Panthera - Therapy Thread

[Panthera]

Introduction
Hi everyone, it's a pleasure to join this incredible forum after lurking for a few weeks. I am a 33 year-old male living in the USA who has been suffering from poor sleep quality for as long as I can remember. For the longest time, I just assumed I wasn't a "morning person" because I could never wake up feeling refreshed and would often be late for anything morning-related. 

I didn't suspect that I might have Sleep Apnea because I never received complaints from family members or my wife about snoring, choking, etc. I also have a fairly thin build so, in my mind, I didn't fit the typical mold of someone who could have Sleep Apnea. Over the years, as I noticed my situation getting worse, I started to notice other signs such as my Fitbit consistently logging below-average amounts of REM sleep, seemingly random morning headaches, labored/shallow breathing upon waking up, ever increasing bouts of ED/low sexual libido, etc. 

Diagnosis
I just knew that something wasn't right with me so I decided to bite the bullet and take a Lofta at-home sleep test. The results are attached. In summary, the doctor diagnosed "Obstructive Sleep Apnea (G47.33) - Moderate based on pRDI=17.4 and O2 nadir of 84%". My AHI was measured to be 4.6. 

The more I started learning about Sleep Apnea, the more I became convinced that I might have Upper Airway Resistance Syndrome (UARS). Instead of going through the headache of the traditional medical system and insurance, I decided I would self purchase the necessary equipment to attempt PAP therapy. If it doesn't work, it doesn't work, but at least I would know for sure instead of wasting away years of my life speculating like I had done previously. 

Dilemma
During the recent Black Friday/Cyber Monday sales, I purchased a Resmed AirSense 11 Autoset. The equipment just arrived earlier today and I haven't yet opened the box. Also today, I noticed a potential opportunity to purchase a Resmed AirCurve 10 VAuto (Card-to-Cloud Version) for $250 more than what I paid for the AirSense 11. 

I've seen plenty of perspectives which suggest that the AirCurve 10 VAuto and its ability to provide BiLevel therapy might be better suited for my situation. This leads me to the first major question as I embark on this journey:

Considering my situation and sleep study results, would you recommend that I return the AirSense 11 Autoset and purchase an AirCurve 10 VAuto (Card-to-Cloud) if the marginal cost is $250+return shipping?

Thank you so much in advance for your time and help,
Panthera

[SarcasticDave94]

The VAuto would be more capable, generically speaking. You don't have Central Apnea, so you'll not need higher therapy requirements than the VAuto.

You'll have to decide if the extra money is needed. The AutoSet will provide up to 3 cmH20 of pressure differential in the exhale to inhale via EPR. The VAuto has the similar functionality but called PS, which goes above 3 cmH20. That is your biggest difference.

[Panthera]

Noted, thank you. I decided to pursue the AirCurve 10 VAuto.

I will be sure to post some Oscar graphs after it arrives to request feedback on fine tuning the therapy.

[SarcasticDave94]

OK, it'll be easy enough for members to help you dial it in. When I've had the proper therapy, I've only been the one to edit my settings. The ASV I had for 2 years, took about 1 minute to program. Really easy, and good luck on therapy.

[Panthera]

Hi Everyone, I purchased a ResMed AirCurve 10 VAuto and have been utilizing it for the last 2 weeks. The first two nights, I couldn't get much sleep with the machine on due to anxiety but was able to overcome that. The next big issue I ran into was mouth leaks so I started mouth taping and that's been a big help. The current struggle I'm facing is that I have a tendency to subconsciously/unconsciously wake up in the middle of night and remove the mask because it almost feels suffocating. As a result, I'm only logging a handful of hours of therapy per night vs. a full night. I've always suspected my REM sleep to be the most poor so it's a shame I'm not getting the therapy benefits for those later hours of sleep. 

Attached are charts from 2 recent nights with the most data (Dec 25, 2024 and Jan 4, 2025). 

Help requested: 

• Any suggestions for how to make the therapy more comfortable so that I don't take the mask off in the middle of the night? I'm doing the typical things such as climate line tubing, humidifier, etc. 
  
  
• Any suggestions on how to further fine tune my settings? I'm not surprised by the low OAs because I've never really exhibited signs of obstruction but the CAs are a bit surprising. I figured that my poor sleep quality was caused by UARS, but it doesn't seem like flow limitations have been an issue. The part I'm most unsure about is what Pressure Support (PS) to use. 
  

Thank you.

   
   

[SarcasticDave94]

Try PS 3 or 4, it's very likely too high.

PS or Pressure Support, it's the difference between EPAP exhale and IPAP inhale. It is used to leverage inhale intake some by that differential. It also makes exhale easier as well.

Try Trigger High or Very High to reduce some CA, after lowering PS.

[Panthera]

Noted, I will lower to a PS of 4 and report back. If that doesn’t help much, I will adjust the trigger to High or Very High to see what happens.