New diagnosis, Vauto on the way, some questions

[SBTApnea]

Hi all,

I just went through a short diagnostic process and have Resmed Bilevel VAuto. Posting results, any insights or recommendations would be appreciated! A few questions:

1. I expected to need a more sensitive test to get a diagnosis, or be given a script without meeting criteria for even mild (I am on so many meds to sleep, stay awake...lot's of symptoms, but doubted apneas would be picked-up). As a fairly fit, healthy, 38 year old woman, was under the impression the PAT watch types tests were not great at diagnosing and that I probably had UARS vs OSA. Now with a diagnosis of Mild and script, do I need to follow-up with more sensitive test for any reason? 

2. What ca I conclude from these results? Do I have UARS or just mild-ish OSA (with lots of symptoms)? Does this really matter at this point for treatment? If I am reading correctly, there are no central apneas.

3. Went straight to Vauto after reading this forum, which fortunately was something I could do...hopefully this was right choice for me. I signed up for the $200 Lofta service because it included a free mask. But just realized there is a a lot of support here, open source software, etc....any concerns/experience with Lofta respiratory therapist program? I'll be sure to share experiences, if helpful for others.

4. Started with the Phillips Airwisp nose mask. Although it came with nose piece sizes (S,M,L) and it seems S will be right, the frame itself feels large. It looks like I can order a size small Mask Connector (plastic piece at top to shorten) and small headgear strap (velcro part). I assume it came with mediums. In the meantime, can I put something (foam, etc.) on top of my head to take up space? I just have the velcro overlapping, which seems like it might work. Longer-term, any masks work well for smaller sized heads/faces? (I sleep in all positions, especially stomach and toss and turn).

Thanks for any thoughts and answering random questions!

***  Moderator Note: Corrupted image removed  ***

---

Images can not be hosted from a personal computer.
Please upload apnea related images (only) to the Apnea Board server or use an image hosting service for all others.  
Please read this link for further information:  "How to: Attaching Images and Files on Apnea Board" .

[Deborah K.]

You need to download Oscar, a free program, and post your results. Under the Event Flags, you need to list

Flow Rate
Pressure
Leak Rate
Flow Limits

That will help us help you.

[SBTApnea]

Okay, doing my first night now. Will figure out transfer in the morning. So it seems like using machine gives more info than the tests? 

Thank you!

[SBTApnea]

Attaching night 1 data. Subjectively, amazing and semi-objectively (apple watch and sleep apps), huge improvement night 1. But, I have a bunch of central apneas vs none in sleep study (at home PAT watch style). Thank you!
   
   
   

[Sleeprider]

A couple things I see here. First, change your trigger sensitivity from medium to high. That will reduce the CA events. We may move to very-high after looking at results. A higher trigger sensitivity will cause IPAP pressure to trigger more easily with less spontaneous flow. This increase in pressure can stimulate a spontaneous breath and eliminate many CA events. Second, you clearly have clustered events. Read our wiki on positional apnea and consider if your sleeping position or pillows can be modified to help. If eliminating pillows or sleep position alone is not sufficient, we can move to a soft cervical collar to mitigate. Your PAT sleep study shows you don't spend a lot of time on your back, but when you do, or are in REM stage sleep, that's when you have events. Something to consider.
Positional Apnea https://www.apneaboard.com/wiki/index.ph...onal_Apnea
Soft Cervical Collar: https://www.apneaboard.com/wiki/index.ph...cal_Collar

[SBTApnea]

Thanks so much; after a week of believing I made this change, I realized I had not pressed the button . 

But, it has only been 7 days since I started, so perhaps too early to understand anything. Interestingly, the CAs varied night to night and were only high again 1 night, again at the end of the night. But, I made the change last night, attaching the results. 

A couple of questions/context:

-I realized I had the added diffuser attachment ('training wheels'....forgetting the name) night 1 and 2. Perhaps I need to add it back?

I had a call with the RT coach, and this seems to be very focused on severe apnea, just FYI on Lofta service. Coach said Vauto was bad idea, probably the result of reading things online, etc. This was recommended at purchase, so a bit confused. She said Vauto is for high pressure, I don't need high pressure b/c of Mild Dx. and most people are in the 100's, etc. She also said CAs are only problem in deep sleep and recommended limiting upper pressure to 10-16ish or maybe 20 max (after I expressed concerns that apneas were not controlled until 16-20), but ultimately left it alone.

I was approved for an in-lab sleep study based on in-person visit with sleep specialist (but it is a long wait to schedule), have clear symptom improvement: I sleep through night sometimes, HR dropped dramatically and consistently with treatment- if mask falls off or I fall asleep without it, I am right back to min of 100 BPM all night, going up to 140 BPM. Last day or two, I am seeing energy start to trend with numbers. Taken together, I have to think it is worth controlling the Mild AHI (which does go to 30+ at the times I am having events)?

-I have had what seems to be catathrenia for years (holding breath, groaning sounds while exhaling a bit every few seconds, as it has been described). Would this be visible in data and reading like CA? Any difference in approach for either scenario?

-On pressure, why would the recommendation be to reduce since most times I don't need it when I have REM & Positional apnea? Isn't that when I need it? 

-Any thoughts on PS? It came at 4 and RT did not seem to know what I was talking about. When I eventually explained it using a different description, she said it is always kept at 4, and no one changes this setting. If I should have started with APAP according to RT, shouldn't this be 3 or less on Vauto?

Thanks again all! I was a little discouraged after a discussion with the coach, but I know how I feel and what my vitals are doing, so I am thrilled with this decision and want to keep making progress. Given it was mild in PAT Dx, I clearly am impacted by even a low number of events, so why call it a success without much of a relative decrease vs dx? I realize it probably isn't nearly as bad as most people, which I cannot imagine...I couldn't take it!

Night 6 (med, med settings)
   
Night 7 (high trigger)
   

(ignore times, it was set incorrectly and corrected last night/night 7)

[Sleeprider]

I’m on my phone now. This is positional obstruction. Read the soft cervical collar article in my signature links, and I’ll touch base in a bit.

[Sleeprider]

I'll just add, the RT coach is clueless. A Vauto can operate in complete CPAP mode, but with more options, comes better treatment for more people. I have used a Vauto since 2015, but I don't use it because of pressures over 20 cm. The problem you have right now is apnea occurs in clusters. Read the Positional Apnea article https://www.apneaboard.com/wiki/index.ph...onal_Apnea and Soft Cervical Collar https://www.apneaboard.com/wiki/index.ph...cal_Collar

There are a lot of options to beat this problem. Just think about it, try a few of the simple solutions, use a collar if needed, and you will see significant changes.

[SBTApnea]

I appreciate this advice, thank you!

The position seems to be an issue. I ordered a collar. I have never been able to sleep on my back (at least while aware of it) because I can't breathe. I could relate when COVID happened, and they described this sleeping position on the stomach. While awake, I sleep on my stomach, stretching my throat and neck out....and can feel the pressure, making it easier to breathe. But I guess I move while sleeping. I went to a PT for some jaw and neck issues. They had me try and correct the 'forward position' of my head (basically stand against a wall so that there was no forward head position and everything was touching the wall), and I remember thinking, 'How does anyone breathe?'...my chin was tucked in and I was breathing through a straw at best. So this makes sense.

Based on your advice, I tried a blow-up cervical collar (because I had one available) and put the inflation device behind my back for additional reinforcement (like a tennis ball). Unfortunately, I took it off in the middle of the night without realizing it. I guess these bad positions are ones I seek out in my sleep at some point? The soft collar sounds more comfortable, so will likely leave it on. Should be here tomorrow.

Should I leave it on high sensitivity or go back to the medium trigger? Not sure what will help if I can't improve my position. Somehow, despite this, I am still sleeping better than I ever have!

[Sleeprider]

The idea of positional mitigation is to get comfortable. Easy solutions are things like less firm or fewer pillows, and it goes to things like soft cervical collars (SCC). My needs are met by using a medium fill down pillow I can pull between my jaw and and shoulder when I lay on my side. but that won't work if you're and active sleeper. I can't sleep prone, and I have seen many prone sleepers with the same problem because it requires turning the head to the side, which is just another contortion of the airway. Keep settings as-is for now, and we can change if needed later. There are a surprising number of members of this forum using SCC therapy. There are a number of collar reviews in the review forum. Keep in mind, correction of the issue is a very individual matter, and requires experimentation and patience. If it doesn't work, look for a different size, fit, firmness, etc. A small change can be all it takes to kill the positional issue.