New Bi Level AC/11 VAUTO

[skcampbell2]

Sleep lab sent me home with these settings on a new Aircurve 11 Vauto.  12/8 PS 4. Can someone make some suggestions as to setup that can help me sleep.  I had better results with my Airsense 11 CPAP.  My chest hurts in the morning with this new device and my O2 levels have dropped significantly.  I use the N20 mask try to side sleep and tape my mouth.  Here is a recent screenshot of my data.  Any advice is appreciated.

[PeaceLoveAndPizza]

I suggest going back to basics and not using the suggested parameters from the sleep lab, at least at the beginning. 

Try starting with the following and we can adapt from there.

Mode VPAPauto
EPAP min 8
IPAP max 15
PS 4
Ramp off
Trigger med
Cycle med

You also have quite a bit of positional apnoeic events going on. Most likely chin-tucking. Try using a flatter pillow and consider getting a soft cervical collar, both will help quite a bit. 

Here is some reading on what is going on…

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[skcampbell2]

Thank you for the information.  I will change the settings and am in the process of getting a soft cervical collar.  I will post my results after a couple of days with the new settings.  Thank you.

[Sleeprider]

It would really help if you have some Oscar data from your CPAP to post it. It gives us a starting place to judge where you were on CPAP. I prefer to use Vauto mode, so I agree with the settings recommended by PLAP, as well as the positional apnea assessment.

[skcampbell2]

Here is a posting of my CPAP data before BiLevel.  Let me know if this helps.  Thank you.

[Sleeprider]

Yes, thanks for that. Your CPAP used fixed pressure of 15.0 that with EPR 3, resulted in EPAP pressure of 12.0 which avoided most obstructive apnea events. Since EPAP pressure is what stops obstructive apnea and stents the airway, we can safely conclude your current EPAP pressure of 8.0 falls well short, resulting in the abundant OA and H events. It's not hard to see what we need to do here, and my recommended settings are:
Mode: Vauto
EPAP min: 9.0
PS 5.0 (if PS 5.0 is too disruptive, back off to 4.0 and we will raise based on flow limitation as your tolerance allows)
Max IPAP: 18.0

This will stop that mess you posted above based on the titration from CPAP.

[skcampbell2]

Thank you for the advise.  I will try this settings for a couple of nights along with some new positional aids.  I will post my results.  Last night at 15/8 PS 4 the events lessened but still high.  Your advice is much appreciated.

[skcampbell2]

Hi Sleep Rider.  Here is some of my most recent results since your recommendation.  What are your thoughts.  I have not received the cervical collar yet.  Thank you in advance.

[Sleeprider]

Well, that was unexpected, but lots of OA events. Flow limits have dropped from 0.20 to 0.03 which is a significant improvement with PS 5.0. Most of the respiratory statistics look better. We control OA with higher EPAP min, so that is the logical place to start, but there are some indications of positional apnea (cervical alignment that causes obstruction). Read about positional apnea here, but I think we need to increase EPAP min from 9.0 upwards until OA events are better controlled. Your pressure was previously 15/12, and currently 14/9, so if you're okay with the pressure, change EPAP min 10.0 and IPAP max to 20.0. Watch out for possible positional issues.

[skcampbell2]

Your a life saver.  Your input is much valued.  I made a small change to the mask settings last evening.  I have been listing my N20 mask as "nasal" in the settings.  I changed this to pillows as that what I read it should be.  All other settings are as you suggested.  No changes to trigger or any other settings.  I now have a SCC now and will use tonight with your advised changes.  Thank you.