Oscar Data. No events flagged but weird flow rate pattern during REM

[Ynot]

Hi everyone

I should be getting the aircurve 10 vauto in a few weeks

What settings should I try out based on my data and problems.

I'm thinking maybe PS 4 to start out, but are there any complicated settings that I will have to adjust?

Thanks!

[Dormeo]

On your current machine, your settings are 8.4 to 15.4, with EPR of 3. This means that your current maximum IPAP is 15.4, and your minimum EPAP is 5.4.

So on the new machine, start by trying minimum EPAP of 5.4 and maximum IPAP of 15.4, with PS of 4. (Remember, PS is added to your EPAP pressure values to yield your IPAP pressures, not subtracted from your IPAP pressure values to yield your EPAP pressures, like EPR.) Leave all the other settings at their default values.

I hope someone will check my arithmetic on this!

[Sleeprider]

I agree Dormeo. The actual range would be EPAP min 5.4, IPAP max 16.4 PS 4.0, but Ynot does not use the upper part of that range anyway, so it could be quite a bit lower.

[Ynot]

I see. Sorry about that - just updated my profile, I compressed the range to 9.0-13.2 which I think is more appropriate, but I see the pattern.

Thanks for the insight

[Ynot]

Hi all,

With cpap, my flow limitations were quiet extreme each time I entered rem sleep. I switched to the aircurve 10 vauto, and my flow limitations have greatly improved, and I feel much better. However, I have tried a variety of different epaps and ps, and it seems like I'm always having either flow limitations or treatment emergent central apneas. I am still tired regardless of the settings.

I wonder if you guys can help me find a solution or the optimum settings.

Has anyone with UARS and TECSA manage to solve this problem?

Reading the optimizing therapy apneaboard wiki, I came across this potential solution:
"I was experiencing random CA events in the 1 to 3 CA per hour range at 3 cm pressure support on both the PRS1 760 BiPAP Auto and the Resmed Aircurve 10 Vauto. Anecdotal evidence from various forum posts suggested these events might be reduced by increasing trigger sensitivity on the Vauto from Medium to High or Very High. The OSCAR overview chart shows the trend for reduced CA events after this change was implemented in late June 2019. While this may not work for all individuals, it appears that increasing trigger sensitivity on the Vauto may improve the incidence of idiopathic CA events from the use of pressure support."


I've also seen ASV used as a treatment method.

However, it seems to me that TECSA is different from complex sleep apnea since the cause is overtitration and low serum CO2, assuming it is not a hypersensitivity. If so, wouldn't it be unhealthy to force a breath and continue to wash out the CO2 if TECSA arises.... or is it just a hypersensitivity?

Thank you!

[Dormeo]

I don't know the answer to your specific question. But for others, it might be helpful to see a recent chart showing the CAs and FLs that are of concern to you.

[Ynot]

Here's last night. I decided to see how I slept with the minimum epap since OA was never an issue. I previously tried 8ipap, 3epap, and lowered it because I noticed some central events (there is flow limitation as well). I added a closeup of a segment with flow limitation and one with both flow limitation and a central like bundle pattern (I think according to a leankylefty video). 

I can find a sweetspot with the "appropriate" ipap for any given epap where the obstruction and centrals are minimized although present. If ps is too high then I get pretty much no flow limitation but lots of centrals. I decided to give epap 3 a try but I think the flow limitation looks worse than "sweetspots" with higher epaps. 

Thanks

[Ynot]

Here, all the tagged central events, I'm awake

[Ynot]

If you want to see specific settings, just let me know, since I have probably tried them or tried similar ones.

[Ynot]

Worth mentioning that pretty much all of my breathing problems are exclusively during rem sleep.