[Treatment] Newbie

[RainbowFish]

Hi!  I am new to this forum but started APAP in November.  Like so many here, I had no idea I had sleep apnea, but it took exactly one day for me to get used to the machine because I felt so much better using it.  After a variety of changes to my settings, I ended up on the ones below with 1.5 liters of oxygen thrown in as well. Airfit F30i mask with a ResMed 10 APAP.

I was originally diagnosed with mild-moderate obstructive sleep apnea with an AHI of 15-20 via in-home test. My O2 sat minimum was 78%, and it never gets much above 95% without O2. (I have had a chest x-ray, echocardiogram, and PFT's which are all normal. BMI 25. And my only med is lamotrigine for well controlled epilepsy - no alcohol.  But I do live at 7000 feet.)  I was supposed to get a BiPAP in hopes of getting off the O2 after a titration study, but it is on crazy backorder. So, I was hoping I could get some feedback on my present settings since my set up is not going to be changed by the provider anytime soon. 

   
   
   

  THANK YOU!

[RainbowFish]

Machine Settings
 
Mode
APAP
Pressure Min
11.00 cmH2O
Pressure Max
12.00 cmH2O
Antibacterial Filter
No
Climate Control
Manual
EPR
Full Time
EPR Level
3 cmH2O
Essentials
On
Humidifier Status
On
Humidity Level
5 
Mask
Full Face
Ramp
Auto
Ramp Pressure
6 cmH2O
Response
Standard
Smart Start
Off
Temperature
26 ºC
Temperature Enable
On

[Gideon]

Welcome to the forum.
You are doing AWESOME.
You have no significant DSats and IMHO you do NOT need overnight Oxygen or a BiLevel.
Why?
Because EPR = 3 Fulltime is the same as PS = 3 on a BiLevel. I suspect they if you set EPR = 0 (Off, and do NOT do this) your DSats could worsen.
One suggestion, Set your Ramp pressure to nothing less than 7 because that is the value that enables the full functionality of the EPR. Note: Pressure of 7 with EPR = 3 = the AutoSets minimum possible pressure of 4. WIth a ramp pressure of 6 and EPR = 3 you will only get EPR=2.

So Set your Ramp pressure =7 as a minimum ALWAYS, and Nothing lower than a Min Pressure of 7 for the same reason, your pressure is above this.

[RainbowFish]

Thank you so much for your insights.  In the titration test and on the “official” overnight readings they use a fingertip oximeter whereas I use a more comfy Wellue Ring on a toe myself. It consistently reads 3% higher (I think because I have cold hands), so I believe the discrepancy is why they recommended oxygen.  I felt hugely better when I started the CPAP, and dropped my Hb from 68 to 48, but have not really felt any difference on or off O2.  They recommended no O2 and a BiLevel set at 13 and 9 on the titration study (whatever that means).  
I have a couple questions please.   

1) how low/long a desat is too low?  I regularly dip into the high 80’s without the O2.
2) if this 13 and 9 is better on a BiLevel, is there a way to emulate it on the APAP?  Should I?
3) when my AHI increases (typically to the mid-2’s) it is always with central events.  Should I worry?

Thank you again!!

[Gideon]

13/9 is a PS=4, your AutoSet maxes at PS=3.

I'm absolutely not against you, or anyone, getting a BiLevel, they are more flexible than an APAP and have a few other settings that we use when needed. I'd recommend a VAuto. Do note that the VAuto has an "S" mode as that is what your 13/9 is.

Typically the min PS used with a BiLevel is 4

all a min dsat value says is you need to look deeper. Often spikes are the result of movement and as such are of no concern.
Duration is the key. Total Time at or below a given percentage. The trouble is different doctors use different standards. Hopefully your oximeter produces a table showing time at or below various levels. Looking for several minutes 8-10.

<= 92%
<= 90%
<= 88%. 8 minutes is the medicare standard
<= 85%
<= 80%
<= 75%

Typically 90-92% means keep an eye on it
88% is usually the action point

[Gideon]

On the issue of Centrals, they are what we call Consistently Inconsistent, that is they have a tendency to jump all over the place. I am not concerned with the 1.4 CAI you showed

You can expect that number to increase with the PS of 4 on the BiLevel. Higher PS tends to increase centrals in those sensitive to their CO2 levels BUT we do not know if you are one yet. Your body is adequately managing with a PS of 3 currently and if it jumped when you get a BiLevel we would simply adjust PS down to 3.which you are tolerating well

[RainbowFish]

Thank you again.  Last night I just turned off the O2 with no other changes and got, with my Wellue ring, an average SpO2 of 94%, with a minimum of 87% and only 1m 12s of <90%.  But I was > 95% only 10% of the time, which makes the question of whose O2 sat monitor to believe - my Wellue ring or their fingertip VirtuOx - the crux of the issue. 

I have worn them simultaneously and compared the readouts.  The ring - on either fingers or toes - pretty consistently records 3% higher than the fingertip (which I find somewhat disturbing myself, but my provider waves it off). Thus, the difference in that night's recording made it <90% for less than 1 minute on the Wellue vs. 50% of the time with the VirtuOx.  The pulse tracings are very similar.  I would like to believe the ring, but the fingertip is the "official" recording.  Have other people had issues like this?

[RainbowFish]

Hello again!  I have been fooling around a bit with a variety of changes in my setup and I was wondering what, if anything, you might recommend changing to optimize the APAP, since my AHI is higher - basically all centrals. Still no sign of a BiLevel, and, with all the shortages, I feel like others need them more than I, so that's ok.

My initial post was with a ResMed AirFit F20 mask.  But even though it worked great, the nasal bridge was irritating, so I switched to a F30i, which overall I like better, but it leaks more, and I seem to be between the small and medium sizes.  And, in the meantime, I also got a MAD for a combination of a longstanding dislocating jaw issues, and in hopes (unlikely I know) I could skip the CPAP entirely if I go off-grid.  The MAD works great for the jaw and makes me much less of a mouth breather (though I still desat with it alone), so I tried an N30i last night with it, and was pretty impressed that my O2 sat looked as good as ever and I slept well.  I forgot to change the APAP setting to Nasal - which I did this am.  I am hoping this set up is a keeper, as it is the most comfortable combination I have tried. 

   
   

[RainbowFish]

New suggestions?

Well, it has been a month and I seem to be doing worse, not better.  I have tried various changes but am back to using a ResMed F30i (keeping my mouth closed with the nasal mask was too much of a pain).  I lowered my minimum pressure to 10.2 and kept the max at 12 (less bloating) and got rid of the ramp (just found it irritating).  I also switched to Soft mode which I find more comfortable.

My obstructive events vary from 0 to 0.8 and are usually steady at 0.4, but the centrals are all over - from 1 to 3 - both random and clustered.  About half seem to be after sighs. I basically have no leaks, snores, or flow limits.  Thank you for any thoughts.