this machine.

Please try to tell us, in words what you mean by that number.

Do you have an SD card to put in you old machine so we can one the last nights and its settings?
Don't use the same card you have in the new machine!

Posted: **Fri Jul 12, 2024 4:29 pm**

Pugsy wrote: ↑
Thu Jul 11, 2024 5:28 pm

Thanks Pugsy, I was able to review your replay and you made sense of what I was asking. I'll also check the 95% leak link you sent, thanks for that!

Posted: **Fri Jul 12, 2024 4:34 pm**

ozij wrote: ↑
Thu Jul 11, 2024 8:49 pm
Do you have an SD card to put in you old machine so we can one the last nights and its settings?
Don't use the same card you have in the new machine!

I have saved my data from old machine in OSCAR and will attach. Detailed statics are not available, so I'll post Overview as well, thanks!

https://imgur.com/a/7sSzOux

Posted: **Fri Jul 12, 2024 4:44 pm**

Here last night's data on new machine for an FYI. AHI is 3.21 with 0 CAs.

https://imgur.com/a/Q8IgoOS

Racking my brain on different reasons why I feel so awful and noticed that I wake up at 5:00 AM every day to either go to bathroom OR from the sun coming into the room. Either way, it's difficult to go back to sleep. So doing pelvis exercises in order to empty bladder BEFORE bedtime fully (I don't drink coffee or caffeine, or anything with 3 hours of bed). Also getting a sleep mask so sunrise doesn't wake up. This should give me 8 solid hours instead of 6 and trying to go back to sleep. Maybe that is adding up more than I realize.

Thanks everyone for the continuing support.

Posted: **Sat Jul 13, 2024 1:13 am**

chuck29 wrote: ↑
Fri Jul 12, 2024 4:44 pm
Here last night's data on new machine for an FYI. AHI is 3.21 with 0 CAs.

https://imgur.com/a/Q8IgoOS

: Vpap S9.png (101.72 KiB) Viewed 12440 times

You old machine was not an Automatic Machine.
You did have an EPAP of 10 and an IPAP of 18
The majority of your apneas were central apneas
Contrary to what you think, you never used VAuto before.
VPAP is not VAUTO
https://www.resmed.com/en-us/sleep-apne ... -and-cpap/

The short answer: An abbreviation of variable positive airway pressure, VPAP™ is the ResMed brand name for a specialized form of positive airway pressure (PAP) that provides two continuous levels of pressure. It’s called “variable” because it varies between two different levels to better meet the needs of people with sleep apnea. Because of this double-level approach, VPAP is also commonly known as “bilevel” PAP. Again, bilevel literally refers to two levels of air pressure: one for exhaling, and one for inhaling.

VPAP belongs somewhere between CPAP and APAP on the PAP scale. It doesn’t adjust airway pressure automatically like an APAP device does, but it offers a greater variety of customization than standard CPAP technology.

I don't think your new machine was ever set up to be identical to the old one.

According to last nights OSCAR, you're still letting your machine go lower that the 18 IPAP you need - it rarely stays long beneath that 18, and every time it drops too low, you snore, probably wake up, and the pressure obligingly return to 18.

So let start with making sure minimum IPAP pressure at 18, no less than that.
Do not let your IPAP go lower than 18.

The question is how to do that.
I've never touched - let alone set up - a VPAP machine of any kind, but I have a vague memory of reading you set up EPAP and then PS.
The first thing I would do, for the sake of trouble shooting it to set up the new machine identical to the old one. Which mean to forgo auto mode for a week, try min EPAP= Eax IPAP =10 and PS=8.

Until we know if it was the old machine's age, or if the old prescription no longer fits you, we won't know enough to get you feeling better.
Of course, if you immediately start having many CA's, there's no need to stick to that setting for a week.

Who decided your PS should be 8, and when was that determined?
Did anything in your life or health change at about the time you became dissatisfied with your bi-level therapy?
Bottom right of the OSCAR overview lets you choose the time period for the overview. Can you see in the overview screen when you started getting all those CA's? was it sudden or gradual?

Posted: **Sun Jul 14, 2024 12:30 pm**

ozij wrote: ↑
Sat Jul 13, 2024 1:13 am
You old machine was not an Automatic Machine.
You did have an EPAP of 10 and an IPAP of 18
The majority of your apneas were central apneas
Contrary to what you think, you never used VAuto before.
VPAP is not VAUTO

Ah right, I did realize that about VPAP mode being simply a BiPAP, that is the terminology that Resmed uses, thank you for breaking that down for me!

I did run the machine is S mode, using IPAP 18 and EPAP of 10 but my my AHI was at 55 and CAs at 45.
Currently in VAuto with IPAP=18, EPAP=10, PS=4.
Trigger changed from Medium to Very High (brought CAs from ~3 to 0)
EPAP changed from 10 to 12

As far as machine history (I think that is what you are asking), I had that S9 BiPAP for years.

[2020] Then got a S10 Aircurve VAuto in 2020 (I believe settings were IPAP=18, EPAP=10, PS=unsure). Got that because I was feeling exhausted on S9, but later found out I had COVID, and found I was suffering insomnia, as I did not fall asleep until 2AM every night for months.

[2023] The S10 completely died (lost power) in 2023 and I still had S9, so went back to using that

[2024] Felt so, so sleepy in March of 2024. The S9 pressure did not feel the same. I had it tested and it showed pressure to be 8 at EPAP, but I don't 100% trust the person testing it as it took them a long time to figure out the manometer.
I got this replacement S11 Aircurve.

I see CAs on the S9 all of 2023. They were around 30 and increased to 60 over the course of one year, according to OSCAR. I do not ever recall being diagnosed is CA when I was prescribed therapy. Hope this makes sense and this helps!

You mentioned that IPAP runs near 18 most of the time. Unless I misread charts, I see it running lower and only peaking near 18 a few times during the night. But is that is case, this is why you recommended PS to be higher?

Thank you again!

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