Effort to improve treatment of OSA and IH

[Gideon]

 I'm not exactly sure how to get more Event Flags to show up in Oscar though - it doesn't seem to be displaying RERA's, flow limitations, snoring etc.

It really is pretty easy.
Decrease your pressure to 4, turn EPR Off, they will be back. 

or you can enjoy the good therapy that you are now getting.

If you haven't had them OSCAR will not track them.  Note the 0.0 that many have in the RERA field, that means they have a history of them with the current machine.

[QuietSign]

Wow, what a difference! Flow limitations are gone, and obstructive events like flow limitation, snores, RERA and even hypopnea have disappeared.  Your 95% pressure has dropped from over 16 to 14/11.  You have added 80 to 100 mL tidal volume to each breath and nearly 1-L/min to minute vent.  

I think we can even lower your pressure and get good results. Keeping all settings the same, just lower minimum pressure from 13.0 to 12.0. We will lower it until we see indications of obstruction trying to come back in.  The big difference here is the EPR or "pressure support" of 3 which is helping you to breathe much easier.  You have some mouth leaks and once those are better controlled, you should have even more restful sleep.  If you can tolerate the idea, check out the Knightsbridge Dual Chin Strap from   Supplier #37.  This really exceeds my expectations, and points to why we push so hard for members to try the Resmed if they can get it.

Don't worry about more event flags, there aren't any.  The Resmed charts flow limitations instead of marking them as events. There is a snore summary and it is charted, but they don't show in events.  Want to remember the "bad old days"?

It definitely feels like an above average night's sleep and I'm super curious what it will look like tonight when I sleep during more reasonable hours. Are we confident that this machine is good at accurately detecting flow limitation, snores, and RERA's ? Someone earlier in the thread was saying the machines are not so accurate with regard to these events, and I'm wondering how confident we can be that they are really gone.

I'll lower the pressure as you suggest. I actually already use the Knightsbridge and mostly like it, but am sizing it down from XL to L (regarding this, the company said I had the option to pass on the XL to spread the word. I thought I might just make a post about giving away the headband on this forum so as not to waste it. Would that be ok with the mods/ the rules? I'll be sure to put it in the dryer for a couple minutes as a pandemic precaution). I also used a piece of Somnifix tape, but it somehow got lose during the night and allowed leakage.

The supplier who sold the Resmed says he actually got a hold of a new Vauto (edit: to be explicit, it is model 37212. I believe that's the relevant model right?). I'll ask him about price, but do you think I would benefit from it, or is the Autoset 10 sufficient? Maybe we get a few days more data?

It really is pretty easy.
Decrease your pressure to 4, turn EPR Off, they will be back. 

or you can enjoy the good therapy that you are now getting.

If you haven't had them OSCAR will not track them.  Note the 0.0 that many have in the RERA field, that means they have a history of them with the current machine.

Haha point taken. I didn't realize that Oscar's UI adapted to not show stuff if you don't have any of those events. Are we confident though that I'm not actually having RERA's/flow limitations? I remember someone earlier in the thread saying machines aren't very accurate at identifying these events.

[Gideon]

We are confident that you are having flow limitations, but not enough of them to worry about. (You have flow limits in the stats, but very few.
We may or may not find RERAs on close examination of the flow rate but by not having any show up it is unlikely that you have enough to worry about.

If you mention symptoms that need to be resolved we might dig deeper, look at zoomed screen prints showing the flow rate so we can evaluate your individual breath wave form.

[QuietSign]

Gotcha. I'll post another night's worth of data tomorrow, and try to evaluate how I feel - it feels like I've been dealing with perpetual exhaustion since my teenage years, so I guess I don't know what "normal" feels like. Because I can't precisely compare to a baseline, I don't know how to qualitatively tell if the Autoset is sufficient.

The seller is asking $750 for the Vauto, new in box, which seems like a fairly competitive offer. I guess I was hoping to better understand what the VAuto offers over the Autoset - I understand on paper it offers a larger pressure delta, but in practical terms when is the Autoset's EPR insufficient and the VAuto is needed? For the users in this thread who themselves are using the Vauto, can I ask what circumstances made you decide on that machine? RERA's, flow limitations, comfort, etc...?

[staceyburke]

I can not compare it to the autoset but the VAUTO is so much better than the Dreamstation Bipap I owned for 5 years I can not say something. I struggled with the philips for the entire 5 years almost quitting several times. My average AFTER being on this site for a couple of months and taking all suggestions was the mid 20 to 30 events a night. Now I am at 2 to 0. Nigh and day difference. The VAUTO is a great machine IMO.

[Gideon]

I got my VAuto because I was maxing out the pressure of my machine, a DV54 APAP, and still frequently getting high AHI. The VAuto gave me a better look at my data and it's pressure support allowed me to considerably lower my pressures.

[Sleeprider]

Send me a PM on where you are finding the great deals on the Vauto. That is really a great price. I did not see where a Vauto is necessary to improve a very good night of therapy with the Airsense 10. The Vauto allows much finer adjustment of pressure support. While you can select 1, 2 or 3 cm of EPR, the Vauto allows adjustment in 0.2 cm increments. It also has some tricks with the trigger and cycle sensitivity that can fine-tune when transitions from EPAP to IPAP and IPAP to EPAP occur based on your breathing. Let's look at a few more nights and see what you think. You can see and probably hear the difference this makes in snores and other problems. RERA does not occur without flow limitation, and on the Airsense 10 with EPR 3, I don't expect to see either.

[QuietSign]

Send me a PM on where you are finding the great deals on the Vauto. That is really a great price.  I did not see where a Vauto is necessary to improve a very good night of therapy with the Airsense 10.  The Vauto allows much finer adjustment of pressure support. While you can select 1, 2 or 3 cm of EPR, the Vauto allows adjustment in 0.2 cm increments.  It also has some tricks with the trigger and cycle sensitivity that can fine-tune when transitions from EPAP to IPAP and IPAP to EPAP occur based on your breathing.  Let's look at a few more nights and see what you think.  You can see and probably hear the difference this makes in snores and other problems.  RERA does not occur without flow limitation, and on the Airsense 10 with EPR 3, I don't expect to see either.

It's the same supplier who is giving me a discount since I already bought an Autoset - ordinarily he said he'd sell for $1000.

I got what feels like a really good night's sleep despite being pretty late from 5:30am - 2:30pm, but for some reason the machine only recorded the 12pm-2:30pm part. I wonder if it's because it was too late a night's sleep Here's what that data looks like. 
   

Here's a zoomed in portion at a spot where a flow limit was indicated. Does it still look a little strange?
   

Edit: I think I'm gonna go for the VAuto but keep it in the box for a week while I experiment with the Autoset. If the Autoset isn't cutting it I'll switch to the VAuto, else I'll probably resell the VAuto.

[QuietSign]

Here's another night's worth of data. I messed around with the date-time settings a bit, so this sleep was actually pretty late 5:30am-1pm, despite what it indicates on Oscar. I'm wondering what's going on with the CA apneas - are they a sign of central apneas? I also included a picture where the flow rate looked a little strange.

I'm gonna try to be more aggressive with the mouth leaks - the Somnifix tape doesn't seem to create a very good seal, so I'll try to use regular hypoallergenic micropore tape tonight.


   
   

[QuietSign]

I can not compare it to the autoset  but the VAUTO is so much better than the Dreamstation Bipap I owned for 5 years I can not say something.  I struggled with the philips for the entire 5 years almost quitting several times.  My average AFTER being on this site for a couple of months and taking all suggestions was the mid 20 to 30 events a night.  Now I am at 2 to 0.  Nigh and day difference. The VAUTO is a great machine IMO.

So if I understand correctly, did you go right to the bipap, skipping over cpap entirely? 

I got my VAuto because I was maxing out the pressure of my machine, a DV54 APAP, and still frequently getting high AHI.  The VAuto gave me a better look at my data and it's pressure support allowed me to considerably lower my pressures.

Looking at your profile, it seems you have a pretty wide pressure range of 9-25. Is this after getting on the bipap to lower your pressure?

Overall, I guess I'm trying to understand the technical reason that would indicate bipap usage to understand what to look out for, because I feel like I only have a layman's understanding of using the bipap because it feels more comfortable on exhales (and perhaps for situations where you are maxing out on pressure). I still struggle to understand whether the pressure relief directly addresses the flow limitation, or if it's Resmed's smarter algorithm that is handling this issue