Need help Aircurve 10 AutoASV Settings/Insights

[Jarlo]

               
Hi

Almost a year ago i posted here first time regarding having issues with my CPAP. I had some Home tests afterwards with the hospital where they noticed a lot of Central Apneas, and then supplied me with a Resmed Aircurve 10.

Since i've got the Aircurve my sleep and energy levels have increased, my focus etc. 

But lately i felt like my sleeping nights are not as consistent as before, and i dont know why.

I'm fighting a bit against my airfit 20 mask since it vibrates sometimes at night, and i assume its leaks, but it holds better to me than my older dreamwear full face.

I have some Oscar charts attached from 2 different nights. Sometimes i hit below 1 in AHI and sometimes i can go all the way to 4, and i would like to try consistently to get below 1 or around.

I can still wake up feeling tired and exhausted. I'm fairly active workout 5-6 times week and maintain healthy sleeping habits with dark room and good temperature.

[Sleeprider]

Clusters of UA appear to be positional. I'm not in a position to judge your minimum PS setting, but would like to know how you arrived at that as an optimum minimum. It seems to work, but may increase the number of central events that the ASV has to use more pressure support to address. I really think the most important reason your results are not as consistent is because of something that has changed your tendency for chin-tucking or similar airway restriction. Changed pillows?

[Jarlo]

Hi sleeprider

Thanks for replying, ive seen some of your advice to other People using asvauto etc with great succes.

I made a old post regarding if I had positional apneas, where i tried 4 different collars, 6 different pillows and heights, thickness etc.

Right know im not quite sure about my settings since theyre set from the sleep clinic at my hospital, and its been really hard for Them to understand that im tired since my ahi was 22 before the aircurve.

I dont know if these UAs are from me unintentionally holding my breath. My gf have recordings of me making almost like squeeking sounds while sleeping.

Let me know what info you would need to try help me further, as im really desperate.

[Sleeprider]

Jarlo, back-off the PS min to 3.0 and give it a try. I have no problems trying higher PS, but I'd like to see you progress and compare.

[Jarlo]

HI Again

I have now collected data with a PS min on 3 from last night. My AHI seems a bit higher with this setting, but i feel that same either way.

IS there anything else can we try to do after seeing this?

[Sleeprider]

In addition to changing your PS min, your EPAP min was reduced from 7.0 to 4.0. Lets try with a high minimum EPAP.
EPAP min 7.0
EPAP max 12.0
PS min 3.0
PS max 12.0

I think these settings will be more comfortable as you really don't need more PS, and all the unresolved events are obstructive. I'm pretty sure there is a positional component at work here. You do apparently need the higher EPAP. I think we should look at another night of data before moving PS min up to 4.0.

[Jarlo]

Hi Again.

I tried to use the settings sugested by SleepRider, but i was stupid enough to forget to plug the SD card back into my Machine... So all the data i got is lost.

What i could tell thought from just looking at the machine my avg. AHI got to over 3, and i've been feeling really tired.


What i've noticed aswell is, if i been drunk the day before i go to bed, my AHI almost hit 0, but days where i workout and do a full day of working etc, it usually gets around 2-3.


I've found some old settings where my AHI would be around 1-2,(attached) but i don't know if they're good to use? 

I might have some positional Apnea, but i've tried so hard to deal with that before, and collars never seemed to help, nor did smaller pillows.

I might have an idea that im unintentionally holding my breath (Like going under water) when im awake, and im abit scared it translates into when im sleeping too (Stress or anxiety related)

[Sleeprider]

Provide some close-up views of the flow rate during events. We can tell if it's a breath-hold.

[Jarlo]

Hi SleepRider

I've posted some of my Flowrate close up in this picture.

It always seem to be the same type of events it registere with same breathing pattern, some days it's a lot and some days it's not so much. I rarely see these type of evens when i have been consuming alcohol/drunk/partying, so it's so hard to tell what the exact reason it.

I've posted 2 different nights sober (Working days) and then 1 night with almost perfect AHI where i've been drunk/partying.

This is surely a mystery, since i've tried sleeping with different collars, neck pillows, smaller thin pillows etc.

[Sleeprider]

This graph confirms breath olds at 01:43:40, 01:44:05, 01:45:00, 01:47:00 and 01:47:15. We see the ASV hitting you with PS breaths, but there is no where for the air to go. So these are legitimately UA, neither central or obstructive.  The other cluster looks similar and shows high inspiratory flow with little or no expiratory flow.  I don't really know how to advise on this because the machine seems to be responding appropriately and we can see the deflection of your airway from the PS.  We can see the EPAP pressure is relatively high in these events and it may be locking up your ability to exhale.  Let's set a maximum EPAP pressure of 8.0 (EPAP min 6.0, EPAP Max 8.0) and see if that helps. Normally with UA, we increase EPAP, but you seem to have an unexpected expiratory obstruction with high pressure.