Help for Bipap newbie

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Wed Jan 24, 2018 11:17 pm

For leak evaluation just go by the LL line on the Events graph. If you don't see many prolonged LL flags (Large Leak) then leaks aren't an issue no matter what they are from. If you were mouth breathing enough to affect therapy pressure it would still show up as a Large Leak flag.

How do you feel about another 1 cm increase in the minimum pressure and turning Flex of 1...off??
I don't know if you will be comfortable enough to sleep at 16 cm minimum...if not and you need that little bit of Flex...try 2 cm more minimum.

It's still odd that parts of the night the pressure does a good job at the lower settings...so I can't help but wonder what is changing to cause the increase in pressure needs.

Did you ever try the cervical collar thing?
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ajack
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Re: Help for Bipap newbie

Post by ajack » Wed Jan 24, 2018 11:57 pm

Your first chart with 6 CA an hour will qualify you for ASV, after they sort the obstructive.
I think the US ins rules are, obstructive under control and then see what CA are left. There doesn't have to be 75% CA
You may need to go to a hospital lab with a good tech. Most techs don't get to titrate many that need an asv, it is a subset of people.

_________________
Mask: AirFit™ F20 Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 ST-A iVAPS and adapt ASV

shadowwolf218
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Re: Help for Bipap newbie

Post by shadowwolf218 » Thu Jan 25, 2018 10:56 pm

I'm okay with turning off the 1cm PS, if that's what you mean. I tried putting this thing in cpap mode, but it only does constant non-adjusting pressure, so I went back to bipap auto.
I wish I knew what the factor was. I've had my adenoids removed (partially for this, partially because I couldn't breathe well through my nose during the day) if that matters.
I haven't tried the cervical collar, no.

That is great to know, ajack, thank you. Unfortunately, both of my sleep studies have come back with well below 6 centrals per hour.

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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Thu Jan 25, 2018 11:02 pm

We may need to explore the cervical collar option if we can't get better control over those OAs with a little more pressure.
We are fast running out of pressure options.

Leave it in auto mode with max IPAP of 25...we need the auto mode and the higher pressures.
Try 16 or ever 17 min EPAP with PS set to 0 if you can handle it.
I am trying to get EPAP up so that the OAs are better prevented and still crossing fingers that centrals don't pop up.

I wish you had the ResMed equivalent of this machine but you don't...so wishing doesn't help much. :lol:
I may have to RISE but I refuse to SHINE.

shadowwolf218
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Re: Help for Bipap newbie

Post by shadowwolf218 » Thu Jan 25, 2018 11:24 pm

I may actually be able to switch to the Resmed bipap, if you think that would help. Are there advantages to it over this thing?

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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Thu Jan 25, 2018 11:30 pm

ResMed responding algorithm might be a bit faster meaning maybe better airway collapse prevention.
I don't know if it would be enough but I have used both brands in the auto bilevel and I could get by with a little less pressure with the ResMed and get the same results.
Wasn't that big of a deal for me but I wasn't coming close to maxing out EPAP and still have a double digit AHI that was primarily obstructive.


For sure the ResMed ASV would respond faster and you might do well with ResMed ASV simply for OA control even if the centrals aren't a problem.

See if you can get your DME to swap the DreamStation BiPap Auto for the ResMed AirCurve 10 VAuto....must be the auto model...not the S model.
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ajack
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Re: Help for Bipap newbie

Post by ajack » Fri Jan 26, 2018 12:03 am

change doctors, You aren't a new user with pressure induced CA that will settle in 3 months. CA 6 should be enough for an ASV

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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Fri Jan 26, 2018 12:14 am

ajack wrote:change doctors, You aren't a new user with pressure induced CA that will settle in 3 months. CA 6 should be enough for an ASV


Even if he can get this doctor or a new doctor to prescribe ASV ...here in the US that doesn't guarantee insurance will pay.
Insurance companies still have their own requirements and often that is above and beyond just the doctor's say so.
It sucks...but it is just the way it is.
Just because a doctor writes a RX for something doesn't mean the insurance company will just fork over the money without whatever requirements they have being met also.
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shadowwolf218
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Re: Help for Bipap newbie

Post by shadowwolf218 » Fri Jan 26, 2018 11:10 pm

Update from last night:

[url]https://photos.app.goo.gl/EjuSBVxasVcyQ7oq2
[/url]

I forgot to up the minimum, and it looks like I paid for it a bit. I think I also didn't set the max PS down to 0 like I thought.

I got in touch with my DME, and it looks like I can't switch directly since I've had this one for so long. They do, however, have a small stock of refurbished units that I might be able to switch out for - I'll get a call back about that on Monday.

Meanwhile...yeah. My doctor ordered the second sleep study purely because of what my insurance said when they were contacted regarding the asv. The DME doesn't care one way or the other, as long as there's a prescription and payment. Doc is happy to prescribe and asv. Insurance won't pay without either 75% centrals during an in-lab study or more than a year on the bipap without positive results (while still meeting minimum compliance of ~4hrs per night.)

ajack
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Re: Help for Bipap newbie

Post by ajack » Sat Jan 27, 2018 3:30 am

An ASV isn't going to fix that obstructive part of the chart. Ok it's 75% after the oa/h are under control. so OA/H 2 and CA of 6
That could also be chin tucking, where the airway is constricted by the chin to chest. A $10 soft foam collar for a couple of nights will tell you either way. If you aren't clearing obstructions with 24cm of pressure, there may be other stuff happening. If a straight airway doesn't fix it, it's back to the doctor. Or you could start again with a manual titration at home and move out of auto mode. It is possible the machine is misreading a breathing pattern. I'd try the collar first.

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Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 ST-A iVAPS and adapt ASV

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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Sat Jan 27, 2018 8:13 am

ajack wrote:An ASV isn't going to fix that obstructive part of the chart


Why do you say that?
ASV can treat both obstructive and central apnea and does it quite easily.
He's going to have to start with a higher than usual EPAP minimum but it can be done. Might even do a better job on the obstructive stuff because it can respond faster. I used ASV for my obstructive apnea...I don't have issues with centrals but it did a fine job on obstructives and the rare central I did have...took care of that also.
ResMed makes a point of saying it will treat both...as does Respironics.

I do agree the cervical collar is worth investigating though. Something is causing the change from when the pressures are effective and they are not effective...I doubt it's REM because REM doesn't last for hours but it could very well be chin tucking or simply being supine.
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shadowwolf218
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Re: Help for Bipap newbie

Post by shadowwolf218 » Sun Jan 28, 2018 1:52 pm

I'll try the cervical collar as soon as I get my next paycheck.
I did build a sort of wall so I wouldn't be able to turn onto my back as I slept. Seriously mixed results.

https://photos.app.goo.gl/Qm0PmBI4UOiJJNa33

https://photos.app.goo.gl/Jd6gXjLmnZIoRFAw1

The worse of the two nights, I woke from the pressure and feeling severely bloated. I'm not sure that's related at all.

I'm wondering why this machine keeps maxing the pressure out. I never went above 15cm on the cpap, and my obstructives were nearly zero most nights. I only ever switched to bipap because my centrals kept getting higher every few days. I haven't gained (or lost) weight, and I tend to fall asleep on my side or stomach/side.

Is it possible there is an issue with the bipap itself? Something not sealing right after I cleaned it? I don't hear it leaking or making any noise.
Then again, the hose type jumps back and forth between 15 and 15-H - or at least it has been since we've been altering settings each night.

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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Sun Jan 28, 2018 2:05 pm

shadowwolf218 wrote:hose type jumps back and forth between 15 and 15-H - or at least it has been since we've been altering settings each night.


Is this just in what SleepyHead is reporting? If so, it's possible that SleepyHead is having a problem with the settings reporting which is very possible.
SleepyHead has been known to report settings that aren't entirely accurate...it's a known SH settings bug.
What matters is what the machine is set at no matter what SH says it is set at.

shadowwolf218 wrote:The worse of the two nights, I woke from the pressure and feeling severely bloated. I'm not sure that's related at all.


Seriously bloated on the obviously worst night...Doesn't surprise me at all.
You spent over well over 2 hours maxed out and sustained maxing...that would inflate the best of us. More pressure equals more chance of pressure sneaking into the stomach. I would actually be more surprised if you reported no bloated with pressures like that.

Is there something wrong with the machine itself? Honestly I doubt it but it wouldn't be totally impossible and part of the reason I suggested seeing if you can try the ResMed equivalent of this machine.
Part of the suggest was because of the different algorithm the ResMed bilevel uses but part of it was just on the off chance that something weird is going on with this particular machine.

As to what changed to cause this type of result...that's an unknown. The common things are weight, meds/drugs, sleeping position, neck position, etc but maybe something changed that we just don't have any outward known reason for whatever it was.

If the machine had a leak somewhere as a result of cleaning or whatever it's unlikely that you would have half the night be fine and the other half in the toilet. It should be in the toilet all night. :lol:
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shadowwolf218
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Re: Help for Bipap newbie

Post by shadowwolf218 » Sun Jan 28, 2018 8:23 pm

That makes sense. The 15 to 15-H is on the machine, not software.

I also slept with a pillow under my chin, if that matters.

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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Sun Jan 28, 2018 8:36 pm

I have not seen a DreamStation BiPap manual. I don't know what 15 or 15 H means. If these are options on the machine itself...I don't know what it means. The 15 is the hose diameter...they H...I dunno.
H for heated hose or humidifier would be my guess. I don't think it means anything bad in terms of these results you see.

If the bad night was with a pillow under the chin and it stayed in place those 2 or 3 hours...I don't know that I would be attempting that experiment again if it were me.

Edit...looks like the H is for heated hose.
page 14 of the manual
http://incenter.medical.philips.com/doc ... 3D11405972

As to why it seems to change...I don't know.

Edit again...you know more and more none of this makes logical sense.
I would push to try a different machine to rule out machine malfunction if it were me.
I may have to RISE but I refuse to SHINE.