First time therapy, settings and progress

[Schernenk]

Basically I THINK my flow morphology looks reasonable, but not quite the nice bell curve on top.  Flattening on top could represent a bit of inspiratory flow limitation?  Increase pressure perhaps?  My med/average that the machine gives me when it has a range has always bee in and around 9.5 for pressure.

[UnicornRider]

So I had to do some catch up reviewing your thread. I was glad to hear you reached out to CPAPFRIEND, sorry to hear you got the wrong Bi-Level machine. If you used PayPal or eBay you may be able to return it for being listed as ST Vauto. Both PayPal and eBay have a very good buyer coverage program. I have returned or was reimbursed for several items I have purchased that were not as advertised or not functional as listed. Definitely a misleading advertisement. 

   I do not know all there is to know about the various ResMed Bi-Level machines available, it is understandable how you could make the mistake with the listing as posted. Try to return the ST you have, and invest the funds in to an AirCurve 10 Vauto.

   Meanwhile as another of your fellow Canadian has been known to say, "sometimes we have to dance with the girl we bring to the prom". 
So going back to your original AirSense 10 Try setting your:  Mode to Apap 
                                                                                       Pressure min to 10.2 cmH2O
                                                                                       Pressure max to 12.0 cmH2O
                                                                                       EPR :  On Full time.
                                                                                       EPR to 3.0 cmH2O


    That should keep your Epap above 7.0 cmH2O, perhaps more comfortable for you and trying to minimize the Hyponea events, the Flow Limits would be better addressed with the additional Range that Bi-Level Pressure Support offers and the timing and tuning plus the wave shape curve that a Vauto provides.

  You may try mixing up your sinus routine, it might be that you have become acclimated to Nasonex, and a different product may provide better effects. I have to change up my allergy relief routine every 6 to 8 weeks to keep from acclimating to the meds. Now that cottonwood is flying, I bring out the good stuff & I also saline rinse several times each day and tweek the Pressure Support on my Bi-Level to keep prime sleeping therapy going.

   

[Schernenk]

Thanks Unicorn!

I reached out the person I bought the ST off of, it was a FB Marketplace purchase, and she was mortified she advertised it wrong, she has offered me a refund when I return it.  It was her fathers, who passed away and she just put down what was on the manual which covers many models, it was an honest mistake.  I saw ST and VAuto on the ad but Assumed VAuto just meant it had the ST features along with being VAuto...Que cera cera, the seller is being really good about it. 

You concur though that it might be worth looking at the correct BiLevel machine?  The VAuto in this case?

CPAPFRIEND seemed to think a correct titration/set up on bilevel could solve my final hurdles, but it's a big investment and a second opinion is appreciated.  

I have started dancing with my AirSense 10 again...I guess I'm learning because I had already turned up the pressure a bit, to 11 over 10 but I will try 12 over 10.2 and see how that works.  EPR has been on for quite a while.  

I  do saline nasal rinse 1-2 times a day, but trying a new nasal steroid could be a good idea.  I will see what my pharmacist can show me, I've been on Nasonex for years.

Thanks for all your support.

[UnicornRider]

It is good to hear the seller was being so good with the return, The majority of machines I find on FB Marketplace are a similar situation, relative passed and most people, including CPAP users do not know the differences in Bi-Level machines.

You potentially could benefit from an AirCurve 10 VAuto, keep looking, in the mean time try the new settings for a couple of days and post back. We can try to get the most bang for the buck, out of your current machine.

I am not knowledgeable about Canadian health Care. 

After you find an Air Curve 10 VAuto, and we fine tune it and prove it, you Might be able to get your Lab that did the home study, to give a new prescription for a new AirCurve 10 VAuto, if you have had the AirSense 10 machine less than three months. 

I am not knowledgeable about Canadian health Care. 


I would just tell the Lab personnel that you have use of the AirCurve 10 VAuto only to try it, then they have to replace it.

 But in the mean time we have to prove your current machine will not provide the relief you need. So I say we work that AirSense 10 machine,,, like a rented government Mule.

Are you ready to ride?

[Schernenk]

Canadian Health Care system basically works like this...get a prescription from a medical doctor, in this case my general practitioner, then show said prescription to a store that sells sleep apnea products (machines need a scrip, other paraphernalia do not), buy machine in question, claim back through health care plan if eligible.  Fortunately I am on a very flexible health care spending account program and can get the machine covered.  I was out of pocket for the Facebook Marketplace purchase so I am very happy the seller is a decent human being.  

Basically I don't need to prove *PAP therapy isn't working, it won't help me as far as my next machine goes.  My doctor is pretty open minded, he already re-wrote a prescription for Bi-Level should I need it.  It will take a week minimum for an Aircurve VAuto to arrive though so regardless I will get some more saddle time with the AirSense.

Stay tuned

Giddyup!

[UnicornRider]

Well Good!

Ride Hard, Ride Long!

[Schernenk]

I'll just post a couple shots of last nights OSCAR's, this has been pretty indicative of my last 3-4 nights back on the AirSense 10.  To me it looks pretty darn good, but you can definitely see the flow limitations, primarily "Class 2" if my reading is correct.  As the night goes on they are pretty consistent, but everything else looks pretty good.  I have tried a low setting of 10-10.2 and found 10 works best for me.

My ST model has been sent back to the seller, and I have an Aircurve 10 VAuto on order....I checked three online retailers and found one of them was offering an $800 discount!  Lucky me LOL.

Anyway, any more advise for the Airsense 10 is welcome but I'm not sure how much better it can get.  I hope to have the Aircurve by very early next week so my my plan is to keep riding this pony until the Aircurve arrives....then ride into the sunset.

[UnicornRider]

It will be fun to play with Pressure support and plump up the top of your wave forms.

Do we be conservative and plump them up a little at a time.

Or go in like gang busters and knock them all up at once, then back off until they start to collapse again, finally give it just enough to plump them up again.

[Schernenk]

I'm gonna say gangbusters at this point, I'm so excited, and I just can't hide it.  I think they ship the machine tomorrow so I hope to have it by mid week - we can start talking about initial settings for the Aircurve any time.

So Unicorn....who has two thumbs and also struggles with asthma (saw that in another post), sinus issues & allergies?   this guy!  It's like we were born under the same star. 

Anyway, looking forward to playing with things and getting it dialed in, what a journey, I think I still have a fair bit of runway ahead of me to work with.

[UnicornRider]

AAAAAHhh,,,  Young Grasshopper, you must learn Patients.

You have the opportunity to "Live the Experience"...

"So Unicorn....who has two thumbs and also struggles with asthma (saw that in another post), sinus issues & allergies?   this guy!  It's like we were born under the same star.    "

Looking at our geographical location, there is a very good chance we share the same pollens, volcanic dust and allergens in the air that we breath, that possibly leads to our shared pollen allergy and asthmatic experience.


        "Anyway, looking forward to playing with things and getting it dialed in, what a journey, I think I still have a fair bit of runway ahead of me to work with."


  In the mean time you should request your very own copy of the Clinicians Manual for the ResMed AirCurve 10 VAuto.  
    
     https://www.apneaboard.com/adjust-cpap-p...tup-manual

 Half way down the page you will find a quick entry guide and a reference to the bottom of the page. Go to the bottom of the page, Request your copy. 

When you get the Clinicians guide you will find that you have control over timing of the inspiration, trigger and cycle sensitivity controls, Vsync to compensate for unexpected leaks. Not to mention that EasyBreath technology that will ease you into every breath you take.

   You see, as you introduce Pressure Support to suppress the Flow Limits that cause your pressure to increase under Auto control, you are introducing additional volume of air into your lungs and sweeping the CO2 out, therefore your chances of Central Sleep Apnea Events increases, so you will have to increase the timing sensitivity to ensure you keep the CSA Events under control. in the meantime you will get to see CSA detection utilizing Forced Oscillation Technique (FOT).  FOT is an oscillation of approximately 1 cmH2O at ~4 kHZ,  riding on the dynamic pressure of your therapy to determine if you are experiencing a Obstructive or a Central Sleep Apnea. If it is an OA Event, your machine will want to increase pressure under VAuto, but if it is a CSA Event it will not increase pressure.

     But you will be able to see the crest of your Flow Rate wave shapes gradually plump up and restore that full breath you have been waiting for as Pressure Support is increased.

    It will be an educational opportunity you will not regret.

Enjoy the Ride.




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