Rogueshot's Therapy Thread

[Rogueshot]

Good day all,
New to the forum. Thanks for being here and allowing me to join.

I've been on a BiPAP for 7+ years. Back then the sleep study could hardly figure out the issue through the haze of so many CA's (I don't have a copy). But a few weeks using the AirCurve 10 VAuto along with an anti-anxiety med, sleep on right side (always) allowed me to adapt to using the Bipap and reduce apneas to around 1-5 AHI. Pretty successful and felt rather rested. In those 7+ years I've never had numbers adjusted, never revisited doc (they actually forgot I was a patient), and have just slowly replaced pieces/equipment (ie. nasal, hose, etc). 

Fast forward to now. I've been working to shed weight - lost about 45 pounds over last 7 months. Thought this would really help my apnea and maybe even get me off the machine. But, I've been struggling with higher AHIs for the last couple months. Now routinely struggle to keep AHI's down - seems to range from 6-19 AHI. Almost all are CA events and I do find they flare up if I'm stressed. I find myself now rolling on my back, air escaping through mouth, drooling. 

After fighting with my doc about being their patient I do have an appointment next month. I will share some of my Oscar reports - I have years of data. lol.  I'll try to share data later today. 

Definitely interested in your input on suggested changes and also on questions to ask the doc. 

Many thanks!

[Rogueshot]

I've attached snips of my August data which was pretty normal and then a couple recent data in October. I'll spread it over 2 posts.

Note one day in October I was on vacation in a new bed and my numbers were pretty good though I woke-up often to check on them. Which makes me think anxiety/stress does have a role in this, but I have to believe setting adjustments could help.

Rather Normal Readings
           

Current Readings
   

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Current Readings (cont)
         

Vacation Reading
   

[Rogueshot]

I changed my bed some to make it more firm and forced myself to sleep on my right side and had better numbers for part of the night. When I rolled to my back the CAs went crazy. Overall ended with an AHI of 7 last night.

I welcome suggestions for improved settings. 

Take care all!

[Sleeprider]

There are to things we need to do to improve your results. First your pressure support is 6-cm at 14/8 pressure. You have no suggestion of obstructive events or flow limitation with this, so I strongly recommend reducing the pressure support to 4 or 5 cm. My suggestion is to use Vauto mode and keep the same settings with trigger sensitivity at high. This will give you auto-variable pressure with PS 4. if you must use S-mode, you can try 13.0/8.0 to achieve PS 5.0, or try 13.0/9.0 to get PS 4.0. Since you are using S-mode, be sure EasyBreathe is on. Top-line recommendation, use Vauto mode.

[Rogueshot]

Many thanks for the reply Sleeprider! I'm happy to give the tweaks a try.

My first inclination is to try the S-mode tweaks to 13.0/9.0 to get PS 4.0. EasyBreathe is on.

If I'm still struggling then I'll jump to Vauto - very interested in seeing how this works.

Thanks!

[Rogueshot]

My suggestion is to use Vauto mode and keep the same settings with trigger sensitivity at high.  This will give you auto-variable pressure with PS 4.

Question - if I use Vauto mode you mention keep the same settings. Should that be 13.0/9.0 to get PS 4.0 or something different?

[Sleeprider]

With Vauto mode, you set a range for EPAP min and IPAP max, and the pressure support. The machine will maintain the minimum EPAP as long as there is no significant flow limitation or obstructive apnea. If either of those are detected, the machine increases EPAP and maintains the same pressure support. So if you started at EPAP min 8.0 and IPAP max 14.0, your initial pressure would be 12/8 (PS 4). That could rise as high as 14/10, but considering your posted results I don't think you will see much pressure variation. Vauto works very well to put you in the zone that prevents respiratory resistance or obstruction. My own range is EPAP min 9.0, max pressure 18. PS 4. I don't very often see the maximum pressure.

Your central event index is going to drop dramatically with the reduced pressure support and use of high trigger sensitivity. I hope to hear some amazement tomorrow.

[Rogueshot]

Sleeprider...you sir are a magician or some sort of miracle worker.

I checked my numbers way too many times last night as I was in disbelief. AHI of 1.1.

Simply changing the mode to Vauto and setting my values to 8 & 14 and trigger high would result in such a low AHI...I'm amazed.

I even tried sleeping on my right side, left side, my back and yet the numbers stayed low. It's a new world for me.

Many thanks. Now I'll try to not wake-up as often and get a better night's data sample to share. I also might change my ramp from 15 to 10 minutes.

Thanks again!

[Sleeprider]

Not to make this sound too simplified, but those are the expected results, and I'm not a magician. This is simply a set of practices I have used over and over with consistently good results in members like you.

[Rogueshot]

Crazy immediate improvement. Didn't think such a thing would be possible. AHI < 1 .... something I haven't seen in almost a year.

Many thanks. Here's data from last night. Don't give up hope all. 

Now, how to explain me changing my settings to my doctor next week...