Biennial Reality Check -- Expert Feedback Requested Please

[AndyB]

Hi folks,

I'm looking for expert feedback on my current state of treatment efficacy.  I received some very insightful advice and information a couple of years ago when I made a similar request, and I'm hoping for updated thoughts on what, if anything, I should be doing to improve my treatment results.

Here's my situation:  I was diagnosed 4 years ago with severe OSA (untreated AHI of 44).  The sleep lab titrated me to a CPAP pressure of 11.0 cmH2O, resulting in a residual AHI of 1.7.  Tolerance to CPAP was rated as excellent.

Thanks to the guidance provided by this forum, I requested and received a ResMed AirSense 10 Autoset which I used virtually every night in Autoset mode until 2 months ago, when I purchased a lightly used AirCurve 10 VAuto as both a backup machine and in hopes of improving my already decent treatment results.  Excluding the first 3 months of getting used to the machine and trying out multiple masks, my average nightly result with the S10 Autoset was about 2.0 AHI, usually comprised mostly of clear airway events, an almost equal number of hypopneas, occasional but much less frequent RERAs, and almost always no obstructive events.  These results were surprisingly consistent over a broad range of different settings.

For the last 2 months I've been using the AirCurve 10 VAuto in VPAP Auto mode.  As with the Autoset, I've experimented with multiple settings, but I haven't been using the VAuto's true bilevel functionality, except to the extent that I can adjust PS in 0.2 increments rather than in 1.0 increments as with the Autoset's EPR setting.  My relatively limited results with the VAuto at PS 2.2 over 6.2-16.0 are decent (average AHI 1.29, of which 1.11 comes from CA events).  I feel pretty good and continue to tolerate my therapy quite well.  I'm 74 years old, in generally good health, and reasonably fit for my age.

So the question is: should I continue to fiddle with my settings in hopes of reducing the frequency of CA events, or should I call this pretty darn good and stop trying for perfection?

I think I know the answer (the latter alternative), but I'd be very grateful to hear the thoughts of more experienced and knowledgeable members of this forum.  Attached below are screenshots of my VAuto statistics, overview, a representative recent night, and a couple of 2-minute segments.

Thanks in advance for any advice, observations and suggestions.

AndyB

[Gideon]

Your number are excellent, don't chase numbers!
Any changes should be about how you feel

[AndyB]

Thanks Fred -- that's the answer I expected, but I have so much respect for you, Sleeprider and many others here that I thought I'd test the waters just to see if you smart folks have any other thoughts.



AndyB

[jaswilliams]

Thanks Fred -- that's the answer I expected, but I have so much respect for you, Sleeprider and many others here that I thought I'd test the waters just to see if you smart folks have any other thoughts.



AndyB

I agree with Fred there is little more you can do about the CA’s there are not enough to worry about and an AHI of less than 2 is great. Well done.

[Sleeprider]

Everything looks good, and appears to feel good to you, so Fred's advise is solid. Since you're using a Vauto, you can also try the trigger/cycle sensitivity and Ti Min/Ti Max. It might be worth seeing if increasing trigger sensitivity results in a slight drop on your CA. FWIW, your results are similar to my own, and I don't do any manipulation of the settings, since it is really just a matter of diminishing returns for how you feel, when AHI is generally under 2.0.