Help for Bipap newbie

[shadowwolf218]

Yeah, I figured it was something like that.

I should hear back from my DME vendor tomorrow, hopefully. Even if I can't get an asv, I think switching machines will be the next logical step.

[shadowwolf218]

No response yet about switching brands or machines. Expecting a callback from "our sleep clinician."

Last night went about on par with my usual.

https://photos.app.goo.gl/YrojEnTJC8qgjREc2

[ajack]

have you tried a $10 soft foam cervical collar to see if you are bring your chin towards your chest while you sleep? That would be the first thing I'd try. An ASV or another bpap won't fix those obstructives at 20cm They might titrate a bpap that has higher pressure, but you may not need it.

[shadowwolf218]

I'm waiting on my next paycheck to be able to do much of anything, but the cervical collar is the next thing on the list.

I got in touch with my DME and it seems like I can switch from the Respironics to a Resmed without too much fuss - I just won't be able to switch back after. I really don't understand why I hovered around an AHI of ~8 with the Resmed CPAP, but the Respironics Bipap has been so much worse. But at this point, like I said, I'm more interested in getting it controlled first and trying to explain the nuances later.

[shadowwolf218]

After talking to my DME, their clinician made some adjustments to the machine...including turning the PS up to 4-6.
I turned that back off immediately, but I didn't catch the minimum pressure change until the morning after.

Bear in mind that I am sick (and not entirely sure I should use a cpap/bipap at all while sick) with an upper resp. infection of some sort.
But...what?

https://photos.app.goo.gl/Mfma1tL3FKQWW8JJ3

[ajack]

There is nothing on that chart that points to an ASV, the CA are fine. The only thing that points to using the bpap setting is the insp exp ratio, other than that the fixed pressure same epap/ipap if fine. I would use the auto bpap features for comfort as you are heading into higher pressures, but that's up to you. You know to keep raising the minimum epap pressure till the OA are gone?

[TedVPAP]

After talking to my DME, their clinician made some adjustments to the machine...including turning the PS up to 4-6.
I turned that back off immediately, but I didn't catch the minimum pressure change until the morning after.

Bear in mind that I am sick (and not entirely sure I should use a cpap/bipap at all while sick) with an upper resp. infection of some sort.
But...what?

https://photos.app.goo.gl/Mfma1tL3FKQWW8JJ3

Why is the pressure charts so broken?

[Matt00926]

Bear with me as I did scan all the posts in this thread, but may have missed something. Have you attempted to use static IPAP/EPAP pressures? I've found it helpful to find the exact IPAP and EPAP required to prevent the majority of events. Then set the machine back to auto mode, with the min and max something like -3/+3 for both IPAP and EPAP. I find the machine changing pressures all the time to be disrupting to my sleep.

[shadowwolf218]

ajack: the simple reality is that the machine I currently have, despite moving min epap progressively higher, is unable to deal with my obstructives. That doesn't make sense, especially compared to my in-lab studies - which both required CPAP at ~10cm to reach a near-0 AHI. The charts with < 10 AHI are outliers, not averages. What do you mean about the insp/exp ratio?

Ted: Wish I knew. It does this from time to time. The last few days I've been dealing with an upper respiratory infection, but I don't know why that would break the graph like it does.

Matt: I think that's a great idea, but any time we turn the PS back up, my central apneas get markedly worse. So a fixed bipap is probably not a great choice for the time being. Thanks for the suggestion though.

All: Here are the last two days. I tried a cervical collar (thanks Pugsy) on the 3rd, for as long as I could tolerate it. That's the cleaner chart. The 4th, I fell asleep before I could get it situated (too much cough syrup, probably.)

https://photos.app.goo.gl/MzepAzRl5wMEG6r82

https://photos.app.goo.gl/DEDoUMMfUwneACZM2

[Pugsy]

Looks like both links point to the report from the 3rd.

When did you remove the collar on the 3rd? Any idea how long you kept it on?

If you are ill with an upper respiratory infection we have to sort of take any data with a grain of salt. The flow rate when we are ill with the usual upper respiratory symptoms just gives us too much chance of false positive events..SWJ...unless you take so much cold medicine it knocks you totally out and I have yet to find one that does that for me when I have a cold.

[shadowwolf218]

*facepalm* Fixed.

I took off the collar at the end of the 2ish hour session, took some more medicine, and fell asleep without the bipap on.

[Pugsy]

Was the report from the 4th with or without the cervical collar?

Your report on the 3rd...is there any part of that report without the collar? It's a short night 4 hours of sleep...did the collar stay on until you took it off and turned the machine off and went back to sleep without anything?

Just trying to get a clear picture of what each report represents.

[shadowwolf218]

Only wore the collar for the 3rd, full duration of bipap use.
Nothing on the 4th.

[ajack]

You really need a few nights to get the pattern. On those two charts, it seems that the collar has helped a lot. it seems a lot is positional. You can get pillows that will keep your head and neck in thew right position, After the collar, you know what that should be.

The other thing is you may have a freaky breathing pattern that makes the machine go to its max. Unlikely, but it is possible.
You could try the collar/pillow and fixed 10 PS and then fixed 15 for a week, before opening the machine back up to 25

[shadowwolf218]

Another night with the collar, managed to keep it on awhile longer this time.

https://photos.app.goo.gl/zyEwflHDeotAn1EB3

I am fascinated by the pattern in the VS/VS2 lines towards the beginning of the night. Otherwise, I don't know. Better?