Is my CPAP machine catching all my apnea events?

[Sleeprider]

Earlier you asked if a Resmed might do a better job. You have chronic inspiratory flow limits throughout the charts you posted. The flat tops in inspiration is pretty typical for upper airway restriction and flow limitation. The Dreamstation's Flex algorithms don't do much for those, but the Resmed's EPR does. I could see a bilevel approach working pretty well for you to improve your breathing and resolve FL, but even the Resmed CPAPs offer up to 3-cm of pressure support.

[fs12]

@Sleeprider - would it be worth buying an AirSense AutoSet 10? There's one on CraigsList in my area for $200. Or should I think about getting an AirCurve instead? I'm not quite sure I understand the difference between the APAP machine with EPR and a BiPAP machine...

Looking at the curves, the way the inhale slopes upward, holds steady and then goes up again does seem to be concerning. I've had that type of curve from the first day I started this CPAP venture...

[Sleeprider]

I think you are better off with the Aircurve because higher pressure support is possible. This wiki article summarizes the applicability of pressure support for you http://www.apneaboard.com/wiki/index.php..._and_BiPAP

The Resmed Airsense 10 Autoset is by far more useful in dealing with this than the Philips, and it may be worth trying the used machine for $300 since you are unlikely to lose money if you need to resell it. In your case, the EPAP pressure needs to be set at the lowest pressure that prevents obstructive apnea events (OA) and pressure support (IPAP) needs to be set to reduce hypopnea and flow limitations. We don't know what those pressures are. If you use the CPAP you could probably set Pressure at 11.0 and use EPR of 3.0 which would deliver 11.0/8.0 pressures. With a Vauto, you would set EPAP min to 7.0 and PS at 4.0 with IPAP max of 16 and would get pressures from 11/7 to 16/12. If that does not resolve flow limits, we just raise PS to 5 for 12/7 to 16/11 etc. Eventually that restriction would yield to the pressure support.

[fs12]

Thanks Sleeprider. I'll see about getting the used machine, since it's relatively cheap. Maybe that will help the flow restrictions.
Thank you also for your very helpful explanation!

[tedvpap]

Yeah, I wasn't using the Flex setting, as I had a really rough time with it when I tried it early on in therapy. I tried it again last night and it worked decently well. Going to give it a few nights to see how things settle in.

Bumping the minimum pressure to 12 has helped again. My average AHI for the past three nights is 0.78.

Thanks for everyone's help!

How do you feel?  Are you well rested?

[fs12]

I do feel well rested.
Although right after I started CPAP treatment, the shift in how I felt was really large, so now it doesn't feel quite so novel anymore... But I'm generally much more well rested, and I don't have to take naps in the afternoons anymore, and drinking coffee late in the afternoon/evening will keep me awake in a way it never did before.

That said, my partner says I still exhibit some apnea signs when asleep, so my guess is there's still some residual events that are not being helped.

I did go get the ResMed Airsense 10 Autoset and used that the last two nights for an average AHI of 1.2. I'm off on vacation right now, but will post charts once I'm back next week.

Thanks for everyone's help!

[tedvpap]

I do feel well rested.
Although right after I started CPAP treatment, the shift in how I felt was really large, so now it doesn't feel quite so novel anymore... But I'm generally much more well rested, and I don't have to take naps in the afternoons anymore, and drinking coffee late in the afternoon/evening will keep me awake in a way it never did before.

That said, my partner says I still exhibit some apnea signs when asleep, so my guess is there's still some residual events that are not being helped.

I did go get the ResMed Airsense 10 Autoset and used that the last two nights for an average AHI of 1.2. I'm off on vacation right now, but will post charts once I'm back next week.

Thanks for everyone's help!

Thanks for the response.
After the first few months of my treatment, I travelled without my machine as I was thinking the benefit was not necessary for a short trip away from home.  Boy was I wrong.  It is easy to forget just how much benefit you are receiving.
I tuned my treatment to get my AHI as low as possible.  I just had 6 straight days of zero.  I don't know if my AHI of ~0 results in a much better sleep than 1.0 but since the "cost" is only a little higher minimum pressure for me and it doesn't seem to bother me, I prefer to see my OSA fully treated.

[fs12]

Well, it's been almost two weeks with the new AirSense 10 machine.

It seems my AHI is doing well overall - it's at 0.72 on average.

Here are my graphs for Thursday night. It seems like my inhalation is still a little strange. Any thoughts on that? I have the EPR set to 3...

I am having some mask leaks in the night, but I imagine that is me breathing out through my mouth accidentally. I've been trying to sleep without the chin strap, as it makes me clench my jaw uncomfortably. So I'm trying to keep my tongue up against the roof of my mouth.

Overall I'm feeling well, but I do notice being mildly tired during the day if I don't manage to get 8 hours of sleep at night.



Full Night:
   


Some close-ups:
   

   

   

[Sleeprider]

Other than a pretty persistent mouth-leak, this looks great, and the inspiratory wave form looks normal to me other than a little bit of flow limitation that was also flagged about that time. I don't see any need for changes. Good job with the optimization.

[fs12]

Thanks Sleeprider!
I'm glad the inhalation curve looks good. I wasn't sure what to make of that sloping curve.

I'm hoping that I can see my sleep doctor in the next month or so - been rough getting an appointment as I've been out of town so much for work.

Thanks for the help and support!