New- CA CA-Tired help with settings advice

[jenjabba]

           
I have symptoms of being tired all the time. Waking up feeling like I haven't slept. My doc ordered a basic sleep home test. Came back positive for apnea. Sleep doc ordered a bipap. I don't have good insurance so I bought a used one. AirCurve 10. The sleep doc said use it and that will show what kind of apnea I have. From what I see it looks like CA only.

I have a full face mask I couldn't sleep in. I bought the nasal pillow but it pushes on my nose and bothers me. Maybe I will get use to it. When I loosen it, it leaks. I am a side sleeper only, I don't snore, (as far as I know) . I had my deviated septum and tonsils out years ago and I'm normal weight. I am not financially able to keep going to docs or pay for a full study. I would like to figure out what to do. Docs don't seem to do much.

What should I have my setting at. I have been changing them but don't really know where to start. I've watched many videos /leftylanky/ and read up but I'm not sure.

Thanks.

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Here are a few more screenshots. I wasn't sure what to include for best interpretation. Thanks.

[jenjabba]

        was trying to fall asleep. i might have, I gave up.

[PeaceLoveAndPizza]

First and foremost, please read the link in my .sig “Organising your OSCAR charts”. That is the format that contains the most important information we use to tweak settings. There is also no need to zoom into things unless someone asks to see something specific. The overview is what we start from.

One quick thing to try. Set the “Trigger” from med to high. That will likely clear up most of the CA’s you are seeing. We may need to set it to very high, but I think high will be sufficient to start.

For settings, I recommend the following:

EPAP min 5
IPAP max 12
EPR 3 full-time
Trigger high
No ramp

Give that a go and let us know how it worked.

[jenjabba]

Thank you for the advice. I set my OSCAR settings per your request
My Ramp is off.


I'm confused about the settings you suggested:

I only have EPAP and IPAP on mode: VAUTO.

I do not have EPR or TRIGGER settings in VAUTO. I can only access them in the CPAP mode.


In CPAP mode I can only choose "Set Pressure"  which allows me to choose 4-20. I do not have EPAP / IPAP settings in CPAP mode.

[PeaceLoveAndPizza]

My error. I should have said mode VPAPauto and PS 3. Trigger is available in BIPAP-S mode as well as VPAPauto mode. BIPAP-S mode is like CPAP mode, but allows the bilevel settings.

[jenjabba]

I think I got my OSCAR and the machine all setup as you recommended. I don't understand why I'm so tired. I wake up feeling like I haven't slept with the BiPap or without. Is there anything else I can provide to help? Do I even have apnea that would cause my symptoms. The home sleep test said I had 10 episodes an hour. I know they are not the best tests. Thanks.    

[Jay51]

The only other thing I see is a tidal volume that could be a bit low compared to average.  How tall are you?  The taller a person, the larger the tidal volume usually.  This is a very rough estimate, but the best internet resource I found gives a rough average of around 400 for females and 500 for males.  This can vary widely though. 

PeaceLove&Pizza has given some excellent suggestions.  Have you tried setting the trigger to very high? This would reduce central apneas the most.  

And last but not least, your therapy looks pretty good to me.  Not perfect, but not bad.  There could be something else causing your extreme fatigue that is not related to apnea therapy.  Might be worth pursuing with PCP and tests, etc.

[jenjabba]

Thanks. My trigger is on high. I'll move to very high to see if it makes a difference. I've been tested for many things,  lost 100 pounds,  thin and in good shape.  I'm 5'3. Short.  I've got inappropriate Sinus tachycardia which could be related to apnea. I'm thinking I need a full sleep study since this doesn't seem to be showing any obstructions. I don't want to use a BiPap if I don't have to. It's no fun.  

Last question.  Does the machine show all my events? If so,  it doesn't look like much to me.  

Or 

Is the pressure I'm getting now preventing events? 

I don't want to keep this machine if I don't need it.  I paid cash.  

And I will follow up with my doc once I've gotten a better understanding of what I might need.  
Thanks.

[SarcasticDave94]

Here's the thing about Central Apnea, your VAuto may enhance the few you might have naturally. This doesn't mean you're doing something wrong, or that the VAuto isn't for you. The edit to the trigger high should help, but you can try trigger very high if you want. Always revert back to the last known good setting if it feels "off" or uncomfortable.

Centrals can be as simple as a breath pause. Your VAuto helps you exhale more effectively, and exhaling more CO2 will likely throw off the natural balance of oxygen to carbon dioxide ratio your brain expects to be there. When this strays off that expected balance, breathing may pause a bit then continue as CO2 builds up enough to trigger the next breath. This is likely the type of Central Apnea your VAuto marks as the purple flags in Oscar. Try it a few days and see if CA doesn't begin to diminish, signifying your brain is adjusting to VAuto affecting exhaled CO2 levels.