AirSense 10 AutoSet - optimizing settings?

[RadarRalfs]

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Hello,

I am relatively new at CPAP and this Forum has been a valuable resource.

Background:


I had an "at home" sleep study last October which showed an AHI of 34.  In Canada the way it works is that your family doctor refers you to a private sector respiratory-care company who sets you up with an initial CPAP trial.  The machine was the ResMed AirSense 10 AutoSet.  I tried several masks starting with the ResMed P10 and then other nasal products - none worked well due to mouth leaks and intermittent congestion.  I then tried a couple of full-face options and thought the F&P Vitera seemed to work best.  The trial didn't go well for a number of reasons.  I had a large molar extracted in the middle of it.  I was having heightened anxiety due to being recently diagnosed with atrial fibrillation and having to be cardioverted (this was the reason I was tested for sleep apnea as afib can be a factor).  I was surprised to get a "severe" diagnosis and was reluctant to accept it - the idea of being permanently tied to a CPAP machine was NOT welcome.  The CPAP therapy seemed to be causing numerous Central Apneas which was alarming.  My sleep quality seemed much worse than before the diagnosis.  I thought maybe there were other options.

There was also considerable sales pressure to purchase the equipment after the first month free trial.  As things were not going well I decided to discontinue the trial and returned the equipment after about three weeks - just before Christmas.

Responding to my concern about the Central Apneas my doctor referred me to a Respirologist who ordered a Level I Polysomnography.  I couldn't sleep well in the lab so the results were inconclusive (see attached).  A followup overnight CPAP titration study was recommended but that would take several months to happen.

In the meantime I learned more about sleep apnea and associated health impacts.  My sleep was poor and I continued to feel foggy and fatigued in the daytime.  I decided to purchase the AirSense 10 and Vitera mask from a vendor on Amazon (at about 40% of the price quoted by the respiratory-care company).

I have now completed 35 consecutive days and am averaging just over 7 hours per night.  I've experimented with a few of the machine settings based on reading through this forum.  Things seem to be slowly improving.  The Obstructive Apneas seem to be virtually eliminated.  The Centrals Apneas continue but are reducing in number and I am hoping they will just be considered "treatment emergent" and disappear after a month or two.  I think I am feeling more rested and less foggy during the day but that varies and is a bit subjective (the beta-blocker I am on for the afib is also a factor in that regard).  I have attached a recent OSCAR Daily screen-print which is one of my better nights with an AHI of 0.80.  The AHI average for the last 30 days is 2.43 - the last week is 1.50.  I would like to feel confident that the machine settings are close to optimal.

Questions:

1. Some people seem to prefer a fixed pressure.  The company I first dealt with had mine fixed at 11 cmH2O.  I decided to use the AutoSet feature and have ended up at min 8.4 and max 12.8.  With EPR set at 2 this seems comfortable and seems to be working.  Does this seem reasonable?
   
2. I now question the need for a followup CPAP titration study.  I sleep very poorly in a lab setting and things seem to be going well at the moment.  I wonder if I could just provide them with the machine data or OSCAR reports and see what they have to say.  I am interested to hear any opinions on this.
   

Regards,
Dave H

[Cpapian]

Congratulations on doing so well with your machine.  Another Canadian here. 

I noticed in your sleep report they mention positional sleep apnea.   For that, you might try a cervical collar.  There are a number of recommendations on the forum.

You might try increasing your minimum pressure to 10.  Try it a bit at a time till you get there.

In terms of the titration study, it's your choice.  I didn't find mine was useful. 

There is a reliable Canadian supplier....I think it is supplier no 32 on the list.  They are based in Richmond Hill in Ontario.  I have had good service from them.  Quebec prices are higher than Ontario prices, because the Ontario government pays 75% of machine costs at negotiated prices.  Canadian suppliers who aren't registered with the government don't follow the negotiationed prices, but they still may be lower than Quebec.  Shoppers home health care sell cpap machines and masks.  It's a good place to go in and look at masks when you are in the market for a new one.

[Melman]

I agree with increasing your min pressure. I suggest you also increase EPR to 3 to reduce flow limitations. You may see an increase in CA but the the number your seeing now are pretty low.

[Gideon]

I noticed in your sleep report they mention positional sleep apnea.   For that, you might try a cervical collar.  There are a number of recommendations on the forum.

This typically means sleeping on your back vs one side or the other.  This is the only "positional apnea" the medical system understands.

When the forum is talking about positional apnea it means chin tucking and is typically indicated by clustered obstructive events.  The typical 'medical' response is to increase the pressure until it goes away, and it usually goes away because the user simply gives up and 'goes away'.

two completely different things.

[RadarRalfs]

Thank you all for you suggestions and comments.

I also just noticed in Gideon's signature the link to Optimizing Therapy:
http://www.apneaboard.com/wiki/index.php...ng_therapy

Don't know how I missed this in my browsing but it is exactly what I was looking for.

What a great forum and knowledge base!

Dave H

[Gideon]

You will want to look at "OSCAR - The Guide" too. It's a work in process.