New CPAP user looking for OSCAR review (no DME)

[WillSleep]

Hi WalkingDead. 
 
Actually I believe it is a time for celebration.   We do not stop to celebrate enough in life and that alone taking the joy out of life and increasing our blood pressure.   
 
 
Congratulations, you have accomplished the major milestone of find a reliable range of settings to get good treatment (and hopefully a much better night sleep). 
 
 
For sure you want to ride multiple days with the Autoset and let your body adjust, get better sleep and also maybe heal up a little bet. 
 
You can rest with Autoset for weeks, months or years  .. or try the improvements steps I list above now or try them later.  I have seen people get the same AHI results at multiple EPAP settings so I would not discourage you from testing that now.    Some people (especially younger) experience a need for lower EPAP as they lose weight so I would encourage you to periodically re-titrate from a lower starting point anytime your physiology changes. 
 
If you know you’re the type to want to test and tweak and improve every now and then I suggest considering migrating at this time to a VAuto rather than an Autoset,  A “one and done” purchase rather than go through repeat cycles of upgrading to new machines.   The VAuto provides more Pressure Support (PS) range than EPR and more fine tune control of pressure than EPR as well as the other settings SuperSleeper mentions.   The VAuto is a effectively a superset of the Autoset and Autoset for Her except for the slower rising and descending EPAP changes and your screenshots do not yet show any call for that feature. 
 
A quick check showed:

• ASVs selling for $500 to $1000 more than VAuto’s brand new
  
• ASVs listed to sell for $900-1200 on VAutos listed to sell for $350-500 on Craigslist   
  

 
So it seems like through either a recommended supplier or Craigslist, Facebook Marketplace, etc so you might be able to turn that ASV into a VAuto without too much trouble and turn the new Autoset back in. 
 
The timing and choices are always yours. 
 
Don’t forget to take the time to celebrate, to enjoy the sense of accomplishment and bask in better therapy.
 
WillSleep

[walkingdead]

Thanks WillSleep! I appreciate that.


Last night I used the AutoSet for Her mode with great results. I even brought everything down to a min 6 and max 14 with EPR 2 and my AHI was 0.00. I started typing some of the results and realized it's just easier to attach the screenshot for anyone that's curious.

Will the VAuto be capable of at least providing the same level of support for me as the Autoset for Her? If that's the case, than I don't see the risk in trading the ASV for a VAuto and returning the Autoset for Her. I just want to make sure I'm not losing out on what the Autoset is currently providing.

[WillSleep]

Thanks WillSleep! I appreciate that.


Last night I used the AutoSet for Her mode with great results. I even brought everything down to a min 6 and max 14 with EPR 2 and my AHI was 0.00. I started typing some of the results and realized it's just easier to attach the screenshot for anyone that's curious.

Will the VAuto be capable of at least providing the same level of support for me as the Autoset for Her? If that's the case, than I don't see the risk in trading the ASV for a VAuto and returning the Autoset for Her. I just want to make sure I'm not losing out on what the Autoset is currently providing.

Your Welcome. From all of us!


KAA-ZING!!

That's what I am talking about! It just felt that like that lower EPAP option was there waiting for you.   

Min EPAP 6.0  Nice, Congrats!
Now you know you are not suffering at a higher EPAP when it is not really needed.  Also over time if you no longer need as much pressure your average total peak pressures will just automatically drift down without any needing any more testing or adjustment work from you.     
   


This is what near PERFECT therapy looks like.  

• Biggest Flow Rate and Pressure changes occurring only at the end of Leaks, so EPAP and EPR are correct.  
  
• Respiratory Rate stays smooth for long periods of time despite Leaks and Flow Limitations
  
• Note you may find this kind of stability in Respiratory Rate might suit as a loose proxy for a desired low Heart Rate Variability and a measure of low arousal driven interruption to the natural sleep cycle your trying to perfect.   
  

            


So switch to VAuto?  Man that would be a hard thing to do.  Technically yes, VAuto more options so provides a lower long term risk that of not having all the tools you need.  But if you get results consistently like this each night I would not change a bleepity-bleep thing for a while.    

The VAuto has higher a trigger sensitivity option, like the Autoset for Her (AfH) setting, but we (at least I) do not know if the two are exactly the same.  

The VAuto does not have the same "slower to rise but uses a look-back of only one breath" EPAP algorithim.  If review of 2-3 min sections of your screenshots at each pressure change confirm you are using that specific algorithm feature and these results continue then you would be walking from a known "really, really good for you" to a known really good algo.  

So enjoy the therapy and scan your charts in 2-3 windows at change points to see what you can learn.  

Or just keep these results coming and throw a big party to celebrate!

WillSleep

[Gideon]

Your numbers on the "For Her" are excellent with the "For Her" algorithm. The VAuto does not have that. It is a good replacement for the standard AutoSet algorithm.
I do see fairly high Flow Limitation but unless you are having an issue with them I wouldn't change them.

I would keep the "For Her".

[walkingdead]

Thanks for the confirmation that I’m on the right track! I’ve donated to the forum as a token of my appreciation for everyone’s help.

Now it’s time to sleep well, lose weight and (hopefully) watch the blood pressures drop into normal range. Oh, and get that ASV traded in.  

Sleep well, my friends.

[Gideon]

Thanks, and stay in touch, you who was formerly called the "Walking Dead".

[walkingdead]

I can't believe it's been a year already. Some things have improved since then but there's still lingering health issues (hypertension, palpitations) that have me questioning if my CPAP is titrated appropriately so I'm hoping for some feedback. My AHI is always around 1 so I assumed everything was fine with my pressure settings. I'm visiting a cardiologist next week to make sure everything's structurally sound and I'd like to be able to tell the doctor my apnea is under control.

I have attached a chart for the last three months. Let me know if you want a closer look at any of the events. Thank you so much for your help.

Edit:
Reviewing my charts in the last few comments, it's clear that I started messing with my pressure settings at some point for some reason that I don't recall. I'll go back to what I had last year for a few nights to see how things go.

[Sleeprider]

Welcome back! At 8-18 cm pressure with EPR 3 you have excellent AHI. Your pressure is consistently driven to a median over 11.5 by flow limitations. We can draw a couple conclusions from that alone. You could use a higher minimum pressure, but without bilevel it won't really change very much. Most doctors are not concerned with flow limits, because they are not recognized as an event for insurance purposes, but they tell us there is residual upper airway resistance that can interfere with better sleep by causing micro-arousals. Your therapy is fine, but if you had a Resmed Aircurve 10 Vauto instead of the Airsense 10, you would immediately address the flow limits and actually end up with much lower pressure. Your therapy looks like mine before bilevel. It's fine in every way, but it can be better with bilevel., and I would actually set you up at the same pressure settings I currently use with a minimum EPAP at 9.0, PS 4.0, which is a starting pressure of 13/9 (IPAP/EPAP).

Your current settings start you off at 8/5 pressure. That's too low. Take the minimum to 11/8, and you will experience less variation in pressure, which may translate to disruption. Feel free to step up slowly so you adapt to the higher starting pressure, but your results are so consistent regarding median pressure, I think that is where you need to be. Translation to CPAP settings: Minimum pressure 11.0, Maximum Pressure unchanged 18 with EPR 3.

[walkingdead]

Thanks for the assurance Sleeprider! Maybe it's time for me test out a VAuto since WillSleep suggested the same thing last year.

[Dormeo]

Another vote for the VAuto.  I moved to it from an Airsense 10 Autoset with EPR of 3; my pressure support is currently at 4.8.  Before/after graphs attached.  The main benefits are  that I can sleep longer at one stretch and feel better during the day.