JCinPA - Therapy thread

[JCinPA]

This forum has been very good at bringing up my knowledge level, thank you all. I think I'll make a donation today. It's not often you find forums this helpful.

I am not having any problems I'm just looking to tweak things to the max and become better at interpreting OSCAR data. Some background ...

• I've been on CPAP therapy for about 8 years, never had any issue at all adapting to therapy, I took to it immediately
  
• I use a ResMed AirSense 10 Autoset card to cloud and have my first AirSense as backup (got the second when they discontinued it for about $400 less than they were and are selling for now   )
  
• I use a ResMed P10 mask, but recently got a F&P Nova Micro, not sure which I prefer yet, both are good
  
• After my titration study they started me at 10-14 APAP
  
• After looking at my median and 95% numbers I went to APAP 9-13 about a year ago, median was about 10, 95% was about 11
  
• AHI is typically below 1.0, almost always below 2.0, for the last couple of years
  
• A few weeks back I switched to CPAP at 11.0 EPR=2, last night was at CPAP 12.0 EPR=3
  
• Absolutely no issues at all with the switch to CPAP from APAP
  
• Average flow limitations have been around 0.05, 99.5% around 0.15-0.20
  

I understand people have strong feelings about APAP vs CPAP, for reasons I don't understand, but both seem to work fine for me, and since I don't seem to need any pressure relief, the argument for using CPAP has appeal to me. Not advocating against APAP in any way, just want to make that clear since it can generate some "warm" discussions, I've noticed.

As I learn about this stuff, I've become aware that my breathing pattern is a little flat-topped, and that is related to flow limitations, I understand. I sleep great, feel rested, and have no issues sleeping during the night. As I've moved up from CPAP 11.0 to 12.0, and since I went from EPR=2 to 3, I've noticed my breathing pattern looks a little better, and my flow limit 99.5% last night was 0.10 rather than the usual 0.15-0.20. That's why I'm going to try 12.4 tonight, hoping to creep up on the ideal settings.

Oscar graphs from last night are below. The wave is slowly getting rounder, less flattened on top. I'm hoping for an incremental improvement tonight. Any thoughts would be appreciated. Thank you all very much.

[Deborah K.]

To get help you need to post the full night chart, not just the two minutes you posted.

[Sleeprider]

Your therapy looks great and the increases in pressure seem to be helping with how your feel. I don't have much of a bias for APAP or CPAP, but I have a tremendous bias for bilevel. Lots of individuals get very good therapy and less sleep disruption with fixed pressure, but you are using bilevel IPAP/EPAP pressures. You are using the maximum pressure support available from your Autoset, and higher pressure is gradually improving flow limitation. From what I can see, you are doing just fine with 12/9 pressure, but I 'm certain you could take it to the next level with 12/8 pressure. Not being critical nor advocating a change, just pointing out the Aircurve Vauto would likely get the residual flow limit to nearly zero without a pressure increase. I think the majority of members on this forum look on your charts with some envy.

I'm curious to see if your 95% flow limit would be the same if you changed from CPAP mode to Autoset mode with minimum pressure 12 and maximum pressure 12, EPR 3. The settings are the same, but flow limit detection used to not record accurately in CPAP mode.

[JCinPA]

Oh my, sorry I forgot the full night chart, I wanted to highlight the shape of the breathing flow. Below is the whole thing. Thanks for that.



@Sleeprider  Thanks for your comments, but owning not one, but two AirSense 10 machines, I'm not going to splurge on and AirCurve. lol  I think I understand it, basically the AirSense AutoSet is a bilevel with EPR limited to 3 cm of water. Can't see the sense in getting a third machine to get the extra cm, as I am feeling pretty good.

If I understand you, though, resetting it from CPAP to APAP with 12/12 will be essentially the same therapy settings, but change the way the machine records flow limits? Is that a correct understanding? I'm happy to do that. I was going to go from 12 to 12.4 tonight on CPAP and see if I could round off the tops of my trace a little more.

I'm glad you like my results, I've always responded well to therapy and (thank God) never had a lick of trouble adjusting to it. I'm just trying to really dig in and grow my understanding of this stuff. I did make a donation today, by the way. You people are terrific and the site deserves some support for all I've learned here.

[JCinPA]

Oh, I've used a ResMed P10 nasal mask for 8 years, and just got an F&P Nova Micro on Saturday. I'm using it for a week to see if my leak rate improves a little. It looks like it will, but I'm wondering it it's worth the extra $7 per nasal pillow. I replace them monthly so that's over $80 per year, so I'm going to compare leaks the week prior with this week see if the improvement (if any) is worth the toll.

Edit: Set the machine to APAP, 12.4/12.4 and left EPR at 3 for tonight.