Initial Post: XhwMikey Treatment Thread

[quiescence at last]

I was excited to see that the PSG showed that you were having an appropriate percentage of deep sleep (N3) and REM sleep. These go a long way in setting up the body/brain for rapid recovery. no more than 12 cm was used to partially resolve your apnea in the lab setting. Most people experience unexplained bloating and burping of swallowed air when they initially get in excess of about 13 cm. Mine was noticeable at 16.5, enough that I immediately changed my settings to not exceed 14. After 7 years, I still use a 9 to 14 range.

Good luck with your new machine.

QAL

[xhwmikey]

Greetings,

I received my ResMed AirSense 10 AutoSet this afternoon.  I also received three nasal pillow type masks to try out.  I initially was provided a full facemask (a ResMed F20) and I noticed some issues with leakage near the bridge of my nose during the Titration PSG.  Going to try everything out and see what works the best.

I set up the machine for No Ramp, EPR On at 2 CM, and Auto start. Temperature and Humidity set to Auto.  I did a mask fit test with the N30i that I want to try out this evening.  The machine is very quiet, but the mask seems kinda loud on inspiration and expiration - I might get the "stink eye" from my wife, but we'll see.  I was under the impression that the machine would be bundled with an SD card, but no - so I swiped a card from an old camera and put it in.  I'll post my first night's OSCAR report tomorrow.

Thanks again for this awesome forum - I feel like I've learned a lot (with much more to learn).

Cheers,

Mikey

[SarcasticDave94]

OK, you may want to format the SD to FAT32 just to be sure it'll capture your data. What pressures are you going to try? If you're going with EPR 2 full time, consider at the least a Min pressure 6.

[xhwmikey]

Thanks Dave!

Since I was prescribed 10 - 15, and that was what the supplier set it up for, I left it as it was.  Do you think I should start with a bit lower minimum?  Say 8?

Mikey

[SarcasticDave94]

You could possibly lower it if events are treated and/or if there's comfort issues. When I posted last, I wasn't aware the PAP would be set that high for min pressure. Most machines aren't even given any semblance of settings specific to the user.

A very high number of PAP machines reach the patient at default out of the box settings, with doc thinking the machine will just magically find the right setting. That's a lazy and incompetent doc that does that.

Show an OSCAR standard chart and answer the question "How do you feel?". Consider the question first so data doesn't alter your opinion. Then we can see a reason for pressures to be set at x instead of guessing. Just part of the process to make therapy work best.

[nightgagger]

The machine is very quiet, but the mask seems kinda loud on inspiration and expiration - I might get the "stink eye" from my wife, but we'll see. 
Mikey

You may have the older pillows which are rigid and do not have a diffuser. Check this video out:
Lankylefty video on improved N30i cushions.

[xhwmikey]

So I've used my spanking new Airsense 10 for two nights now, and learned a few things...

1) The airfit P30i is not a good match for me, and 

2) It looks like a Full Face mask is more promising Airfit F20.

3) I'm not sure what is going on with CA (Clear Airway) events - Do I need to be concerned with them?

Anyway, here are two night's worth of data... I'd appreciate insights.  Thanks!

Some notes:  The first night was with the Airfit P30i, the second night had the first half using the Airfit P30i, and then I woke up feeling kinda panicky and changed to the Airfit F20 (much better).

The third screenshot is a zoom in of some of the "CA" events...


[attachment=38095][attachment=38096][attachment=38097]

[xhwmikey]

Hello Everyone,

It's been 30+ days since starting my therapy with my AirSense 10 Autoset, and I'm not sure if I should be concerned (or not).

For the most part, my AHI has been hovering around 4 - 8 events per hour, with the lion's share being "CA" events.  My settings have been mostly 9 -14 cmH2O with full time EPR @ 2 cmH2O.  I have tried venturing out a bit with EPR @ 1 cmH2O to see if the "CA" events lower, but they did not, and I experienced more (but not a lot) of gassiness (aerophagia) during the evening and morning, so I went back to EPR @ 2 cmH2O.

I'm kind of at a loss as to where to go from here - I'd *like* to lower the "CA" component so that my total AHI is < 4, but I don't know if that is a realistic goal.  Should I be content with my current condition?  With regard to how I feel, I'd say it's been a big improvement - I was waking up in the morning - pretty much every day - with a throbbing headache, and since starting therapy I have not had one headache.  This is a major win for me.  I also feel more rested, but not in an "Oh My Goodness what a difference" sort of way.  Again, a win - but I'm wondering if lowering the "CA" events will improve things even more.

It's also possible that chasing after that last few events might not be rational - I don't know.  Do I have the correct machine to reduce "CA" events?

I have attached my latest screenshot and would like ideas to try to lower the "CA" events - if possible.  If it seems I'm going down a rabbit hole then please let me know because that's good information for me.  I'm open to any suggestions - Thanks!

Mikey

   

[Sleeprider]

Mikey, you have more events than we like to see, but since you are feeling much better with the therapy, that is probably the most important take-away. You are currently using your Autoset at 9-14 pressure with EPR at 2. Your pressures are staying right around 10 cm and relatively steady, and in the course of this thread we have not seen any noticeable obstructive apnea events. Your titration sleep test had mixed results with predominately obstructive events at pressure of 6, which became predominately central at 8.0 cm and then mostly resolved at 10 and 12 cm pressures. I would say your Oscar data is a good indicator of your AHI efficacy.

Based on your titration test, I don't think lower pressure is much of an option. We could try a lower EPR at 1 and see if that reduces the number of events. I think that is the best bet to reduce the CA and H events. If you lose comfort and sleep quality, my backup plan is to discuss how we can increase your respired carbon dioxide slightly by using Enhanced Expiratory Rebreathing Space EERS http://www.apneaboard.com/wiki/index.php...ace_(EERS) Let's start with a reduction of EPR to 1 and see how that works out first.

[xhwmikey]

@Sleeprider, Thanks!

I'll change back to EPR @ 1cmH2O.  How long do you think I should let that setting "soak" before assessment?  Would a week be good?  I'm assuming *no* changes to the basic pressure settings of 9-14 correct?

Wow, that EERS thing is mind blowing!  As cool as I think that it is, I'm hoping machine settings will get me to a better AHI - but ready to take that on if necessary. 

Thanks again.

Mikey