[Pressure] Need Advice On What Settings to Adjust Resmed Airsense 10

[jaswilliams]

Looking at your graphs you have posted this is central/mixed Apnoeas d it’s unlikely that machine setting changes will help and over time you will find the inconsistent data in line with others with central apnoea. One session an ahi of 0 the next an ahi of 10 or more.

[Stoaty]

While I had low numbers with the pressures set at 5.2/4.6 I didn't feel as good during the day.  Felt a bit "drugged" and like I wanted to take a nap.  Went back to 5.6/5.6 with no EPR last night and had just one 5.5 hour session (trying to adjust to wearing mask for longer periods of time).  Came out almost perfectly with AHI - 1.08 and feel significantly better today.

PS I have a heated tube to deliver warm and humid air.  It is currently set to 76 degrees. What temperatures have others found to work best?

   

[SarcasticDave94]

I find that heated hose should be adjusted to prevent rainout, tube condensation. I had run higher humidity on a ResMed ASV, manual mode between 4-8. With that I needed heated hose of 80-86°F.

How I found what heat setting was first get humidity where needed then set hose temperature where needed to combat moisture.

[Geer1]

If I understand your recent comment right you feel better at 5.6 cm then 4.6-5.2 APAP range. That may be the case or it may be a night to night difference, 4.6-5.2 cm range probably ended up at 5.2 cm due to your flow limitations and that isn't noticeably different then 5.6 cm.

As Jas said your results are likely to fluctuate because of the type of apnea you struggle with. These basic machines do not treat central apnea unless your central apnea is caused/worsened by obstructions or if they are treatment emergent centrals that go away after you adapt to CPAP.

If you feel good enough on these settings you can leave them as is. If you think more is required to get sufficient treatment then you will need to try higher pressure again or try ASV (which you would probably have to buy out of pocket or attempt to get a titration study through sleep doctor). Since your results are intermittent a titration study might not result in qualifying you for ASV (if centrals do not occur that night).

[SarcasticDave94]

I don't recall if any one thing has been tried and succeeded in even a several day successful therapy trend. My swiss cheese memory thinks it's been a series of one night only non-trends.

[Ratchick]

Agreed, I really think we need to wait and see what the sleep study said, and especially as effectively the OP is "starting over" after a several month break away from using APAP.

If you're reasonably comfortable here, then keep the settings here and test them for several days or a week. My stats are all over the place and so trying to tell a trend is hard going on APAP (and yes, I need ASV, and yes, I'm still kicking my doctors).

[Grandpapa-G]

I think the last graph indicates most (probably all) of the centrals occur during brief arousals, probably due to movement (changing positions or limb movements). This would result in short periods of SWJ. I make this conclusion from the tidal volume graph which is a good diagnostic for arousals as they will show spikes in the tidal volume.

[Geer1]

You have to be careful drawing that conclusion because centrals also cause peaks and valleys in tidal volume chart. I often use TV chart when analyzing people with centrals because you can even see the periods of periodic breathing that don't trigger central apnea flags (shows up as smaller oscillations).

The flow rate chart is a better indicator of arousal breathing because arousal breaths show up as large uneven breaths. Tidal volume is the area under flow rate chart (bigger breath makes a spike in TV) so it can spike if there are arousal type breaths or for any other large breaths. In central apneas there are periods of cessation followed by larger amplitude catch up breaths which cause a TV spike but these aren't always associated with arousal.

In this case I do think you are right that some of these centrals could be related to obstruction/arousal but you can't always draw that conclusion from TV chart alone.

[Stoaty]

OK, got my sleep study:

   

[SarcasticDave94]

FWIW the big thing in mining out of this is there appears to not be an effort belt. Is this accurate?

If so, CA would not have been flagged. As is, Obstructive events present. Dr. Dolittle diagnosed mild Obstructive Apnea, and scripts a lazy default 4-20 pressure set.