Need help with settings on Resmed Aircurve 10

[kenloupa]

Hi, I purchased a new Resmed Aircurve 10 Vauto due to the Philips recall and my system one being from 2014. My BiPap Rx is old from 2008 but called for fixed 17/13 pressures at the time. My AHI had been creeping up on my old system one from below 5 to in the 10 range with 25% leaks showing (I use a chin strap but still mouth leak and wake up with a dry mouth). On the new system I wanted to try the auto BiPap so I set it up for min EPAP 7, max IPAP 20 and PS of 4.0 with the other settings at default. I have used an ultramirage II nasal mask for many years and I like the way it fits/feels. The first night I tried the Resmed N30i mask I got for $1.00 with the system and I couldn't sleep well at all with it and my AHI was high.

Last night, I went back to my Ultramirage II and slept better with the following from the machine: events per hour 9.8 (it was 28.2 on the N30i), mask seal happy face, pressure 13.0, exp. pressure 8.9, leak 47 L/min (my mouth leak??? the mask felt secure), Vt 440ml, RR 18, MV 8.1 L/min, Ti 1.2 s, I:E 1:1.6, spont cyc 94.5%, AHI 9.8, Total AI 8.0, Central AI 5.1.

Today I feel better than yesterday but still somewhat tired. I felt like I leaked less from my mouth with the lower pressures and my mouth wasn't as dry as on the fixed BiPap at 17/13 I was used to on the System One. I am wondering if you can give me suggested adjustments to my current Vauto settings and any other advice you can think of. Is the central AI of 5.1 of concern? Would different settings help this. At my previous sleep study I was OSA with no central component I know of. Thanks for your help!!

[Pugsy]

Need to see the detailed report from available software to really comment on what is going on.

Your leak number...47 L/min...that's a 95% number and while it means at or below that number...it is a concern even if you got Mr Smiley on the LCD screen because Mr Frowny doesn't show up until you are over 24 L/min for 30% or more of the night.
ResMed machines report excess leak only....unlike Respironics machines which report excess leak and expected vent rate for total leak.
Any leak shown on a ResMed machine is excess leak.

Your central index...a bit high again...and how worrisome it might be depends on if those centrals are real asleep centrals or maybe awake false positives.

So we need more information to really be able to offer anything as to how to fix a problem...if it is a problem.

An important question....did you wake often last night? Spend much time awake with mask and machine on????

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

viewtopic/t158560/How-to-post-images-for-review.html

[kenloupa]

Thanks---I awake several times (usually 3-4) each night to go to the bathroom due to diabetes/getting old/prostate issues. When I awake, I take the mask off right away. I have the machine set to Smart Sense so it turns off and on each time I take the mask off or on.

[Pugsy]

If the centrals are getting flagged at known awake times (with mask on) then we can disregard those centrals.
If you aren't asleep...they don't count.
False positives aren't limited to centrals though...

http://freecpapadvice.com/sleepyhead-free-software

[kenloupa]

I slept much better last night after making some adjustments: increased min EPAP to 8, changed trigger sensitivity to very high and cycle sensitivity to high.
My AHI went down to 3.4. Pressure was 13.3, exp. pressure 9.4, Leak was 49 L/min but still with smiley face on leak. Spont cyc was 95%, total AI 2.1, central 1.7. Does that suggest my centrals are from getting up at night several times? ( I still got up for bathroom about 3 times). I feel better about the AHI. There was no obvious leaking from the nasal mask. I can’t hook up an SD card yet as I don’t have an SD card reader. Should I increase Min EPAP ? Thanks for your help.

[Pugsy]

Actually I would keep these new settings for a few nights and see how they do and let your body adjust.
More EPAP won't help the centrals (if they are real asleep centrals) anyway and if you remove the central index from the AHI...it's actually fairly low as it is even if they OAs and hyponeas are asleep events which there is a good chance that there are a few awake flagged events in those categories as well.

The known wake times do greatly increase the chances of false positive flagging. Probably not all false positive but a few likely are and more pressure won't stop awake flagging. Staying asleep stops the awake flagging.

Not to mention we don't sleep the same each night anyway and you are new to this therapy and your body is going through and adjustment process. Give it time to adjust....might even help with the staying asleep part a bit.

[kenloupa]

Thanks Pugsy! I will keep things as is for now. I am actually quite happy now, as I feel more rested than I have in a long time and my AHI is finally under 5, which it hadn't been on the SystemOne fixed BiPAP 17/13 for some time. I believe that having the lower pressures with the auto BiPap has helped tremendously. I am glad I upgraded the equipment (the recall pushed me to do it). Unfortunately, there isn't much I can do to stop the awake times due to my diabetes and diabetic meds requiring me be well hydrated.

[kenloupa]

I finally got OSCAR working. I just need to figure out how to post the screenshots. OK---here's one, but I suppose I need more?

[kenloupa]

can someone help me make sense of this? do i need to post anything else? thanks!

[Pugsy]

Which mask were you using for the report above?
Did you sleep through those leaks or did they wake you up?

[kenloupa]

I was wearing the Resmed Ultramirage II nasal mask all night. I use a Resmed chinstrap as well. I don't think the leaks woke me up. How would I know? As far as I remember I slept soundly except when I got up to use the bathroom. Can you tell anything about the central apneas I had---were they significant or not?

[Pugsy]

That cluster of central apneas happened pretty much at the exact same time there was a break in the therapy line when the machine was turned off. I would bet my last dollar that they are awake breathing false positives and don't mean anything other than you were awake and I would shrug my shoulders and move on.

Awake flagged anything doesn't count....except to point to not being asleep for whatever reason.

I am so confident that the bulk of those centrals are awake breathing I don't even need to see the flow rate zoomed in up close.

Now a couple of centrals here or there...normal to see and expected but a cluster like that right at the time you woke up and turned the machine off....awake breathing. I am 99.9999999999% confident of that.

The leak...could be mask movement or could be open mouth. It's fairly significant but still under the 30% mark for getting Mr Frowny to show up and since you slept through it you assume....up to you if you see this a lot you might want to investigate further.
But to fix a problem you first have to identify the problem...so is it mask movement or mouth breathing?????
You would have to tape your mouth shut for at least one night to have any chance of figuring it out. I personally have seen mask movement leaks that look just like that and how I know is that I did tape my mouth after seeing similar leaks.
It was when I was trying a different type of nasal mask and having trouble with getting the tension on the straps just right.
Taped my mouth and I still had big leaks...which leaves mask movement as the only possible cause. So more tension on the mask straps was needed.

[kenloupa]

Thanks for all your help, Pugsy! I often have a very dry mouth with my BiPap, so I assume it's mostly mouth leaks. I am scared to tape my mouth shut due to reflux that I have that can lead to aspiration if I am not careful. The reflux is under pretty good control, but the possibility of dying in my sleep from this scares me too much. I ordered the Resmed full face mask (F30i) to try out, which should be here Tuesday of next week. Maybe that will help?

[Pugsy]

The new mask might just do the trick and if it doesn't....well you still have the option of just compromising on leak management.
If you had told me those leaks woke you up all night then I would say for sure they need to be dealt with but because of the sleep disruption more than anything else. Any leak that disturbs sleep is unwanted no matter how big or how small.

If you start seeing a lot of UA flags during times of large leak then it means that the machine is sensing something going on but because of the leak it can't decide what it is. If you start seeing a lot of that happening then you would for sure want to work on leak management because the leaks could be potentially having a negative impact on therapy itself.
Last night...one UA flag at the beginning of the night during large leak...I don't ever get too excited about 1 anything.

For me good sleep is critical to my well being and I don't dwell much on slight variations in any numbers.
The best numbers in the world...AHI 0.0 and a flat 0.0 leak line don't mean much if we don't sleep so great.
You already have a significant sleep disrupter with the bathroom breaks from the diabetes and prostate issues...you don't want more.

Good luck with the full face mask. Crossing my fingers it is an easy transition for you and fixes your problem.
I am zero help with full face masks though...not my cup of tea and I don't even own one.

[kenloupa]

Thanks, Pugsy! I don't know that the full face mask is my cup of tea either, but I thought I'd get one to try and to have one in case of nasal stuffiness as a backup. I'll update when I know more.