SoSmilie therapy thread

[narual]

I have a couple of different night's recordings for my wife using her AirCurve 10  VAuto (which the DME is STILL trying to tell her is the wrong device and she needs an ASV despite the doctor telling them they're reading the prescription incorrectly).

One is from a few weeks ago, before her scheduled zoom call with the DME rep that started the fiasco in the above-linked thread. After that call she hasn't used it much (because why would she believe a bunch of people on the internet over the "expert" whose job it is to tell her over a zoom call how to do something she already knows how to do and had been doing for a few weeks). She was using the F&P Eson2 with that one. The other is from a few days ago, using a Resmed F30i, which definitely leaks a lot more than the Eson2. She doesn't need a full face mask, but I started out with one so she was trying it out. She's still messing around with different masks to decide what she likes best. (Seems like wearing the same mask for more than a couple days starts to irritate her skin). 

In both cases, she was wearing a pulse oximeter ring for at least part of the night, so I included the spO2 graph as well as the standard charts.

There are a few settings changes between the two - the more recent one is probably not correct, but this is why I'm posting them here, so we can get the right settings dialed in.

I'll note that she's been complaining that she feels more tired on days that she's used the cpap the night before. She hasn't gotten into the habit of using it every night yet, and that's one of the primary reasons why (in addition to the nonsense from the DME, of course).

And I should also note that her in-lab sleep study results showed her to have an AHI of something like 78, and her titration study showed that her apneas weren't adequately controlled until pressures were over 20, which was why the doctor prescribed an aircurve rather than an airsense. Her Oscar reports using the air curve certainly don't resemble that in the slightest, and my assumption is that the horribly ill-fitting mask they sent her home from the titration study with had rather a lot to do with those results.

Suggestions to help her dial in ideal settings are most welcome. Thanks!

*edit* I just noticed that I didn't update the Aircurve to full face when she switched masks - not sure if that affects that graphs at all.

[Sleeprider]

Nothing in these charts suggests the need for ASV or any RAD with a backup rate. SpO2 is well-maintained and other than the leak issues on 10/21 results are pretty good at very low pressure. What is the trigger sensitivity setting? Might want to change that to high.

[narual]

Thank you!

Trigger sensitivity was medium, I’ve updated it to high.

Do you think I should move the min epap back down? It’s at 12 now, but on her earlier session it was set at 4 (her prescription was “throw it at the wall and see what sticks” I guess — 4-25) and her 99.5% then was only 6.34, and other records seem to track with that.

I finally got the nurse on the line today, and she says that last week, they sent a revised prescription without the extraneous handwritten part that proved so very confusing to the DME , so hopefully they’ll stop trying to give her an ASV now. ?‍♂️

[Sleeprider]

I don't see a need for higher EPAP min on this user. We are just going to make it easier for the machine to trigger IPAP which should feel fantastic and be more responsive.

[narual]

Thanks! I set the trigger to high and reset the min epap to 4. She's trying a resmed P30i tonight.

[Sleeprider]

Once you have data, it should show whether we are on the right track for both results and comfort.

[narual]

She used it for about 3.5 hours, with an AHI of *zero*
There's a messed up bit at the beginning because they weren't plugged into the headgear properly on one side and it was leaking, and she had a hard time getting it seated properly - we both feel like the angle of the pillows seems off a little, but they still work once they're in.

I haven't seen her yet today, but I'll update with any feedback she had.

[Sleeprider]

The higher trigger sensitivity seems to have helped, and leaks are not bad here. Still no indication that ASV is required. The rule of thumb when dealing with an issue like this is to remember all DMEs are awful and prone to making making serious mistakes. That is the case here. You may wish to let the doctor know that the supplier appears cconfused and is advocating a change in machine. It is beyond obvious that this is effective therapy and an ASV would be a disastrous mistake. It is not the job of the DME to think or interpret a prescription. Their job is to follow it, and if there is any confusion, it is the doctor that must provide the clarification. The DME is the store clerk. Don't let them go beyond that role.

[narual]

Thanks! I’m attaching the prescription that the dme found so confusing. The nurse sent them a new one without the “confusing” bit last week, so hopefully that saga of nonsense has ended.

[Sleeprider]

It's pretty straight-forward, and the Auto SV is not checked and settings would not work for that. The way the script is written it would normally be filled with a Philips BiPAP Auto machine which can be set to a range of PS In fact this looks like a prescription form provided by Philips and uses trademarks like BiPAP, SV etc. This is a marketing tactic to make prescribing their machines easier and technically prevent the script from being used for competing devices. Don't let them take the Resmed which is much better in the way it comfortably delivers air with EasyBreathe™. The handwritten pressure notations of Min IAP 4 and Max EPAP 20 was written by someone that is clueless or distracted. The prescribed settings are a default, full-range for a Vauto, but expect that they should be optimized. While the script stipulated a full-face mask, I encourage you to try the Resmed Airfit P10 pillows as a trial. It could either greatly improve comfort and leaks, or fail due to mouth breathing...worth a try.