[Treatment] John70's Therapy Thread

[John70]

I am a 4/year veteran using ResMed Air Sense 10 with a F30 FF mask. My APAP settings 8 to 15 cmH2o with a daily AHI average 5. From the beginning I had an issue with my mouth opening, hence I purchased every FF mask and have settled with the F30 for almost 2/years. 
My concern now is dry mouth even with Manual Humidifier set @ 8. 

I am on a quest to go back to nasal or pillow mask using "Cover-Roll stretch" tape. I partially cover my mouth in the middle which works great. 
My pulmonary doctor agreed I could lower my pressure to 10 cmH2o on the CPAP setting, no ramp, no EPR with my AHI's still under 5. 

My issue is that I feel weak and tired that I am not sleeping as shown in my RERA and Leak Oscar report.  I do not have a problem with the F30 leaking. 

I am trying the new F&P Evora, Dreamwear Nasal mask and the P10 and Swift FX pillow mask to see which will give me a better result. 

I am wondering if I should go back to APAP with a range of 8 to 11 cmH2o or stick with CPAP.

Tonight I will be trying the ramp on "AUTO" to see what happens. Also, I will use the EPR on 1 with a P10 nasal mask.

This is my first post on the Apneaboard. I am looking for a successful outcome, so I can start to feel less tired. Granted I know it could just be that I am getting closer to dying.  

[OpalRose]

John70,
Post a screenshot of your data so we can see what or if any changes are needed.

Follow the link below on Organizing your chart and then use the Attachment Feature to post a chart.

[John70]

The attached chart show using the P10 for 2/hrs using EPR setting on 1 and ramp on Auto. I did use partial mouth taping. CPAP pressure setting @ 10 cmH2o. The whole 2/hrs I did not sleep.  I thought about the situation for awhile then switch to the F30 using APAP 8-11 cmH20. no ramp or EPR. Sleep was not good, so turned off the machine and went to sleep. My wife said I did snore a little. 

The pulmonary doctor messaged me yesterday to let him know if 10 cmH20 is a struggle. He said CPAP should help as much as APAP. He knows I am using the Cover-Roll tape as I have tried other tape and options. He said there are videos on oromyofunctional therpy to improve snoring and breathing.

   

Tonight I will leave off the AUTO ramp and EPR setting. Still stay on CPAP @ 10 cm with a full mouth taping to see how I do. Again if I am not sleeping I will go back to using the F30 on APAP maybe 10 to 15 CM 

I appreciate this forum and reading other members stories. The people really inspire me to do whatever it takes to succeed.   

Thank you, 
John70

[Gideon]

John,
You need to set EPR = 3 full time

do that and let's see what happens to your excessive flow limits.

[John70]

The attached OSCAR reports shows: APAP setting 11-13 cmH2o, EPR 3. Partial mouth taping.

I used the P10 until around 12 with partial tape which indicates large leaks. I was dead tired so at least I was getting some sleep. I put the P10 back on for a hour which looks really good however I notice a very small leak while still not asleep and switched to my Swift FX nasal around 2 am. The Swift FX is showing leaks also with more CA's.

Conclusion: My APAP setting going higher to compensate for the leaks. 

Tonight I will stay with the P10. I will try a new cushion with Partial mouth taping.

I do not know why I am seeing so many CA's while using the Swift FX  The other events flags look really good using the P10.

The EPR setting full time @ 3 really made a difference, Thank you. Gideon

   

My doctor did not have a preference using CPAP verses APAP, hence last I went with the APAP setting, last night. It I were to use CPAP the setting would be closer to 11 cmH2o rather the 10 cm as previously noted. 

Any comments or suggestions would be very much appreciated.  

John70

[OpalRose]

John,
Looks like you did better with the P10, although it was only about an hour and maybe you weren't sleeping.  

I think you should stick with one mask instead of changing throughout the night. Pick the one that's most comfortable for you. Give it another day or two, and try to stick with the same pressure settings for a night.

[Gideon]

Conclusion: Incorrect,  Pressure (setting) does not higher to compensate for leak.  Flow from the blower increases to maintain set pressure when a leak occurs.

Pressure (setting) goes high in response to Flow limits, and your 95% FL stat .f  .19 is nearly double the .10 we like to see as an indicator.

We reduce Flow Limits by increasing EPR or PS (which may increase central apneas.) and it has on both counts. Your Flow Limits are reduced from .31 95% value and your hypopneas and RERAs are both also significantly reduced.  Unfortunately (both good and bad) your CA events are up (Bad) from .97 to 2.47 CAI as predicted.  The good is that the CA went up indicating that they definitely are CO2 related and are likely to become much reduced after 2-3 months of use.

Pressure fluctuations also tend to increase centrals.  To minimize this try setting min-max = 11.8.

John, you have been using CPAP in some form for 4 years, thus you are way beyond the 2-3 months to reduce the CA unless you have been a very non-compliant user and have not used your pap enough.  I don't believe that is you.  BUT, the answer to that question makes a difference in your path forward so please let us know which you are.

Your path forward. 

1. Looking at your Obstructive events.  You need the ResMed AirCurve 10 VAuto, a BiLevel.  Your obstructive numbers responded well to the increase in EPR (PS) from 1 to 3 but your flow limits are not where they need to be.  The path to there is to raise PS above the max 3 (EPR) we can achieve with your current machine.  My Guess is you likely need a PS of 5, maybe 6 but if you go this route we will start with 4.    There is a setting on the VAuto called the Trigger setting.  Setting it to High, maybe VerHigh increase the quickness the VAuto responds to an inhale, think a weak inhale, thus triggering a full breath and thus preventing some central events.  Several of our users here use this trick successfully.  Will it work for you? I honestly don't know but it is worth trying.  Note that increasing the PS/EPR to above 3 will almost certainly, in you, increase the CAI.  The hope is the trigger setting overcome this.
   
2. Looking at the increased CA events with the increased PS/EPR needed to the obstructive events, Hypopnea, RERAs, Flow Limits resolved an ASV is a choice.  The ASV is designed to treat central and mixed apnea, it also does a fine job on obstructive events.  This is normally a followup to the BiLevel therapy (which will not/should not work for CA events) in a long road to getting ASV
   

IMHO in your case I think the VAuto may be the better option, hoping that the VAuto Trigger setting will help you out.  Note that this is "trick" that your doctor is unaware of.



Note the doctor's typical book says try CPAP/APAP (done), Try BiLevel without backup (timed forced breaths) (VAuto), and if that fails and CA is present try and ASV.  So doing #1 above should fit his playbook.

[John70]

        Gideon, 


I was not 100% compliant after my 1st Sleep Study 4years ago. Since my 2nd Sleep Study 3/years ago, I have been 100% compliant. I thought I was doing well with the daily info I received from ResMed myAir report. Apparently, I was wrong according to my OSCAR data. Now I know, I have not been treating my Sleep Apena as good as I can.
I am semi-retired and have more time to study the problem. The problem is now compounded since initially I wanted to address the dry mouth problem that has caused many teeth cavities. I do use the biotene spray and mouthwash. At any rate the mouth taping with a nasal or pillow mask was my attempted solution. 
I see all the events going back years with OSCAR that I have completely ignored, since my doctor never made them an issue. 

I called my DME supplier Lincare. They said I would need a RX from my doctor for a BiPap machine. Obviously, I want to control my CA's with a BiPap machine if needed. 

I am assuming my Doctor will want to do another sleep study before giving me a subscription for a BiPap machine which I will do if necessary. 

In the meantime, tonight I will set my CPAP pressure @ 11.8 cmH2o with EPR full time on 3 and see what happens.

Thanks Gideon so much. If you looked at my SD over the last 1100 days, I would be curious to hear what you would say about my therapy. I purchased a new SD card from Amazon in case you would be interested. I am also going to see if my Doctor would do the same, since it seams my flags have been all over the place seen with OSCAR not seen by me ResMed myAir report.

[Gideon]

In preferences, change OSCAR to report RDI.

RDI = AHI + RERAS and is legitimate for the evaluation of therapy.

I'll guess that typical Summary info Cherry picked and printed and presented to your doctor will be enough to show a CPAP isn't cutting it generate a list of symptoms as well.

[John70]

   

Good Morning Gideon,

CPAP pressure @ 11.8, EPR 3 Full Time looks good. Thank you.

Leaks were with the P10 full mouth tape and a 3/4 slit that did some leaking. I will be trying a different type of tape to cover the slit that can be pulled off quickly if I need to sneeze or talk.

CA's not so good without a BiPap machine. It is clear now I need a BiPap machine. I will be messaging my doctor today. 

I will be indebted to the Apena Board for the help I am receiving.

Will this thread stay open for awhile until I get my BiPap machine?

I would love to report a successful outcome with the Apnea Board.

Thanks again, Gideon

John70