[Treatment] Oscar data help bipap

[Moemah123]

I agree with sheepless, the latest graphs look like excellent therapy with very steady minute vent, tidal volume and low low event rate. All respiratory statistics are right on the money.   We prefer to go by how you feel, but you are totally killing it by the numbers.

Thanks sleeprider and sheepless, 

I have a question. Given that you agree that numbers look good i.e. 5-6/7 epap and 1->6 PS. What is my goal here, should I be experimenting with upping settings see if i can feel even better ? or maintain them for couple of months before changing settings?

Second question. I have experimented with going from 5->6 epap and 1-> 6 PS to 5->8 and 1->6 PS and found that 5->8\1->6 brings back my drooling where 5->6\7 didn't. I don't know why increasing epap by 1 caused such drastic changes? and ideally for complex apnea or my case what should i be increasing epap or PS? i.e. would you suggest i expirment with epap changes first or PS going forward?

Thanks so much!

[Sleeprider]

The key is comfort, so don't do what is uncomfortable. I can't explain your individual response to subtle pressure changes, but you are certainly aware of them and have been taking the right steps. I am saying that you have done an outstanding job of optimizing your settings for your personal comfort and efficacy. I have no argument with someone that has self-optimized settings experimenting with subtle changes to those settings to improve them. Just have an idea of the problem you are trying to solve, and I will be glad to help. No mater what experience I may have with coaching CPAP, I will never second-guess success. If I saw something that could be improved in your last post, I would have certainly discussed it and suggested a try.

[sheepless]

no reason to think your situation is just like mine but with asv, raising my ps from 0-5 to 1-6 increases my lip leaks from close to zero to upwards of around 14. if your ua/oa is adequately addressed by epap lower than your current setting, by all means reduce your max epap. otherwise, keep your epap settings for now and see if drooling is reduced when you lower ps to 0-5. if ua/ca goes up, you can try keeping min ps at 0 and incrementally raise max ps, hoping to thread the needle between reducing drooling and increasing ua/ca. about all you can do is try one change at a time to see what happens to the numbers, drooling and how you feel. (of course you'll only see ua events but we can make some reasonable assumptions about what they are according to how they respond to specific setting changes and/or look closely at a few.)

[SarcasticDave94]

Put the settings in that maximize your comfort. If these settings you mentioned are good for you, run with it.

[Moemah123]

I am back one more time with a question.

I fixed drooling, last night i tried to increase pressure settings a bit since i tolerated lower pressures. I woke up and all the numbers look good. However, i did not feel well rested at all infact, i wanted to go back to sleep after i took the device off. What could have gone wrong even though the numbers in theory look good and i slept 7 hours with no interruption?

Thanks once again

[SarcasticDave94]

If it were other machines, I'd say flow limits are your current likely suspect. Just a maybe is to add a small amount of Min. PS from 0 to 1 or something like that. See what others say but it might be worth a try.

[sheepless]

chart looks very good. if I had to pick something I'd say your ps is very active. although I'm unaware of it when I use my asv, I think the asv's ps activity wears me down. I think this because I feel better with vauto, even with higher ahi, because it lets me minimize the pressure swings. you might try limiting max ps to 5 cmw above whatever min you need. I haven't re-read this thread to know but if you get oa, you can try raising epap to compensate in part for reducing max ipap.

[Moemah123]

chart looks very good. if I had to pick something I'd say your ps is very active. although I'm unaware of it when I use my asv, I think the asv's ps activity wears me down. I think this because I feel better with vauto, even with higher ahi, because it lets me minimize the pressure swings. you might try limiting max ps to 5 cmw above whatever min you need. I haven't re-read this thread to know but if you get oa, you can try raising epap to compensate in part for reducing max ipap.

Thank you sheepless, this post was yesterday. I actually changed settings to what you mentioned yesterday night. So slept with ps 0-5 as opposed to 0-8 of yesterdays post. I once again got a 0.0! and while sleep was relatively better than yesterdays, I still woke up feeling sleepy. Attached charts because i feel i am very close in what right treatment should be but not sure what is missing to feel energetic (I try to workout)

Thanks again

[sheepless]

well, your pap therapy looks about as good as it gets. I'd give a lot to get 8.5 continuous hours wo masking off. I think I told you way back in this thread about my experience with asv and vauto so I won't repeat it. active ps leaves me tired even at 0-5. if that's affecting you too, you might look into vauto. otherwise, we have to look elsewhere for why we're still tired. in my case, plm is exhausting, even with meds that reduce it. I can attribute a couple of mask off's a night to that but I continue to wake up dozens of times, masking off between 3 and 9 times for reasons I cannot identify (aside from flow limitations, leaks and the occasional apnea event). I refuse to believe there's no reason for it so I keep trying to work out what it is. sounds like you may be in the same boat. sleep hygiene, meds, diet, stress, room environment; the whole long list of possibilities.

meanwhile, idk if it'll help but you could incrementally reduce epap until you start seeing too many events. too many is either ahi of 4.9 or when you start feeling still more tired than you are now.

hope you figure it out and let us know if you do.

[Moemah123]

Thanks alot for your suggestion. Actually based on what you said I have noticed the following. The times where my events are 0 are times I feel most tired (relative to pap treatment in another words much better than without but relative to say times I have 1 AHI) it is curious why I would feel more lagged with 0?
So today what I did was I changed epap to 5 min/max and ps 0 to 5. I ended up waking up to go bathroom (I know that's a symptom of apnea I used to have pre getting treated) but I found I have so much energy that with 5 hours of sleep I didn't want to go back to sleep. My AHI reported 0.6 with those Low settings but felt better than 8 hour sleep and 0 events. 

3 questions come to mind.

1. Why did I feel I have more energy with 5 hour sleep with 0.6 AHI events compared to 8 and 9 with 0 events?
2. Is it sustainable to keep going that way i.e. 5 hours a day with more energy or I have to find way to pump it to 8 hours even if I split sleep during day
3. You mentioned apnea events of 4 as worst case is that what I should be going for i.e maximize comfort and sleep time while keeping myself under 4 and if say AHI is 4 but I feel good it's better than 0 but feeling tired ?


Thanks once again!