New to Sleeping and CPAP but willing to learn

[Stbrnd]

I am a newly diagnosed sleep apnea patient. I have had symptoms for at least 10 yrs without any MD I ever saw even mentioning it as a possible reason for my fatigue and insomnia. Instead, I was given Ambien and it bought me a few hours for a few years, until I came to the present 4 months of no sleep, waking up underwater, balancing myself on my side, hyperventilating myself, etc to sleep at all. Get up feeling worse each day. Common story on this site.

My Dx came from my own self referral and insistance on a sleep study that lead to my AHI of 69.3 and a O2 sat of 82%. The tech doing the study actually walked me out afterwards and said, "Whatever you do, don't try to sleep on your back until you get a CPAP."

Finally, a week later, I get my new machine. Since my Rx was for a Max pressure of 20cmH20 and my average was an 18cmH20, I opted for a VPAP machine to give me more range in the future if needed.

Now comes the problem. My tech wasn't familiar with the Resmed S9 VPAP Adapt, so they set it to CPAP mode with a 18mmH20. I had a rough time of it for 1 1/2 nights. At 2:30 am, I am up looking, as it turns out, for this site. I was able to adjust the machine down a bit as I was completely unable to handle the constant flow.

Two nights in now, I have tweaked the numbers more but could use some help with the fine tuning. My current settings are:
EPAP Min 4cm EPAP max 9.4cm PSmin 5cm PSmax 10cm IPAP 9.0 min and IPAP max 19.4. It was comfortable and SleepyHead says my AHI was 0.5. I have about 40% leak rate, but I have a full mask and a full beard.

Lastly, it might be important to tell a new person to KEEP THEIR MOUTH CLOSED during CPAP. I wasnt ever told this. Might have made a difference on mask selection.

[Mike1953]

A full face mask is for those who don't or cannot keep their mouth closed. Not sure why you think it is important to tell new people to keep their mouth closed.

[PaytonA]

It is important for PAPers to keep their mouths closed regardless of what type of mask they are using. The reason for that importance is different for a full face mask than for others but it is still important. It may have other importance for ASV treatment that I am not aware of.

Why were you given an ASV machine. Were a large proportion of your events from your sleep study central apneas? I presume that you are operating your machine in auto mode. I also presume that the IPAP min and max values are what you have calculated since there is no setting listed for them in the clinicians manual.

Your AHI is very good so I am not sure that you need to tweak the machine settings at this time. Although the high leakage may be distorting your AHI.

You listed leakage rate as 40%. Did you mean that your high leakage is 40% of the time over the max target or did you mean that your leakage is 40 liters/minute. In either case your mask needs some tweaking. Your leak rate needs to stay under 25 liters/minute. I have a goatee and my prescribed pressure is 20 cm/H2O. I have the Simplus mask and have used it successfully. Many of the other people on this forum that use the Simplus say to leave the upper straps loose enough so that the stabilizer is slightly away from your forehead. That does not work for me. I have to tighten it down so that it is against my forehead. I also need to tighten the lower straps fairly tight.

Can you feel where the leaks are occurring?

Best Regards,

PaytonA

[TyroneShoes]

What I find alarming is that they prescribed and delivered a very sophisticated machine, yet had no clue how to configure it. That is a little like forking over $47,000 at the BMW dealership and they aren't sure whether to inflate your tires or not.

I am confident that you can get valuable advice here, but I would keep trying for the med community to do their job first.

[Stbrnd]

The closing your mouth comment addresses something that happened even in the sleep study that lead to me being moved to a FFM during the study. Now, if I have my mouth open under the mask, I wake up in a couple of hours with the worst dry mouth ever, and my cheeks feel like I been blowing up balloons all night. Nobody ever during the study or after mentioned trying keeping your mouth closed. I read that for the first time here on this site. Thanks!

The machine. I know now that it is a high end device, but the reason I was given was regarding the higher pressure available (25cmH2O) which, considering I am starting at a 15-20 now, seemed possible. It didn't cost me extra, so, not sure it should be a problem as long as I can get it dialed in.
The IPAP numbers came from the SD card info for settings. They appear to be ps + EPAP , unless I have missed something.

Mask leaks. 40% large leaks? Still learning how to read the info on Sleepy. I know that the leaks seem to be at the bottom. I tightened the straps tight but still get some air leaks. I will not be giving up, but I am a bit concerned that I may have not trialled the nose pillow long enough during my study.

Sorry if I didn't make all that clear.

[PaytonA]

One of the tricks that I found with the simplus is after you have put it on and started the machine, pull the mask straight away from your face for a few seconds and then allow it to reseat. This will ensure that the cushions get properly inflated.

Best Regards,

PaytonA

[trish6hundred]

Hi Stbrnd,
WELCOME! to the forum.!
It's great to hear that you are willing to learn about your machine.
Hang in there for more ideas on how to set it up and much success to you with your CPAP therapy and getting it fine tuned.

[me50]

Stbrnd

Were you diagnosed with central apnea or complex apnea? Your machine treats central apneas but if you don't have central or complex apnea, you wouldn't need that machine and that may be part of your problem....I dunno if it is or not. I have an S9 vpap auto and that treats regular OSA and goes up to 25.

I am curious who determined you needed an ASV machine and just as important, why did they make that decision? Maybe you can look at the start button on your machine and post here what it says.

Perhaps you can tell us more about the results of your sleep study.

[Stbrnd]

I have read the other threads that have people using the same device as me with more of the part where the discussion could be about something other than why I got this machine. Sorry that my explanation does not qualify me to ask questions here. I will figure it out as I did my diagnosis to begin with, on my own.

Thanks for the site and the secondary info I can glean as a reader only.

[DeepBreathing]

I have read the other threads that have people using the same device as me with more of the part where the discussion could be about something other than why I got this machine. Sorry that my explanation does not qualify me to ask questions here. I will figure it out as I did my diagnosis to begin with, on my own.

Thanks for the site and the secondary info I can glean as a reader only.

Stbnrd, the reason people are interested in your machine and diagnosis is that the VPAP Adapt is designed to treat a specific set of symptoms, not ordinary obstructive apnea. In particular, it's designed for central apnea and Cheyne-Stokes respiration. If this is your condition it requires different advice compared with obstructive apnea. If your diagnosis includes central apnea and/or CSR, please tell us so that we can advise accordingly. If it's obstructive apnea, again let us know.

You might already be familiar with the following, but I'll spell out for you and anybody else who might benefit.

The VPAP Adapt has three modes: CPAP (constant fixed pressure), ASV and ASVAuto. In both ASV modes, the three key parameters are exhalation pressure (EPAP), inhalation pressure (IPAP) and pressure support (PS). IPAP = EPAP + PS

The EPAP is either pre-selected (ASV) or automatically adjusted (ASVAuto) to control obstructive apnea. Then, on every inhalation the pressure is increased by an amount termed pressure support (PS) to give IPAP. The PS will automatically vary between preset limits (PSMin to PSMax) to control central apnea or CSR. The machine learns and matches your breathing pattern, so that if you pause in your breathing, it will continue to provide pressure support at the same frequency. If you stop altogether, it will instantly jack up the PS to keep you ventilated and stimulate spontaneous breathing. In this way the Adapt is not just a high end machine, it's actually quite a different type of machine, with a very different "feel" from ordinary xPAP machines.

Your settings will give you an EPAP between 4 and 9.4 cm H2O to control obstructive apnea. This is quite a long way below your Rx pressure. On every intake, the machine will boost this by between 5 and 10 cm H2O. You say that these settings are comfortable and your AHI is 0.5 - that's an excellent outcome. Frankly I'm surprised, but I know the Adapt to be a remarkable machine so perhaps I shouldn't be.

The other problem is the leak. This is measured in litres/minute and should stay below 24. Above that, the machine no longer has full control of the therapy (and the leaks will wake you up anyhow). Sleepyhead will report your minimum, median, 95 percentile and maximum leaks. It would be instructive to see what each of these is. You can pretty much ignore the maximum as that might just be a transient, but the 95% should be below 24 and the median should be well below.

I trust this has answered some of your questions, and also explained the interest in your particular machine. It doesn't disqualify you from asking questions, but it does raise a few questions of its own.