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I recently replaced my Phillips machine with the Resmed AirCurve 10 VAuto device. My DME provider set it up similarly to the Phillips device working off of info from many years ago when my sleep study was done (that doctor closed up shop). I'm having difficulty breathing with the new device as it feels like I can't get enough air. I've tinkered with the settings a bit but this device is a bit more sophisticated than the previous. I've attached a report and was hoping someone could offer advice on changing settings that will allow me to breathe more comfortably when using the Resmed device. Thanks for your help...
You are also having a lot of positional apnea. This is when a number of apneas (not including the centrals) are clustered together. This is caused by your chin dropping towards your chest and results in your airway being pinched off a little, like a hose with a kink. This can be overcome by using a much flatter pillow or (more often) by wearing a soft cervical collar that holds your chin up. Solving this will help you have a lower AHI and will help with your comfort as well.
Try changing the trigger first and give that a couple of days to see how it goes. If it doesn't get your CA index down below 5, I'd suggest dropping you PS from 4 to 3, unless that makes you feel awful. This may help reduce the number of CAs you're experiencing. After a few days, if you're still having a CA index of over 5, try reducing PS to 2.
You may be able to raise your PS back up gradually over time. No particular need to do that if all goes well, but with lower PS, you may see an uptick in flow limitations. The trick is to find the level of PS that is comfortable, does not cause a whole bunch of CAs, and helps to control flow limitations.
The tip about positional apnea is an important one. Please read this entry in the Wiki:
Please follow instructions in my signature links on taking a screenshot in Oscar (organizing your Oscar charts) and posting attachments. Downloading Word documents can be insecure and it is much easier for all of us if you will post a screenshot.
I agree with the advice you have received above. The obstructive events appear clustered as in positional apnea. The centrals may also be related to positional issues, but may be improved with very-high trigger setting.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Adjusting the trigger and PS has really helped, see the attached. I use the dreamwear mask with nasal pillow and the comments on positional apnea got me to thinking about kinking of the mask flow as I move around. Since I wake at least once an hour to turn and also get a drink, I'm also readjusting the mask/hose which may also help. Thanks everyone.
I think it's unlikely your hose is kinking; that's what the spiral ridges are there to prevent. So for positional issues, I'd recommend you try using a low firm pillow, if you don't already, and if that doesn't help, then a soft cervical collar.
Any chance you could turn the ramp off? If you really need it to fall asleep, then keep it, but I'm going to bet you'd do OK without it. It'd be good to have your pressure up closer to where it needs to be right from the start.
You could try turning PS down a little to see whether that helps with the CAs. You could also try raising your minimum EPAP to around 9, which is your median EPAP pressure for the night. That might head off a few of the OAs. But if you try either of those experiments, do them separately and give each one at least a few nights. Otherwise you won't know what's causing what.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
