Central Apneas on Resmed Aircurve S11 VAuto

[chuck29]

Hello All,

Resmed S11 Aircurve VAuto
IPAP: 18
EPAP: 10
PS: 4

I have been on Resmed S11 Aircurve VAuto for 3 weeks. I average ~4 AHI.
I feel worse than when I was on a broken S9 using Fixed and getting ~60 AHI.

-Trigger set to Very High to address CAs:
I'm experiencing CAs when in VAuto mode. They average ~4 when Trigger is set to Medium. On advice of forum user, I set Trigger to Very High and can get CAs to 0. Just not sure if I should keep on Very High since this was not prescribed.

- S Mode
I used S mode (forgetting the reason why now, as I am too tired to think straight) and my CAs went to 45 with AHI being 55. One night of this and went back to VAuto as noted above.

My questions are:
1) What number of CAs are considered abnormal? Above 5?
2) I understand that VAuto Resmed does NOT have a backup rate. Given that I have CAs, is this something to consider? ASV?

Thank you!

[Pugsy]

My questions are:
1) What number of CAs are considered abnormal? Above 5?
2) I understand that VAuto Resmed does NOT have a backup rate. Given that I have CAs, is this something to consider? ASV?

1...One must consistently see over 5 central apneas per hour average and the person MUST be asleep before a doctor gets all excited.

2...Again....one must be asleep when the centrals were flagged and one needs to consistently see 5 plus central apneas every hour all night long before a doctor will diagnosis central sleep apnea and requiring ASV to deal with the centrals.

I am not so sure that all your centrals are even asleep centrals and if they aren't....doesn't matter how many you have if you aren't asleep.

[chuck29]

1...One must consistently see over 5 central apneas per hour average and the person MUST be asleep before a doctor gets all excited.

2...Again....one must be asleep when the centrals were flagged and one needs to consistently see 5 plus central apneas every hour all night long before a doctor will diagnosis central sleep apnea and requiring ASV to deal with the centrals.

I am not so sure that all your centrals are even asleep centrals and if they aren't....doesn't matter how many you have if you aren't asleep.

Ok, that does make sense Pugsy, I won't get excited about these then.

Thank you

[ozij]

Hello All,

Resmed S11 Aircurve VAuto
IPAP: 18
EPAP: 10
PS: 4

My minimal EPAP is now set to 12 from 10 based on recommendation from user in forum.

(my emphasis)

So which is it?

-Trigger set to Very High to address CAs:
I'm experiencing CAs when in VAuto mode. They average ~4 when Trigger is set to Medium. On advice of forum user, I set Trigger to Very High and can get CAs to 0. Just not sure if I should keep on Very High since this was not prescribed.

Who prescribed?
When?
Based on what?

I have been on Resmed S11 Aircurve VAuto for 3 weeks. I average ~4 AHI.
I feel worse than when I was on a broken S9 using Fixed and getting ~60 AHI.

That is not good.

[vandownbytheriver]

When switching from S to vAuto be aware that S mode does not turn on Easy Breathe for you... EB is automatically part of the vAuto algorithm... so the pressure support will hit *much* harder in S mode without EB turned on.

Your settings are 14/10 ranging up to 18/14 if needed... this puts you in the range where this pressure support can strip your CO2, causing CA's. I'm not a fan of vAuto set to this range... at higher pressures you do need help removing CO2, at the lower pressures this is a problem... CO2 causes the breathing response, when you don't have enough you get CA's. I'm on 21/17cm S mode EasyBreathe ON... same as 21/17 vAuto PS4. When you let the vAuto take you across this pressure range the PS causes problems I feel. You might just lower PS to 2 and try a night.

If we could see some graphs we could help more. Get a free SleepHQ account and upload your SD card, then share a night's data here. Don't go wild on changing settings, change one thing at a time and try it for a few nights.

Was this setting prescribed? What kind of sleep study generated it?

[chuck29]

If we could see some graphs we could help more. Get a free SleepHQ account and upload your SD card, then share a night's data here. Don't go wild on changing settings, change one thing at a time and try it for a few nights.

Was this setting prescribed? What kind of sleep study generated it?

Thanks much for breaking that down for me. Makes better sense now.

Here is link to Sleep HQ (Sunday 7/21 had decent AHI):

https://sleephq.com/public/teams/share_ ... 382bdee8bf

Yes these were prescribed settings (for ref):
IPAP: 18
EPAP: 10
PS: 4

That was a in-lab titration study.

Thank you.

[bwexler]

I guess I have been very lucky.
Three years on S9 Auto and I got a new in lab sleep Study/Titration (can't remember why).
Got my new Philips ASV immediately.
4 more years, saw a deal on Resmed Aircurve 10 ASV and bought it.
Never learned the details of Apnea only the broad strokes.
Have always, since before day 1 gotten better information here than from MDs and RTs.
Pugsy and many others have guided me through transitions from 1 machine or mask to the next.

I find that I have to train the RTs at Crapria who barely know the difference between a mask and a hose.

I have never understood the need for the Aircurve line other than the ASV model, other than higher pressure limits. I can't retain a good mask seal at 18 so no need to go over 20.

[chuck29]

I find that I have to train the RTs at Crapria who barely know the difference between a mask and a hose.

I have never understood the need for the Aircurve line other than the ASV model, other than higher pressure limits. I can't retain a good mask seal at 18 so no need to go over 20.

Glad things are working out for you. I was wondering about ASV unit, but my CAs are under 5, so I suppose I am ok here.

Good thing is that my AHI is good, so I'm still holding onto, even though it's been 3 weeks, that it's still going to take more time to feel better, since I was dealing with 60 AHI for months on end.

Yes, I'm finding the front line folks and the RTs have no idea what they are talking about, and yes, folks at these forums know so much more!

[vandownbytheriver]

If we could see some graphs we could help more. Get a free SleepHQ account and upload your SD card, then share a night's data here. Don't go wild on changing settings, change one thing at a time and try it for a few nights.

Was this setting prescribed? What kind of sleep study generated it?

Thanks much for breaking that down for me. Makes better sense now.

Here is link to Sleep HQ (Sunday 7/21 had decent AHI):

https://sleephq.com/public/teams/share_ ... 382bdee8bf

Yes these were prescribed settings (for ref):
IPAP: 18
EPAP: 10
PS: 4

That was a in-lab titration study.

Thank you.

OK... note your PS is now up to 5 and your base ePap is now 12. Note that the CA's were a lot better at lower pressure and PS the night before, Sunday... the FL's don't appear to be much different. Your pressures have been significantly raised from your prescription from the lab... I believe the extra PS is causing the extra CA's. If you started living above 16cm ePap then PS 4 might work... down where you are I feel PS 3 is best. I'd go down one PS, to 3... 12/18 PS 3.

[vandownbytheriver]

I have never understood the need for the Aircurve line other than the ASV model, other than higher pressure limits. I can't retain a good mask seal at 18 so no need to go over 20.

Bi-level therapy is superior to APAP therapy... EPR is inferior to PS with EasyBreathe... EPR ducks the exhales, where PS pushes the inhales... rounded waveform tops are the goal. If your mask can't handle what you need then you need a different mask or a better fit... I find my Vitera barely holds 21/17 PS4, I may need to move to a RM Quattro or Lowenstein Lena.

[Pugsy]

How was your sleep quality Monday July 22? Did you wake often?
How did you decide to use PS of 5? why?

[chuck29]

I'd go down one PS, to 3... 12/18 PS 3.

Thanks for the info!
I will certainly be willing to try PS of 3. But I did read in forum that with my settings that PS 4 seemed low and it was recommended to try 5 or 6.

[chuck29]

Bi-level therapy is superior to APAP therapy... EPR is inferior to PS with EasyBreathe... EPR ducks the exhales, where PS pushes the inhales... rounded waveform tops are the goal. If your mask can't handle what you need then you need a different mask or a better fit... I find my Vitera barely holds 21/17 PS4, I may need to move to a RM Quattro or Lowenstein Lena.

I do have other masks. The one they gave me at supply center was the one "For Her", the purple one haha. They never said anything to me about it, but I assume that was what they meant to give me, as I now recall one guy telling another, "grab the purple mask for him".

I use Resmed Airfit F20. Prior to get the one "for her", I was using my own Resmed Airfit F20. Larger headgear and the velco straps were hanging off when I had to adjust. So, maybe this purple mask is good for me. I don't have any leaks.

[Pugsy]

I did read in forum that with my settings that PS 4 seemed low and it was recommended to try 5 or 6.

Who said that? What forum? I didn't see that recommendation at this forum. I suppose I could have missed it though.

[chuck29]

How was your sleep quality Monday July 22? Did you wake often?
How did you decide to use PS of 5? why?

On Monday 7/22, slept from 10:15 PM to 5:30 PM without waking up.
It was recommended on a forum to use PS of 5 to address OSA, but noted that it could increase CAs, which it in fact did.

So, tonight, PS back to 4. Also my Trigger was set to Medium, and giving me ~3-4 CAs. When on Very High, I was at 0 CAs. But, since I didn't feel any different, I moved back to Medium. Tonight I will be setting Trigger to High.

Thank you for the continued support!