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 Feb 07, 2018 5:14 pm

Are you using the ramp?
If so..at what setting? Smart Ramp maybe? Doesn't appear to be so but thought I would ask because of the response during the snores first seen.
What sleeping position are you starting the night at?
How long do you think it takes you to typically fall asleep?
I may have to RISE but I refuse to SHINE.

shadowwolf218
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Re: Help for Bipap newbie

Post by shadowwolf218 » Wed Feb 07, 2018 10:29 pm

No, and I have smart ramp turned off to be safe.
I sleep on my side/stomach pretty much exclusively (at least when I fall asleep.) If I had to guess, 10-20 minutes max to fall asleep.

ajack
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Re: Help for Bipap newbie

Post by ajack » Thu Feb 08, 2018 1:04 am

insp/exp ratio, You have a similar time breathing in, as you do breathing out. With PS and rise time, this can be changed if needed. Normal is 1:2 or 3

The only thing that has seemed to have helped is the collar, 20-25cm isn't doing much. If you are sure there are no positional reasons left for your high apnea rate. I think it's time to go back to the doctor. Nothing much has changed in the 3 weeks. If your airway is straight and there is no other physical reason you can sort out. It means that it may be an obstructive collapsing airway from other causes. You may need a proper diagnoses and a higher pressure machine. There must be insurance issues, or you would be at the sleep doctor already. So a titration sleep study, as well as the sleep doctor may be outside your budget. A good sleep doctor is a must have.

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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Thu Feb 08, 2018 7:16 am

I don't know what to make of the first cluster of snores and the machine taking it's own sweet time getting up to pressure. Once the pressure gets up there it does sort of a half way decent job...compared to the job at the lower pressures anyway.
It's too soon for REM unless you are having REM rebound and you say you aren't on your back. So something is changing to greatly change the airway patency...what that might be I don't know.

Any idea on the chance to try a ResMed auto bilevel machine?
I may have to RISE but I refuse to SHINE.

shadowwolf218
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Re: Help for Bipap newbie

Post by shadowwolf218 » Thu Feb 08, 2018 1:22 pm

Yeah, I just have to be off work long enough to get to my DME and switch out. Possibly tomorrow, with a little luck.

https://photos.app.goo.gl/5TjL7VypPuL5hP9k2

The collar definitely seems to help.

ajack
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Re: Help for Bipap newbie

Post by ajack » Thu Feb 08, 2018 4:10 pm

I'm glad the collar is helping, I think it's time to start putting back some PS and see how the CA go. I think they are just balancing the co2/o2 pressure induced. If the DME set something like this, min epap16 max epap25, ps4, rise time 1, I could understand why and you may want to increase 1cm ps at a time. I would also get back to a ENT doctor and check your airway, if this isn't sorted in another week.

_________________
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 » Fri Feb 09, 2018 3:45 pm

Still having a bit of trouble keeping the collar on for more than 3-4 hours, but it's getting better.

Not sure what to make of this, now.

https://photos.app.goo.gl/VqlxF9vm6pyZz8wj2

ajack
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Re: Help for Bipap newbie

Post by ajack » Fri Feb 09, 2018 3:58 pm

Now you know how it feels to have your head and neck in the right position, you can find a pillow or even a rolled up towel in a sausage shape. To duplicate this chin up head back way.The support is in your neck and a bit of your head, the top third of your head can be in air.
It looks like a good chart, the last few hours were without the collar? Going by the chart I would raise the min to 18, with no ps.
I would start using a bit of PS and have min 16 min ps 4

_________________
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 » Sat Feb 10, 2018 6:27 pm

Longer night to look at, though I'm not sure it tells us anything new.

https://photos.app.goo.gl/mJkvClgCtEMI7k2j2

This was with the collar on for the full night. I might have loosened it when I woke around 6:50, don't remember.

shadowwolf218
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Re: Help for Bipap newbie

Post by shadowwolf218 » Sun Feb 11, 2018 4:28 pm

Collar for the full night, forgot to turn bipap back on after I woke to use the bathroom.
Seems like there's a bit of a sweet spot with the collar. Too loose doesn't seem to help as much, too tight wakes me up a lot. Still adjusting.

https://photos.app.goo.gl/BMUVVntp1XdxyYO83

ajack
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Re: Help for Bipap newbie

Post by ajack » Sun Feb 11, 2018 7:07 pm

There are also different sizes, it might be too small and need the next size up, being tight shouldn't make it work a lot better. you may need more height between chest and chin.
I would go back to a specialist and get your throat looked at, if your neck is straight. There is a lot of obstruction. If you don't mind me asking and you have the anonymity of the net, but how obese are you?

I think it's time to move the min from 16 to 20 and the max still at 25. I really would start using some PS, even if it does give some CA. I don't know how you can handle one pressure.
I would move ramp starting from 10 to 15, to try and clean up some low pressure junk.

If your budget will allow it, a recording spo2 meter may help you see how bad the desaturations are. a cms50f is available for 60-$80

_________________
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
Posts: 25
Joined: Wed Jan 17, 2018 7:33 pm

Re: Help for Bipap newbie

Post by shadowwolf218 » Sun Feb 11, 2018 9:39 pm

That's alright. I'm 220lbs, 5' 9". Big tonsils and tongue, according to my otolaryngologist, just to make matters worse.

My oxygen desat hit 88% at the lowest, so thankfully that hasn't been a big concern. I'm just not getting restful sleep, obviously. I don't know the last time I did.

ajack
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Re: Help for Bipap newbie

Post by ajack » Mon Feb 12, 2018 5:40 am

well it's not excessive obesity, put it down to your tonsils and tongue. If you are really sure there isn't a positional thing. I think I would talk to my doctor, get my tonsils out and see if you can get your pressures down and not apnea as much.

_________________
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
Posts: 25
Joined: Wed Jan 17, 2018 7:33 pm

Re: Help for Bipap newbie

Post by shadowwolf218 » Wed Feb 14, 2018 5:10 pm

Getting my tonsils removed is part of the long-term plan, actually.

I'm really unsure on whether I'm having positional issues or not. I took off the collar for the last 1/3rd of the night here, and it doesn't seem to change much.

https://photos.app.goo.gl/B302wPqxhqgwGsft2

I'm going to adjust the min epap to 18 and see how that goes tonight, pending other advice.

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Pugsy
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Re: Help for Bipap newbie

Post by Pugsy » Wed Feb 14, 2018 5:21 pm

It's hard to judge potential positional issues because we can't so easily watch ourselves and know for sure what position we might end up.
You had some good (at least good for you) nights or parts of nights before you added the collar.
Maybe last night was just an all night "good" night. Meaning whatever you were doing that the collar seems to have helped with that you didn't do it last night.
We don't sleep the same each night.

Might as well see what kind of results you get with an increase in the minimum EPAP. Worth trying.
I may have to RISE but I refuse to SHINE.