Newbie Needs Guidance

[rliggieri]

Hello Apnea Board,

I have been perusing this forum for a little while and decided it was time to join. Lot's of great people in here helping others out.

In December 2022 I was diagnosed with severe Sleep Apnea. Technically I was diagnosed with this a few years ago and ignored it. Naturally I'm paying the price for such a poor decision on my part. I will ignore it no longer. My Sleep Study Dr. wrote me a prescription for a Resmed Airsense 11 Auto with settings 15max / 5min cm H2O. Not very elaborate. I happen to have a new Aicurve 10 VAuto that was given to me a couple of years ago. My insurance only covers 50% after $250 deductible on the inflated DME provider pricing. So I don't really see a point of going through insurance right now.  I told doc I want to use my own machine and she seemed fine with it. But I haven't been able to attain the correct info to set it up. She was surprised that a user was able to enter these values in without the DME. I don't want to rely on her for the settings.  I know about setting humidity, mask type and all of that. I will be using DreamWear Nasal Cushion to start. I was hoping someone could help me out with some settings for a starting point.

I know I can make the unit sort act as a Airsense 11 Auto, but I figured why not use the features of a bi-level machine? I attached my sleep study report from the ResMed software she uses. My report is not pretty and it makes sense for me to learn what I am doing and take control of the situation. Thank you for any help.

[rliggieri]

Sorry here is my Sleep Study.

[mesenteria]

Welcome, and we're happy you joined.  Who knows, in time you might be one of the gurus here helping others.  I'm working on it, albeit slowly...and part-time. 

Your study shows that most of your 'problems' are at the high end of your trachea and further up toward your mouth and/or nose.  UAI (Upper Airway Index) is by far your highest form of resistance to a clear airway, as you can see for yourself. So, your tongue falls back, or your pharyngeal tissues lose tone and sag, or you experience nasal swelling/congestion....it's not clear without some video and better flow definition than what we have been afforded in the report.  But, my guess is that you sleep on your back more than you ought to.  This would be typical for many who have sleep apnea/hypopnea.  

Your desats (loss of blood O2) are quite severe as well, and contribute to the decision to label your case as 'severe'. You spend A LOT of time below 85%, which is alarmingly low all by its lonesome.  Notice that your highest heart rate was 104, indicative of either a disturbing/racy dream    or a response to the desats and the heart working commensurately harder to keep you alive.

There is nothing inherently wrong with your decisions so far, particularly if your reports in OSCAR show that you are being well treated. However, it couldn't hurt to try your treatment in simple PAP mode and fiddle with the parameters to see how it goes over a week or so.

You might spend a good chunk of your time figuring out how to minimize the risk of upper airway occlusions.  Avoid back-sleeping (supine), and once you start posting some properly formatted OSCAR charts, we may also recommend a soft foam cervical collar if you show a lot of clustering.

[Jay51]

You qualify for supplemental oxygen based on your Sleep Study.  Only 5 minutes below 88% qualifies.  You spent much more time below that limit.  

66% as the low saturation rate of the night.  This is concerning to me.  

If you download OSCAR (instructions given in a thread at the top of the main page), experts can get you dialed in as best as possible with it (to see if it will adequately treat your situation).   An SD card of up to 32 gb (no more than 32gb though) is needed also to transport the data from the AirCurve 10 VAUTO to OSCAR for interpretation.   Can post OSCAR charts here after that for help. 

Welcome to apnea board!

[rliggieri]

I am mostly a side sleeper, but do sleep in all positions at some point in the general 6 hour period.

[quiescence at last]

thanks for stopping in. you will be able to find manuals and assistance at this site. did your doctor access your machine and put initial settings in? does you control panel/screen indicate the current settings?

Look for the tab at the center - top of page, that reads "CPAP Setup Manuals".

Good luck,

QAL

[rliggieri]

No the Cpap machine is my own, all settings are default. The Dr. only gave me settings for Airsense 11 Auto. Thanks again. I will post some results next week.

[rliggieri]

Ok here are some charts from the last two days. The first day was all over the map so I didn't include it. 

Notes:

It should be in my profile now, but it should be known that I have rather large Tonsils. In the first chart (2/14)you will see a big leak near the end of my sleep. This should be excluded as I took my mask off before I hit the stop button. On 2/15 my sleep wasn't as good. I had to stop/start for a bathroom break and I also fiddled with my mask a bit more because it was hurting my nose. So more leakage. 2/15 images are in next post. Anyway, thank you.

          

[rliggieri]

2/15 Chart

       

[Jay51]

A few things jumped out at me.  

1.  Leaks are very bad and need to be fixed (adjust mask or get another one that fits better).

2.  Minute vent. rate is around 20.  Average for a person is around 12 to 20.  You are at the high end (and 31 as a high).

3.  Tidal volume - 380 on the 1st set of charts and 420 on the 2nd set.  Lower than normal.  Around 500 is normal.  420 is not too bad. 

4.  Your inspiration time is very quick (1.00).  Expiration a bit fast also.  

5.  I remember from your sleep study that your SPO2 took very large dips and stayed lower than normal a large period of time. 

Your large tonsils may be impeding flow during breathing.  You seem to breath faster and swallower than a normal person.  It is like you are almost hyperventilating.  I am not sure how to tweak your setting to improve this (or if it even can be improved with your large tonsils).  Someone else may want to post about that.