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[Treatment] Making my own settings
#1
Making my own settings
Long post, sorry. Hello, I'm new here. I'm interested in feedback, and in getting better educated on how to manage my own sleep care.

I started with CPAP therapy ten months ago, but not in the "official" way. My sleep had been getting worse for a couple of years, perhaps around the time I turned 60. Breathing while lying on my back (the most comfortable for sleeping) had become very difficult even when I was awake. I tried sleeping only on my sides for quite a while, but my hips would ache and I'd have to get up. For a long time I'd had episodes of waking suddenly with a racing heart while on my back. For at least a year I would wake with a very dry mouth and a headache. My husband told me I was gasping and snorting for air. Basically, lots of classic sleep apnea symptoms.

I did not want to admit that, and I didn't want to try CPAP. My husband has been using it for about ten years, and I was convinced I would never be able to sleep with something strapped to my face. I tried special pillows and a lot of sleep hygiene suggestions with no effect. Then a friend gave us a secondhand Airsense 10 Autoset with the idea my husband could use it as a backup. I decided to give it a spin one night just to rule out CPAP.

So, I strapped on the mask and figured I'd give it ten minutes or so before taking it off. You guessed it, I was out like a light and slept all night. The best sleep I had had in literal years. My AHI that first night was 7.81, but I felt great. I was sold. I had no idea how to change the settings or even if I should, and it was working for me, so I just kept using it as is, other than eventually turning down the ramp time to just 5 minutes. I read the manual, I bought replacement filters and nose pillows and I kept it clean. I downloaded OSCAR and occasionally looked at the data. The settings on the 10 are APAP with a range of 7.8 to 13. 

About a month after starting it, I talked to my doctor (December 2023) and asked for a sleep study. They referred me right away, but it took until April 2024. I eventually had an in-lab study which confirmed I had "mild" sleep apnea, but by then I think my AHI had gone down from months of treatment and perhaps less inflammation of the airways. I skipped four nights of therapy before going in to the study to try to re-set somewhat, and my sleep wasn't too bad compared to how it had been before therapy. 

So my sleep doctor may have a misleading impression of how bad my underlying condition is. I told him everything I just mentioned about using a unit on my own, but he seemed to wave it off. I went in for a sleep lab titration study a while later. I have all those months of data on an SD card, though I am not very clear on how to interpret most of what I see. 

So sleep medicine being what it is, this last week (late August 2024) I finally got an officially prescribed unit. It's an Airsense 11 Autoset. The tech at the DME place set it with a short ramp time as I asked, and he put in the prescribed settings. This turned out to be CPAP at 8. 

I stuck it out for three nights. My sleep was trashed. The machine was worse than having nothing. It felt hard to breathe out, and also as if I was not getting enough air on the inhale. I have no idea why it was set like that - it's completely inadequate. It can't have been personalized for me. Is that some kind of default setting for people who are just starting out? If so, I can see why so many of them have trouble adjusting. I'm used to my machine and this was still terrible. It was difficult to fall asleep, I didn't sleep much and I kept waking up and staying awake. I stayed in bed TEN HOURS before I felt like I could drag myself out. I had a headache just like I used to get before I started therapy. 

The same thing happened each night. My AHI was low, but that was probably because I wasn't even sleeping. I felt worse every day, and sent a message to the clinic on Saturday, but it's a long holiday weekend and no one will read it until Tuesday.

At my age, I am not interested in spending any more bad nights than necessary. Plus sleep deprivation makes me into a risk-taker. So I looked up how to get into the clinical menu on the 11, and I changed all the settings to correspond with what I was used to on my old 10. Last night I slept much better.

Possibly the doctor will yell at me, since of course they can see I'm monkeying with the settings. I feel well within my rights doing so, however. As long as I'm using the machine, they have no grounds for taking it away. Since the prescription settings were so bad, I figure it's up to me how well it gets adjusted. I'm going to have to study up.

I've now put my SD card into the new machine so I can look at my data in OSCAR. I didn't have it installed on those three nights of bad sleep, unfortunately. All I have is the myAir app. It's giving me a score of 100 for each of them, which is ludicrous. Maybe it's giving me lots of points for staying in bed ten hours.  Rolleyes
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#2
RE: Making my own settings
Welcome to the forum Lady Knitsalot Smile

That's a similar story to mine but I never went back after my first sleep study and left behind the inadequate sleep therapy medical community and kept learning how to titrate myself, edit (I didn't see the first part of your story where you received the first machine from a friend and self titrated-good on you! Smile

So your AS11 is set to CPAP mode at 8cm? Do you have any Oscar data you can share with us from the previous machine?
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#3
RE: Making my own settings
(09-01-2024, 08:35 PM)Lady Knitsalot Wrote: .....The settings on the 10 are APAP with a range of 7.8 to 13. 

At my age, I am not interested in spending any more bad nights than necessary. Plus sleep deprivation makes me into a risk-taker. So I looked up how to get into the clinical menu on the 11, and I changed all the settings to correspond with what I was used to on my old 10. Last night I slept much better.

Possibly the doctor will yell at me, since of course they can see I'm monkeying with the settings. I feel well within my rights doing so, however. As long as I'm using the machine, they have no grounds for taking it away. Since the prescription settings were so bad, I figure it's up to me how well it gets adjusted. I'm going to have to study up.

I've now put my SD card into the new machine so I can look at my data in OSCAR. I didn't have it installed on those three nights of bad sleep, unfortunately. All I have is the myAir app. It's giving me a score of 100 for each of them, which is  Wink  Wink ludicrous. Maybe it's giving me lots of points for staying in bed ten hours.  Rolleyes

Hi Kady Knitsalot,

Risk-taking is sometimes what we have to do, especially with the minimal amount of help we receive from Doctors and Sleep Technicians.  

Don't worry about your Doctor's reaction to you changing your own settings.  Show him the results.  And just so you know, insurance only cares about usage, not pressure settings.  

Ok, so you've taken control of your therapy and since you felt good with the settings on the A10, you're now using the same settings on the A11?  So, keep your SD card in your Cpap while you are sleeping, or you will only see summary data.

Check out the links in my Signature Line for guidance in Organizing your chart and posting it here.  

And yes, My Air is pretty much a joke.  I get scores of 100 even when I've had a bad night.  Little yellow Happy Faces  Wink  Wink
shine brightly at me every morning even if I had a high leak rate.  Oh-jeez

Once we see some data, we can get you dialed in if need be.
OpalRose
Apnea Board Administrator
www.apneaboard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Making my own settings
Yes, I have the whole time uploaded to OSCAR from November 2023 to the present. I'm not yet sure how to post a screenshot here, but I will give it a try.

Okay, this should show my Tuesday night results on the old 10 machine, and then Saturday night on the new 11 machine with the settings I put in from the old. As I say, I did not have the SD card in the 11 on the three nights I tried to use the prescribed settings, so I don't have that data in OSCAR.

I should mention that I changed masks from the minimal nose pillows with the hose in front, to the sort with the hose at the top of the head.

   
   
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#5
RE: Making my own settings
I don't know why the Tuesday night image is saying it's from the 11 set at CPAP 8. I didn't pick up that machine until Wednesday! It's definitely from the old 10 with the APAP setting.
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#6
RE: Making my own settings
Did your sleep study show a lot of CAs?  I'm guessing it did because you have been at this long enough that treatment-emergent CAs are not very likely.  If you don't know, ask for a copy of your sleep study.  They must give it to you by law in the US if you request it.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#7
RE: Making my own settings
I did get a copy of the sleep study results. I don't know how to interpret them, though. I don't think that night was at all representative of how badly I slept before I had the Airsense 10.

   
   
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#8
RE: Making my own settings
Here is Sunday night, the second night with my own settings on the Airsense 11. I have also changed my pillow out for a flatter one. I felt like I slept better, but I have a headache on waking, and the AHI is not great. Apparently there's a ways to go to get this working properly.
I don't know what is significant in the graphs. Please tell me what elements of the settings I should try adjusting. EPR is set at 3. Is that too much?
   
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#9
RE: Making my own settings
I see what you mean about your sleep study.  It shows that you had only hypopneas, no obstructives or centrals.  I think it's because you'd been using therapy for a long while and your body was not back to pre-pap use truth.

I suggest you drop ramp.  You don't need it anymore and you get no therapy during ramp.  Plus, if you get up for a bathroom break, when you return to bed ramp starts again, robbing you of needed therapy.

Your median pressure is 8.6, so you should easily be able to tolerate 8 as your starting pressure.  Give it a try.  I think things will improve. You used 8 before as static pressure, but you need higher pressures during the night.  I think that's why 8 was so miserable.

You can drop EPR lower and it should help with the CAs, but your flow limits will rise in response.  Flow limits are apneas that are less than 10 seconds, so they don't get reported.  Try EPR 2 for now, and see how it goes and how you feel.

Good luck! Smile
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#10
RE: Making my own settings
I think you'll need to start editing small things to reduce CA a bit. Can you try Ramp off? Likely keep the AutoSet range to about 8-12 or so, but you might need to reduce EPR to 2 or 1 for a night to get results in the chart. Just wanting to see the response with those, the goal being reduction of CA, but also not increasing the other events.

Unless I missed something, the sleep study was almost all Obstructive Apnea, no Central.

Colorado... High elevation? If yes, that can be your CA source.

Consider also requesting a machine swap to VAuto. It has some timing controls to help avoid more CA.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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