Effort to improve treatment of OSA and IH

[QuietSign]

After use of 7:12 hours, an AHI of 1.25, overall data looks like the therapy is doing great. Are you feeling better for the therapy? If it is helping you feel better, and there's no symptoms or complaints, I won't suggest changes as it looks like it's doing well. Keep at it and you will continue to feel better for it. Congrats on the success.

Not feeling great in general - I wake up feeling pretty good but I'm exhausted after about 2 hours and everything feels foggy. The doctor says I also have idiopathic hypersomnia, so maybe there's a limit to how much mileage I can get out of my cpap, but I wanted to check in to make sure the data looks good. I still have a new bipap (the vauto) that I'm still debating whether I should try out, and I want to see if the data indicates the Vauto could be helpful at all.

[SarcasticDave94]

OK some more to think on. Maybe the VAuto would in fact be a good move to try out. Your Flow Limits have some activity that thus far the EPR 3 hasn't diminished in the above chart. The VAuto has a larger range of PS, which is what EPR is based on. EPR is limited to 3 cmH2O, while PS goes quite a bit higher. If the PS on a VAuto is like the settings on my ASV, the PS may go up to 15. So you see that it can operate at up to 5x what the EPR can offer.

See if anyone else offers comments, but the VAuto might be a good idea since you have it.

[happydreams]

According to the clinician's manual for the ResMed Aircurve 10 VAuto, the pressure support (PS) can vary from 0 - 10 cm H20 in 0.2 cm increments.

[SarcasticDave94]

Thanks for clarifying the PS range.

[QuietSign]

Right, thanks for the feedback Dave. I also was hoping to get as many sources of input as possible, and I notice so many others in this thread use the Vauto themselves - what was the clue in the oscar data that indicated Vauto for these people? Is there any sign that I am being underserved by the Autoset 10?

[SarcasticDave94]

For me one of the areas that may indicate a VAuto may be better is if one needs higher therapy pressures. You run somewhat higher pressures, as your max is or was at 17. However, OSCAR shows you don't tend to go above 13 or thereabouts so that may not apply in your case. Another area, and again it may not apply, would be if your therapy needs more Pressure Support than the 3 EPR you get on your AutoSet. EPR is like PS in that they both act on therapy. EPR drops exhale by the setting whereas PS adds to your exhale pressure to give IPAP/inhale pressure.

Realistically, you may not need the VAuto. Using it can't make therapy worse unless you had a lot of predominant Central Apnea.

[QuietSign]

Right, I'm roughly familiar with the concept of Pressure Support being used to treat flow limits/UARS, but I don't have great intuition for how to read the graphs. What level of flow limits/variable breathing indicates that a Vauto is needed? What other clues are there? How does one know when a Pressure Support of 3 is insufficient?

[QuietSign]

So a brief update. I've been continuing to experiment with mouth tapes, and the one I used yesterday got my leaks near 0, which seems good, but I'm wondering where the CO2 is going. Does near 0 leak value indicate rebreathing at all?

   
   

[SarcasticDave94]

I'd think not. You would be still exhaling through your nose then if the mouth is taped off.
Discounting the tape assist and a PAP nasal or pillow mask, this is still the same as awake breathing through the nose.

[jaswilliams]

The resmed machine shows leaks as zero when there is no mask leaks. The intentional vent leak which prevents Re breathing is taken into account.