New member, first night with Airsense 10 auto - advice and questions

[trish6hundred]

Hi gcritchley,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy, hang in there for more responses to your post.

[Sleeprider]

Sorry to be back on here late.  Thanks for posting the data, it's good information, although you could fit all the relevant parts into a single image.
Your CA problem is easily fixed, and I think we can improve your oxygen profusion as well.  You are not having many obstructive events, and the pressure is staying very low.  Combined with EPR your EPAP pressure is loitering at 4.0 cm.  First thing you need to understand is that the EPAP (exhale pressure) is what affects oxygenation. It does this by improving the exchange rate in the lung's in a mechanism called PEEP (Positive End Expiatory Pressure).  Your use of EPR is undermining that, and is the reason you're getting only fair SpO2 results.  In addition, EPR can cause a reduction in EPAP that undermines the purpose of CPAP which is to keep the airway patent, avoiding flow limitation, obstructive apnea and hypopnea.  Finally in some individuals, the use of pressure support (different IPAP/EPAP pressure) can cause central apneas to occur by reducing the CO2 content which affect respiratory drive.  This is more true at low pressures like yours.

Answer: simply turn off EPR

[gcritchley]

Sorry to be back on here late.  Thanks for posting the data, it's good information, although you could fit all the relevant parts into a single image.
Your CA problem is easily fixed, and I think we can improve your oxygen profusion as well.  You are not having many obstructive events, and the pressure is staying very low.  Combined with EPR your EPAP pressure is loitering at 4.0 cm.  First thing you need to understand is that the EPAP (exhale pressure) is what affects oxygenation. It does this by improving the exchange rate in the lung's in a mechanism called PEEP (Positive End Expiatory Pressure).  Your use of EPR is undermining that, and is the reason you're getting only fair SpO2 results.  In addition, EPR can cause a reduction in EPAP that undermines the purpose of CPAP which is to keep the airway patent, avoiding flow limitation, obstructive apnea and hypopnea.  Finally in some individuals, the use of pressure support (different IPAP/EPAP pressure) can cause central apneas to occur by reducing the CO2 content which affect respiratory drive.  This is more true at low pressures like yours.

Answer: simply turn off EPR

Sleeprrider - Thank you so much for your detailed and thorough explanation. It's exactly what I needed. Everything you're saying makes sense. Tonight I will use no EPR. Otherwise, unless I hear otherwise, I stick with the current settings, (which I changed slightly for last night):  Range is low 6.4 - high 11
And yes, I learned with another member's help (and you see it in this thread) how to organise my data into one screenshot, which I'll do from here on in. I'll post tonight's data tomorrow.
Again - thank you!!

[gcritchley]

Hi friends!

Posting last night's sleep data (See link please). Turned off EPR, and am now dealing with a range of 7 - 11.

http://s345.photobucket.com/user/CalebLo...a%20031717

Sleeprider, perhaps I should set the range to go even lower tonight, with the evidence I'm seeing of some lingering CA's? (as well as no obstructions). Still concerned that my SP02 gets as low as it does - and I do sometimes notice a pause at the end of my exhale with no sense of needing to breathe in...barely noticeable, but there, and only with the mask on.

I also notice that almost none of the SP02 events correlate with any other event like an OA or CA. I'm wondering about my CMS 50 F oximeter - is it known to have inaccurate data? It can get to 94 or 93 for brief moments even while awake, and I'm an active runner and interval biker...weird. Also, I notice a discrepancy between my oximeter and the handlebar grab heart rate monitor on the recumbent bike I train on. Might my oximeter be faulty? I will say i do feel headachy in the mornings sometimes, but lately that might be because I'm fiddling with everything and getting used to the Resmed.

Thanks for everything!!!

[Sleeprider]

I would hold on changes for now. Your SpO2 line follows pressure (remember what we said about PEEP?) and a reduction in pressure may not have a positive effect on your O2 levels, and hard to say if it would reduce CA. If anything you might want to try fixed pressure at 8.0 and see if that further quiets things down. Your results look pretty good for this early in your therapy, and eliminating EPR seems to have a positive effect. With regards to your oximeter accuracy, who knows. I would expect it to show 99-100% if you do a period of awake deep breathing. Try not to pass out. If it doesn't come up, then I would suspect a calibration error. The CMS 50 F oximeter is "calibrated prior to leaving the factory", according to the user manual, which also suggests an annual calibration. Do I think a Chinese oximeter could be off by 4%? You bet! A minimum of 90 and median of 95, if accurate does not seem alarming.

[gcritchley]

Sleeprider, I'm so thankful. This is great info. I'll try constant pressure tonight (at 8), and see how that goes. Sounds like that won't be much different than my average anyway.

I did (twice) your ultra deep inhale/exhale suggestion at a natural, but fully deep pace to the point of lightheadedness, and first time i got to 98%, and second time 96%. My girlfriend put the same one on and was immediately at 99, so that doesn't help data comparative consistency much. Weird.

In the event I try another oximeter, do you know of a trusted brand/model that might be more doctor grade?

Again, deepest thanks.

[Mark71]

gc, It is important to note that you should make one small change and then stick with it for at least a week before you make another change. Everyone varies from night to night, and when you make a change, it takes awhile for your body to adjust to it.

[gcritchley]

Ok - so it's been a couple of weeks with an new full face mask and some minor changes.

here's a link to data - I think I'm on the right track. Comments/thoughts/opinions and advice all welcome. Thanks for everything

http://s345.photobucket.com/user/CalebLo...a%20032017