[Treatment] Oscar data help bipap

[Sleeprider]

I would worry less about compliance and let your doctor know you got the right therapy. He is welcome to follow along. Your need for mask, tubing, filters and other supplies do not change. I would really try to recruit the doctor and point out...do you think I should have to tolerate 10 events per hour when I can get near perfect therapy with ASV? My guess he only avoided the "right" therapy to save a hassle with insurance. He can write your prescription for ASVauto based on your current settings and results.

ST is fixed pressure, and not intended for complex apnea. I think I provided the link to the Resmed Clinical titration Protocol, but if not, just ask, and I will. You were prescribed the wrong device simply based on your complex apnea, rather than COPD. Compliance is simply using your machine more than 4-hours per day on at least 70% of days in a 30 day period. Unless you plan to go back to ST, compliance is a waste of time. Just have your doctor, or your primary doctor write the prescription for what works. FWIW, if they take back the ST because you don't use it, it's no loss.

[Moemah123]

I would worry less about compliance and let your doctor know you got the right therapy. He is welcome to follow along.  Your need for mask, tubing, filters and other supplies do not change. I would really try to recruit the doctor and point out...do you think I should have to tolerate 10 events per hour when I can get near perfect therapy with ASV?  My guess he only avoided the "right" therapy to save a hassle with insurance.  He can write your prescription for ASVauto based on your current settings and results.  

ST is fixed pressure, and not intended for complex apnea. I think I provided the link to the Resmed Clinical titration Protocol, but if not, just ask, and I will.  You were prescribed the wrong device simply based on your complex apnea, rather than COPD.  Compliance is simply using your machine more than 4-hours per day on at least 70% of days in a 30 day period.  Unless you plan to go back to ST, compliance is a waste of time.  Just have your doctor, or your primary doctor write the prescription for what works.  FWIW, if they take back the ST because you don't use it, it's no loss.

Agreed, i do have an appointment with him. Minor correction is you mentioned 10 events, i think you were looking at S without T experiment we did? Normally i have anywhere from 0.6-2 AHI with ST given 14/9 pressure. But even then it doesnt feel as good as i am now. I will have to check but i think as it stands with COVID there maybe complexity returning device that's why was asking there are pressure recommendations based on ASV while i am trying to meet compliance until i schedule ASV sleep study or whatever doctor asks to get it rolling, any thoughts?

[Moemah123]

I would worry less about compliance and let your doctor know you got the right therapy. He is welcome to follow along.  Your need for mask, tubing, filters and other supplies do not change. I would really try to recruit the doctor and point out...do you think I should have to tolerate 10 events per hour when I can get near perfect therapy with ASV?  My guess he only avoided the "right" therapy to save a hassle with insurance.  He can write your prescription for ASVauto based on your current settings and results.  

ST is fixed pressure, and not intended for complex apnea. I think I provided the link to the Resmed Clinical titration Protocol, but if not, just ask, and I will.  You were prescribed the wrong device simply based on your complex apnea, rather than COPD.  Compliance is simply using your machine more than 4-hours per day on at least 70% of days in a 30 day period.  Unless you plan to go back to ST, compliance is a waste of time.  Just have your doctor, or your primary doctor write the prescription for what works.  FWIW, if they take back the ST because you don't use it, it's no loss.

I wanted to follow back. I got approved for an ASV device so i no longer have to use the one i have i got online. I have a concern. Initially first ASV days i was feeling great, now i am back to feeling tired. I still use the same settings although don't use mouth taping as much now. Is it common on ASV start to feel tired again even with low AHI? I basically still feel super non functional in some days. Better than BiPaP ST but the bad days are really bad even with 0.3 AHI.. What could be going wrong?

[SarcasticDave94]

Somehow I missed your thread. What pressure set are you running? Maybe include OSCAR data. Anything else in the symptom and complaint dept besides tiredness?

[Moemah123]

I wanted to give the device sometime since it was first few days before I report back. To give some idea I have been experimenting with following

Nasal mask + mouth tape = drools that wake me up
Nasal mask + Chin strap = seems to produce leaks and my mouth remains wide open even though i never had a leak issue with ST\CPAP maybe its the new nasal mask (P30I VS P10 although i seal it well) (Today's issue that i will attach charts for)
Nasal mask + Collar = seem to produce my lowest AHIs (0.8->0.2 etc) but dry mouth (sometimes 3/10)

I am attaching charts for today, because at exactly 7:03 my wife caught me sleeping on my face and that even though It seemed i was in deep sleep, you can see my mouth wide open and the device pumping air at an extremely loud volume and then my head shakes a little (not enough to wake me up it seemed) I feel this whole mouth open (air gushing + device pumping air as if i am not breathing) is what keeps me from getting the full rest i expected from ASV. That and i still get air bloated which i had hoped ASV would fix. I am scared to mouth tape for that very same reason it is painful

With this data and knowing exact time (7:03 i had my hardest breathing) does oscar help shed some light into what happened?

Thanks once again for helping me out

[SarcasticDave94]

For aerophagia, I have to sleep on my left side or tilt the head area of the bed. I'd had to do that anyway for other things like bad back pain and GERD.

Anyway so you'll have to decide on a plan to keep the mouth closed or you might need to consider a full face mask. You might get a soft collar or something like a Knightsbridge Dual Band chin strap, but it sounds like you've tried something similar. Dry mouth can point to mouth leaks. As soon as you open your mouth and open the air circuit, the therapy benefits are going to be absent. If you think you're air starved, maybe increase EPAP min up to 7.

[Moemah123]

For aerophagia, I have to sleep on my left side or tilt the head area of the bed. I'd had to do that anyway for other things like bad back pain and GERD.

Anyway so you'll have to decide on a plan to keep the mouth closed or you might need to consider a full face mask. You might get a soft collar or something like a Knightsbridge Dual Band chin strap, but it sounds like you've tried something similar. Dry mouth can point to mouth leaks. As soon as you open your mouth and open the air circuit, the therapy benefits are going to be absent. If you think you're air starved, maybe increase EPAP min up to 7.

Thanks Dave,


One of my main issues is sometimes the device over delivers air even when i am awake and breathing normally (or atleast as normal as the breaths i had before it suddenly decides to pump more air) I had lowered EPAP in hopes that exhaling would be easier so i can avoid aerophagia, is that not true? How does increasing EPAP help

Thanks alot!

[SarcasticDave94]

We're somewhat at a fork in the path where Apnea events are on one side and aerophagia are on the other. So for comfort you'd need not adjust pressure up. So disregard what I'd mentioned earlier on EPAP at 7, but you're probably at the point where going any lower may impact Apnea treatment. Of the 2 areas, comfort wins or you might not even use the ASV. So make it as comfortable as you're able to while not losing therapy.

[Moemah123]

I wanted to report back. On every setting low or high my AHI on asv is always between 0.1 and 0.5. My issue now is drooling. I mouth tape with somnifix and medical tape. I use soft collar and sometimes chin strap and yet drooling finds a way to leak and wake me up and I am not able to get more than 5 hour sleep anymore. I am not sure what more can I do ? Should I start another thread for suggestions?

[SarcasticDave94]

I'd say let's keep it contained in this thread.

I don't know what to suggest for a drooling issue.

How is the ASV therapy helping otherwise?