AHI low at all pressures - Eye issues and still tired

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johantv
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Re: AHI low at all pressures - Eye issues and still tired

Post by johantv » Sat Nov 15, 2014 7:12 am

For sure my adviser is lacking in depth experience. She didn't knew she could download a day detail in ResScan, so has in the past always looked at the global overview. Mentioning flow limitations made it clear she didn't knew what to do with that.
I think I'll have to find my own sweet spot.
After following her advice after 2 weeks of CPAP 8, I now switched to APAP 7-8 so the S9 can again respond to FL's.
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
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Re: AHI low at all pressures - Eye issues and still tired

Post by Guest » Sat Nov 15, 2014 7:55 am

johantv wrote:The tear duct plugs are new to me. The specialist indeed said air could go through the nose to eyes (inside the body that is) and could also give issues. I will look into that. Thanks.
Visited my eye specialist on thursday. He normally used tear duct plugs for persons with extreme dry eyes.
He thought the idea of mechanical closing the tearpipes (?) with duct plugs (punctum plugs in Dutch) thereby preventing air blowing in your eyes through eyepipes, a logical thought. He installed duct plugs. Now 2 weeks with eyedrops and than 2 weeks without eyedrops and than evaluate with him again. Hope it works out fine.

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johantv
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AHI low at all pressures - Eye issues and still tired

Post by johantv » Sat Nov 15, 2014 7:59 am

Guest wrote:...
Guest above=johantv
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

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johantv
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AHI low at all pressures - Eye issues and still tired

Post by johantv » Sun Jan 25, 2015 8:01 am

Hi,

Since I'm still feeling fatigued after 8 months of APAP (tried out several pressure with always AHI<1) I got another sleeptest (PSG) end of december. The conclusion was I'm having a fragmented sleep with several wakeups during the night so my sleep quality is poor. The specialist is a bit puzzeld what to do, since no obvious reason is detected.
He wants to try bilevel for a month, just to see how that works. I was told it will be an S9 again which I will receive tomorrow. I Googled a little and noticed Resmed S9 has several bilevel machines. Could anybody give me some tips for tomorrows visit? Which S9 bilevel is the best, what settings should be set (ipap/epap), can bilevel also self regulate pressure (ipap) like the S9 Autoset etc.

Thanks
Johan
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds

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archangle
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Re: AHI low at all pressures - Eye issues and still tired

Post by archangle » Sun Jan 25, 2015 12:02 pm

I think we're discussing air coming out through the nasolacrimal ducts. Wiki it.

If that's your problem, you can stop that with an Oracle oral mask. Used properly, there will be no pressure in your nose, and no air coming out into your eyes.

You put the mask into your mouth like a SCUBA mouthpiece. It has some nose plugs to keep air from coming out your nose, but you need to learn to use the mask without the plugs if you want to fix nasolacrimal duct problems. For me, the trick was to act like I'm blowing up a balloon and close off my nose as I blow. Then I could relax and the CPAP pressure would hold my soft palate closed and keep the air from leaking out my nose.

I found the mask uncomfortable and it dried out my throat too much. You need to use a humidifier if you use this mask.

By the way, a "Total Face Mask" may also solve nasolacrimal duct problems because the pressure inside the nose and around the eye are the same.

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johantv
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AHI low at all pressures - BI-LEVEL?

Post by johantv » Sun Jan 25, 2015 1:44 pm

Thanks for your answer. The eyeissues could have that reason. As I suspected that also I had duct plugs inserted by my eyedokter so no air should come through anymore. The eye issues are still there.. By using teardrops / moistening a few times a day I'm managing that issue reasonably.

At this moment the focus is on trying to improve sleep quality. I hope bi-level could improve that.
So I'm still hoping to receive some S9 bilevel tips today so I'm prepared for the consult tomorrow. (I'm Surfing the web and this forum at this moment, but not abble to differentiate between all ResMeds S9 machines (like S9 auto 25, Vpap S, T, ST, ST-A, Autoset CS, CS-A)
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
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Re: AHI low at all pressures - Eye issues and still tired

Post by OkyDoky » Sun Jan 25, 2015 4:27 pm

I can't give you specific bilevel info but you can check out and compare the bilevel machines here. https://www.cpap.com/cpap-machines/bipap-machine.php
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Re: AHI low at all pressures - Eye issues and still tired

Post by musculus » Sun Jan 25, 2015 8:07 pm

The problem is that you still have airway obstruction causing RERAs in deep sleep even with cpap therapy. Optimizing your pressure setting to minimize the flow limitations will be the first thing to consider.

Try sleep (comfortably) on your side or prone will help.

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Re: AHI low at all pressures - Eye issues and still tired

Post by johantv » Mon Jan 26, 2015 6:43 am

This morning I received the Resmed S9 VPAP S with setting 10/7 (IPAP/EPAP).
Unfortunately it's not an auto machine so EPAP is fixed

I'm wondering what the difference is between:

Resmed S9 Autoset CPAP-mode 10 and EPR 3
VERSUS
Resmed S9 VPAP 10/7 (IPAP/EPAP)?

Kind regards
Johan

PS.
@musculus : I don't think RERA's are there. Sleepstudy did not record any. Restricting flow limitations I tried, but they never disappeard totally with higher pressures.
@OkyDoky : Thanks
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
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Re: AHI low at all pressures - Eye issues and still tired

Post by Jay Aitchsee » Mon Jan 26, 2015 6:48 pm

Johan, I can't answer your questions about bi-level, but this will bump you back up to the top where someone who can answer your questions might see it. You might have better luck if you changed the Title of the thread (1st entry) to include Bi Level as you did the in the post a couple up.

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Re: AHI low at all pressures - Eye issues and still tired

Post by Macpage » Mon Jan 26, 2015 7:19 pm

johantv wrote:This morning I received the Resmed S9 VPAP S with setting 10/7 (IPAP/EPAP).
Unfortunately it's not an auto machine so EPAP is fixed

I'm wondering what the difference is between:

Resmed S9 Autoset CPAP-mode 10 and EPR 3
VERSUS
Resmed S9 VPAP 10/7 (IPAP/EPAP)?

Kind regards
Johan

PS.
@musculus : I don't think RERA's are there. Sleepstudy did not record any. Restricting flow limitations I tried, but they never disappeard totally with higher pressures.
@OkyDoky : Thanks
If I'm getting what the guys here have explained to me correctly, I would say not much in the basic theory of treatment. I've been told that EPR of 3 on Resmed is jsut the same as PS of 3 on their bilevels. Each gives you the same just as you've written. Of course, the bilevel by function will do higher pressure support and max available pressure with more adjustments. It seems like I also remember reading that some felt the bilevels were tighter in their operational tolerances. I have no idea if this is the case but, if so, I would guess that it would apply more to the auto bilevel. I also believe the question you ask about EPR (1,2,3) vs. PS applies the same to the auto bilevel as well in Resmed world. It's different in Respironics world on the autos. Perhaps, the senior guys here will post and correct me if I'm off base. Good luck!

Best,

Mike

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Re: AHI low at all pressures - Eye issues and still tired

Post by palerider » Mon Jan 26, 2015 7:40 pm

johantv wrote:I'm wondering what the difference is between:

Resmed S9 Autoset CPAP-mode 10 and EPR 3
VERSUS
Resmed S9 VPAP 10/7 (IPAP/EPAP)?
there's really no difference.

a vpap gives you control over the pressure changes, however, how sensitive the machine is to the beginning and end of inhalation, how long the inhalation lasts. etc.

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Re: AHI low at all pressures - Eye issues and still tired

Post by Macpage » Mon Jan 26, 2015 7:44 pm

palerider wrote:
johantv wrote:I'm wondering what the difference is between:

Resmed S9 Autoset CPAP-mode 10 and EPR 3
VERSUS
Resmed S9 VPAP 10/7 (IPAP/EPAP)?
there's really no difference.

a vpap gives you control over the pressure changes, however, how sensitive the machine is to the beginning and end of inhalation, how long the inhalation lasts. etc.
I'm guessing this is a very useful adjustment for some folks

Best,

Mike

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Re: AHI low at all pressures - Eye issues and still tired

Post by palerider » Mon Jan 26, 2015 8:49 pm

Macpage wrote:I'm guessing this is a very useful adjustment for some folks
yes. example settings: (cribbed shamelessly from the resmed titration guide)

obstructive lung disease, Patients with obstructive lung disease have chronic airflow limitation. These patients have particular difficulty exhaling air, which leads to air trapping and hyperinflation. These patients require a longer exhalation, which often leads to asynchrony with standard bilevel settings.
The recommended settings use a faster rise time to ensure that the lungs are filled quickly, and a high cycle sensitivity
to provide an earlier cycle to exhalation. The rapid inhalation and prolonged exhalation will help to prevent auto-PEEP
and preserve synchrony.
ipap 13
epap 5
timax 1
timin .3
rise time 150
trigger medium
cycle high
ps 8

restrictive lung disease Patients with restrictive lung disease have a difficult time maintaining the inhalation phase long enough to ensure adequate tidal volume and gas exchange. This can be caused by a physical restriction of the lungs or by neuromuscular weakness.
The recommended settings use a low cycle sensitivity and a longer Ti Min time to provide a longer inhalation time to
help increase tidal volume and gas exchange.
ipap 11
epap 5
timax 1.5
timin .8
rise time 300
trigger high
cycle low
ps 6

obesity hypoventilation Obesity hypoventilation patients often have reduced tidal volumes due to the additional weight pressing down on the chest and abdomen. Additionally, these patients may also have obstructive sleep apnea (OSA) caused by excess tissue in the upper airway and a high body mass index (BMI).
The recommended settings use a higher EPAP pressure to keep the airway open and a higher IPAP to provide
additional pressure support and ventilatory assistance.
ipap 15
epap 7
timax 1.5
timin .8
rise time 300
trigger medium
cycle medium
ps 8

normal lungs: Patients with normal lungs may use NIV in an institutional environment post surgery or to treat sleep apnea.
The recommended settings provide basic settings for patients with normal lung mechanics.
ipap 11
epap 5
timax 2
timin .3
rise time 300
trigger medium
cycle medium
ps 6

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Re: AHI low at all pressures - BILEVEL

Post by johantv » Tue Jan 27, 2015 6:37 am

Thanks guys.

Last night I slept for the first time with the "VPAP S" and the flow from in- to exhalation is much more rigid with the VPAP as what I'm used to with the APAP.
Does anybody have a clinical quide (or the titration guide) for the Resmed S9 VPAP S so I know what to set on bi level.
I'm also curious what timax, timin etc. means. So if there is a whitepaper on the basics for bilevel it would be very much appreciated if this could be shared.

Regards
Johan
Start therapy: 2014/3 | AHI before 43, Now <1 | APAP 6.6 - 8.0cmH20 | EPR 1
No Pressure, no Diamonds