WW4B Therapy thread

[WW4B]

Hi, I have a question concerning the two attached charts from two entirely separate days using two completely separate pressure settings. Both charts using VPap Auto are displaying "good numbers" therapy wise, however I do not feel any noticeable difference in the two settings whether it be for better or worse. The end result is that I still feel tired and foggy during the day and do not wake up feeling refreshed. Without noticing any variable difference in the settings which settings would be more preferable and recommended that I pursue. The only difference in settings is that the chart dated 7/21 is using a trigger setting of high.
1. Can someone briefly explain why I would have good numbers regardless of the settings used and displayed.
2. If I wanted to try a static pressure on my VAuto using the current auto mode and not with the CPAP mode what should I set the Min EPAP, IPAP and Pressure Support to. I have heard that some people just feel better using a static pressure and maybe its worth giving it a try.     

   
   

[WW4B]

BUMP !

[Jay51]

You are getting very good therapy here IMO.  If this is comfortable enough each night, why try to change it?

You can try a static Cpap pressure, but I doubt you will get this good of therapy.

[WW4B]

Thanks Jay...but if you read my post you would see that I am not comfortable and definitely do not feel well rested in my therapy regardless of how my therapy seems to be going numbers wise. Something is still not right. I had also asked that why would "good" numbers represent themselves on my charts while using two very different pressure settings. Could you explain that to me if possible. And, also to which setting would be more beneficial overall and that I should stick with if there is no discerning comfort value between the two that I can notice. Lastly if I decide to try a static pressure therapy on my Air Curve 10 VAUTO in vpap auto mode would I just set the min EPAP and max IPAP to the same pressure using my 95% pressure as a starting guide. And, what would I set the PS at. 
I would like to wake up each morning well rested and ready to seize the day....
Can you or someone answer these questions please.

[Sleeprider]

You don't need pressure above 8.0 to fully resolve any obstructive events, and PS 5.0 eliminated all flow limits. There is a persistent leak present, and I'd like to see that resolved. What mask are you using, and have you tried others? Do you feel air leaking from the mask seal, or is coming from your mouth? As far as pressure settings, let's move to 8.0 min, 8.0 max, PS 5 or VPAP S at 13/8.0.

[WW4B]

Thank you Sleeprider for your interest and input. Tough to argue therapy with someone when the "numbers" game appears to be very favorable in my therapy induced treatment. But just about in the end of all posts regardless of pressures, systems, masks and machine use everyone is asked "but how do you feel"?
In all honesty, yes things are better, but not to beat a dead horse...still tired in the morning with excessive daytime sleepiness and for a lack of a better term, brain fog. I can feel a mask leak now and than when I shift or move if not fully asleep and I must mouth breathe at night at times because some mornings I wake up with a very very dry mouth. I can only now imagine the leaks this may cause throughout the night when I am actually asleep. These incidents have somewhat decreased since I have acquired a hose holder for over my bed to help eliminate mask movement when and if shifting sleep positions and with practicing the tongue placement on the roof of my mouth procedure. Do you think these constant annoyances may be my root cause for feeling like crap!
 I am not a full face mask person...UGH !  And not a soft cervical collar fan either !! 
I am a side sleeper and for pure comfort prefer and really like a top mounted hose connection but at times feel that positional movement may dislodge the mask and cause leaks. I basically do not seem to have an issue with masks just need to find the right one.
I still have and tried all Dream Wear nasal cradle and nasal pillow masks (including gel) in various cushion sizes and the Resmed Airfit P10, P30i, N30i and Swift FX masks. Thinking of trying the AirFit N30 or F&P Pilairo, Brevida or Evora masks. 

What are your thoughts...will certainly try static pressure and VPAP S for a few days. Do you believe trigger or TI settings need a tweaking.  
I know there are more CPAPers who need more help than my therapy numbers indicates that I do, but I cannot thank you enough in advance for your attention and guidance to my therapy in making me feel whole again.

Side note: just received my Dream Station replacement machine from the recall precess. Will either sell, donate or most likely keep as a backup as my VAUTO is approaching 20000 usage hours.

[WW4B]

Sleeprider, trying to set up my AirCurve VAUTO as you have advised.... "As far as pressure settings, let's move to 8.0 min, 8.0 max, PS 5 or VPAP S at 13/8.0". Want to try the static pressure in VPAP auto mode first for the next few nights and when setting the min to 8.0 & max to 8.0 the machine will not allow me to select a PS value and automatically sets to a PS value of 0.
How can I get around this in auto mode ?

[Sleeprider]

Of course, my bad. To enable PS 5 you née EPAP min 8.0 and max pressure 13.

[WW4B]

Hello, it has been quite awhile since I have posted to my thread. Overall therapy is working but good numbers do not relate to quality sleep and several issues are still apparent. Have been working on my leak rate and positional sleeping. Still waking up and feeling tired with daytime naps quite the norm. I can read my newspaper or work on my laptop and fall asleep at the drop of a hat. There are times I can fall asleep in my chair holding a cup of coffee only to be jolted awake 5-10 minutes later still holding the coffee cup. I am a side sleeper averaging about 7 hrs of sleep per night using a Resmed P10 or Swift FX nasal pillow mask with one pillow and avoiding positional apnea. Working on flow limitations which I feel are arousing me throughout the night and preventing better quality sleep. What does the flat line between exhale/inhale indicate on my flow chart. Based on my charts, should I increase/decrease any settings for better flow limitations. Should I explore a face mask (UGH !). Thanks to all.... 
[attachment=55613

[WW4B]

Below is a response taken from another thread to which I would like to ask a question about....

"Centrals can be as simple as a breath pause. Your VAuto helps you exhale more effectively, and exhaling more CO2 will likely throw off the natural balance of oxygen to carbon dioxide ratio your brain expects to be there. When this strays off that expected balance, breathing may pause a bit then continue as CO2 builds up enough to trigger the next breath. This is likely the type of Central Apnea your VAuto marks as the purple flags in Oscar. Try it a few days and see if CA doesn't begin to diminish, signifying your brain is adjusting to VAuto affecting exhaled CO2 levels."

My concern: I do not really experience Centrals except for the occasional 1 or 2 here and there but I am concerned about CO2 exhalation. I do definitely feel like my breaths are paused briefly enough to possible be a cause or affect my continued tiredness during the day but are not quite paused enough at night to flag an event. Is this possible? Could exhaling excessive CO2 be a reason why I still feel tired upon waking and during the day. Is my breathing to efficient? What settings to Ti max/min, trigger or cycle could I attempt to not exhale more CO2 than necessary. 
I am using a nasal pillow mask. Would lowering Epap/PS/Ipap help with the mask leakage. Would switching to "CPAP" mode or "S" mode help. 
 know my "numbers" look good, but still feel tired and sluggish during the day. Last two nights Oscar charts attached for reference. Looking for any and all support. Thank You