Muse-Inc's APAP Journey Day 1

My ongoing nightly events that wake me up and the super slow recovery of my short-term memory finally convinced me to buy the Resmed AutoSet II I've been lusting after, that and Johny's sale (insurance denied my doc's medically necessary request...healthcare rationing at its finest). Yeah, data, tweaking to optimal treatment!!! Living on unemployment with dwindling funds, I sure hope this was a good decision and it provides the much better sleep I had with the Vantage loaner last July 4th & my brain heals quickly (fingers crossed). Have a followup visit with sleep doc tomorrow, they'll ck it and my now-backup Escape. Will see if he'll loan me a recording oximeter over the Thanksgiving holiday after I adjust to sleeping with the APAP just to verify that my range is preventing significant desats.

These are newbie questions 'cause I'm a newbie to APAP:
1. Pressure range suggestions. Aug07 titrated at 10, CPAP was set=11, current doc recommendation 9, loaner APAP data see below:
Nite..95th%..Median...Max....AHI....AI
1......9.......6.6.......10.4....1.4....0.1
2......9.2.....6.6.......10.4....2.6....0.5
3......7.8.....6.4........8.8....1.3....0
4......9.4.....6.0.......11.8....2.1....0
5......9.8.....6.6.......10.4....2.5....0.3

I think 6-12 (median to max) is a good start range. Not sure which EPR setting I'll need because exhaling above 9.6 is challenging). I will ask doc for his suggestions and discuss my plan: EPR=1 first few nights as I adjust to new machine & pressure range, review #s each morning, if exhalation is immediately a problem or I develop a sore lower rib cage after a few days then increase EPR and review #s & how I feel. Not sure if I should set range to a higher max, I did not have any centrals during PSG, but I might need a higher pressure to stent open my airway yet that might induce centrals right? Will ask doc about this.

2. What MASK SETTING for the Hybrid mask? At 8-12 pressure, it's vent rate is similar to the Swift LT-LT for her (setting=SWIFT), somewhat higher than the 24 L/min for the STANDARD setting. Will ask tomorrow too. Could be that my 95thcentile will determine where I spend more of the night; if >8, then SWIFT would be best, but if <8, then it's more like the Ultra Mirage (setting=ULTRA) -- I'm just not sure what my pressure will be using the APAP. Will ask doc tomorrow.

3. Does the Mask Fit feature really work for those of you who use it? Leak was a problem for me when I had the loaner but I was mouth leaking with my former beloved OptiLife mask and didn't have the Hybrid at that time.

I plan to collect a wk of info for a baseline, then adjust if my numbers are not optimal or I don't notice improvements...will post here for comment, suggestions, and help. Thanks all for help as i transtion to Phase 2 of my SDB adventure!

Friend is ordering me the software; gotta tell 'em which card reader (generic is AC?)

The only question I can answer is the Mask Fitting Feature, which I did use in the beginning. It works fine when you're sitting up, but when you lie down, then you can't see the LED reading. But I'm learning to hear and feel the leaks anyway.

Good luck with your new apap!

KatieW wrote:The only question I can answer is the Mask Fitting Feature, which I did use in the beginning. It works fine when you're sitting up, but when you lie down, then you can't see the LED reading. But I'm learning to hear and feel the leaks anyway.

Good luck with your new apap!

Katie, you can try and cheat by setting mask fitting feature, lying down, and keep the machine below the bed and sort of peak over. Also, what I do, is after I am lying down, to quickly get up and check the mask fitting feature again.

Also, feature should show excellent.

Muse, yes, the mask fitting feature is great, and never mentioned to me by my DME or sleep lab. Your suggested range settings seem reasonable. Another alternative (hate to give you more ideas to consider and get confused about), is to treat your new journey with your Autoset as a titration and set from like 4-15 (like I am experimenting with, with my sleep center's approval), and see what the Autoset does. And I would try to use both masks, to see if one works better for you with the Autoset. I don't think you necessarily have to choose only one, unless you have a personal preference.

Two words... mirror.

Oh, wait! That's only one word. But I'm thinking a handheld mirror would enable you to see the readout from about any position.

LinkC wrote:Two words... mirror.

Oh, wait! That's only one word. But I'm thinking a handheld mirror would enable you to see the readout from about any position.

Yes, a mirror! Spoken like a true astronomer. Thanks.

Sleep doc appt this morning. We set the pressure to 6-15 in case congestion narrows my airways; even tho I never went above 11.8 on the APAP loaner & he doubts it'll ever go to the max, that 'headroom' will be there just in case. They set my APAP up for that pressure, checked it and my Escape.

We discussed what to use for the MASK SETTING. I had decided this morning that "MIR FULL" would be best because the Hybrid's intentional vent rate is actually higher than ResMed's masks and much higher than the "STANDARD" setting which is just 24 L/min. He wasn't aware of just how much higher the Hybrid's vent rate is so he made a copy of that page as well as the two ResMed pages I downloaded: ResMed mask vent rates and mask settings for their flow generators. I believe using "MIR FULL" will enable me to use the MASK FIT feature expecting either the top or next highest assessment for mask fit when it's good (at 6 cmH20, the MIR FULL venting is 28 and at 5, the Hybrid's is 30). This should also help me use the LEAK feature always expecting some leak because my mask vents more than the MIR FULL setting (at pressure of 10, MIR FULL is 37 while the Hybrid is 50).

I set the MASK ALERT to "on" to see if it helps eliminate significant leaks. I'm aware some find the beeps extremely annoying but training myself to gauge good mask fit and assessing if I'm causing mask leaks while sleeping can only improve therapy and can be changed after I've gained any benefit it may provide.

Doc said not a single one of his other patients shows anywhere near the interest I do in optimizing my therapy...I said OSA is my number 1 health issue and I'll have it at least until I lose most if not all my excess #s as I still fervently hope will be the case so optimizing therapy is a priority for me. He reiterated what he's said in the past, that he believes that will happen. His comment backs up what several of the sleep techs have posted.

We discussed my progress-recovery to date and he reviewed the meds and supplements I take to ensure none might affect my sleep. My daytime sleepiness is much less; it takes 8 hrs of sleep for me to feel good and I usually get that much, but my short-term memory still sucks, it's better than it was when I was backsliding but it's still a challenge (4x6 index cards are my best friends, if it's not on a card I can't remember to do it or buy it). I tried Luminosity's new training 'game' and I can't do the '2-step back' version at all...ya gotta remember 2 previous locations for a blue square and whatever letter is announced when the square appears...they give you plenty of time to recognize both but you have to indicate if the square is in the same location as was 2 steps back and if the letter is the same as it was 2 steps back. Each time the square appears it may have changed positions, the same with with letter...I suck at this 'game' . We hope that eliminating more nightly events & wakeups thus sleeping better-more deeply and continuing my program of supplements, exercise, and brain stimulating activities will speed recovery and stimulate new neural connections if not new cells...we know now that humans create new brains cells throughout our lives, not like we do in utero but still we do create new cells and make new neural connections as we age. We agreed that changes in memory due to aging...his and mine...we simply cannot prevent...at least at this time

EDIT: Even with all my mouth leaks, when I had the APAP loaner and recording oximeter last July , my O2 levels stayed >92%...yeah! Perhaps my biggest issue now is just events & fragmented sleep...will see what my #s are starting tonight! I'm so excited...data!!!

Oh Muse, I'm so glad you got this new machine. I've been hesitant to ask you about that since you've mentioned your insurance/financial situation before. I know you'll get to the bottom of things now and looking forward to your cheery updates! Dori

Good news, Muse. Hope this fixes your exhaustion and memory problems you've also previously mentioned.

With your attitude and persistence, no doubt at all you'll get there!

Muse_Inc wrote:Doc said not a single one of his other patients shows anywhere near the interest I do in optimizing my therapy...

Shows your commitment, which is no surprise to those of us who know and love you, but isn't it a shame that's the case? Such an integral part of health and wellbeing, and many people just take it as is and ignore. Can't tell you how many times in my early days people said to me that CPAP 'doesn't work'. Not one of them would have persevered or taken ownership, I'm betting.

Muse, what a winning combination--your strong commitment and your doctor's support and willingness to work with you.

Sleep well tonight.

Good luck on your 'journey', Muse. Will be looking for a full report tomorrow morning!

Last night, mask fit after a bit of fiddling was rated excellent...helped me nail the oral cushion position. Will check this after lying down when I figure out how to to that .

Ok, here's last night's data:
Pressure (95th centile..right?): 8.2
AHI: 1.9...AI=0.2...HI=1.7
Leak: 0.18 L/s. That's 10.8 L/m at a pressure of 7.5-8, the Hybrid vent rate is 8 L/m more than the mask setting I chose, so just about right -- I'm pleased.

Was a bit anxious so only got 7 hrs of sleep...really need a full 8 but had things to do early. I do sleep much better with the APAP (set EPR =1) than my CPAP set to 9. Not sure if it's the lower pressure or what, but the better sleep is welcome. Software not here yet, will post more data and the detailed data when I have it unless something interesting occurs in the next few nights.