Newbie - Help with AirCurve

[Apple83]

Hello, would appreciate any help with my AirCurve settings.

Diagnosed with OSA a few months ago based on a home sleep study. AHI was 15. I'm healthy, in my 30s, normal BMI, loud snorer, have a flat face and lots of nasal congestion.

I struggled with my first machine (AirSense auto 10) due to high clear airway events. My average AHI on that machine was 20 which was almost all centrals. I have had a cardiac workup and it was fine.  I do feel significantly better on CPAP than off CPAP. 

Switched to an AirCurve VAuto - I purchased this myself as the wait to get a sleep study right now with COVID where I live is going to be months and I wanted to at least try to get my AHI better. I set the trigger to very high to try to help with the centrals. 

First night my AHI was 5 which was the best I have ever had with a machine and I thought I was on the right track. Unfortunately last night my AHI was back to 26.

Any thoughts on how to tweak the settings until I can get my sleep study? See attached sleepyhead graphs. 

   
   

[Sleeprider]

There are two things going on here. The clusters of OA are a signature of positional sleep apnea, usually caused by chin tucking. I'd like you to read our wiki on Positional Sleep Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea and the Soft Cervical Collar http://www.apneaboard.com/wiki/index.php...cal_Collar Please note how similar the example charts in those articles are to your own problems. The use of a soft cervical collar can prevent the flow limitations and pressure changes that are disruptive to your therapy and make your central apnea events worse.

The Aircurve 10 Vauto is probably the best machine on the market for obstructive sleep apnea, however it does not have the needed features to treat central apnea. That is the role of an ASV (Resmed Aircurve 10 ASV), which provides enough pressure support when needed to cause a breath when you don't spontaneously breathe. Your Vauto however has some useful features that can resolve some treatment emergent centrals. What we want to do is stabilize your pressure, lower your pressure support slightly and change the sensitivity setting for triggering IPAP which will make the machine more likely to trigger IPAP when you miss a breath or have a weak inspiration signal. Your new settings:
Mode Vauto
EPAP min 7.0
Pressure Support (PS) 3.0
IPAP max 14.0
Trigger Sensitivity: High
Cycle Sensitivity: Medium
Ti Min 0.5
Ti Max 2.5

[Gideon]

Welcome to the forum.

SR you got to this before I did.

Two very different nights.
4 July I saw a lot of Flow Limits (Flow Limit Chart) and was about to suggest increasing your PS (don't right now) then I saw 5 July with the heavy clustering, almost certainly chin tucking there. Since that only happened once, I suggest that you read up on it, and wait for it to happen again. Now you are aware of it, avoid it, if you see it again then act and get the soft cervical collar.

I'd like to see some closeup of the 'clusters' of Central apnea, a 5 minute view just to see what it looks like for now. I want to see if it looks like it is CO2 driven, a reasonable possibility, and if so possibly utilizing EERS to increase your CO2 levels and curb your Central Apneas. http://www.apneaboard.com/wiki/index.php...ace_(EERS)

[Apple83]

Thank you both, I really appreciate the advice. 

I've ordered a soft cervical collar on Amazon to try out.

Will adjust the settings as you suggested. 

Here is a zoomed in view of the CA events. 

   

[Gideon]

Not what I was expecting, The flat bottoms of the flow rate chart indicate expiratory mouth breathing. Normal inhalation and exhaling through the mouth. The soft cervical collar is a fix for this by keeping the jaw/mouth closed. The traditional fix is a chinstrap. Chinstraps freque\ntly fail but a good chin strap is the Knightsbridge Dual Chin Strap which pulls up instead of back.

Your Central Apnea look more idiopathic (unknown) vs. CO2 driven and as such EERS is less of an option.

[Apple83]

Thank you. I am definitely a mouth breather. During allergy season (now) I can’t really breathe through my nose at all.

Hopefully the soft collar would prevent the chick tuck without necessarily completely stopping the mouth breathing as I don’t think I can breathe only through my nose.

[Gideon]

There are many solutions to mouth breathing, Here is the appropriate section of the Mask Primer

http://www.apneaboard.com/wiki/index.php..._Breathing

[Apple83]

Update: Two nights with the soft collar has made a huge difference. 

Dealing with some leak problems - I've but in an order for the smaller mask to see if this helps as it's now leaking under my chin with the collar on. 

Here is my graph from last night, thanks for all your help. 
   

[Sleeprider]

Apple83, what brand of collar did you get? (don't post link). We can use more reviews of soft cervical collars if you are willing to share a review.

[Apple83]

Feeling frustrated. I had 3 nights with AHI below 5 with the soft cervical collar. Then I had a night with AHI 22 (almost all obstructive events) and I increased the IPAP slightly. 

The last two nights here is my graph. This is similar to what happened with my airsense autoset - would have 1-2 good nights and think things were getting better and then it would get worse. 

The only thing I notice is that my nose is more congested the last three nights.