First Night on Auto Bipap. Here I go! (tonight!)

[danjfoley]

Just got the machine. Using swift fx small nasal pillows. My settings are min 4, max 16, ps 4 (should i change ps to 8? i don't see why i shouldn't be allowed the max difference between ipap and epap).

System One Resistance is set at zero. provider had it at 3.3, but she first fit me up with a full nasal mask, then changed to this. I think she forgot to change it. SO i looked up the settings. a lot of people say put it on zero. then some say according to the resporonics chart, their small pillows say to use 4x. From my understanding, this number will increase the output pressure to compensate for the mask's ventilation. So 4x would mean it's upping the output pressure by 4? I'm sure I understand what this should be on?

I just gave it a try, (lied down for 5 min with it on) it felt pretty good. Exhaling seemed to be a bit more work then usual, but nothing i figure my lungs can't get used to. (and probably make them stronger i would guess). My nostrils now feel a bit "chapped, or chaffed".. I didn't have any water in the humidifier, could this be the cause? (i'll get some before I go to bed tonight).

I also feel a bit light headed. Is this normal?

It has a modem on it, which i figure must be a cellular modem. The lady who brought it over says they will want this back after 3 months. I guess they are just remotely monitoring my compliance? If i changed the system one resistance or ps, will they know about it? And will it mess up things insurance wise? Should i just leave them as is till they get the modem back?

Any other tips for someone who REALLY REALLY REALLY wants this to work. I'm so damn tired all the time. I'm sick of it. My AHI was 32 by the way. What should i shoot for tomorrow? 1-5 ? (the machine will show me how i did last night).

Will i wake up feeling great? lots of energy? My dad just got one a month ago, and he reported having more energy then he ever felt. I'm hoping for the same.

That's it for now. Thanks for any support.

[DreamDiver]

Good luck on your first night.

Anything lower than 32 AHI for your first night will be going in the right direction.
My first sleep lab had me with an AHI of 26. I couldn't get below 11 for couple months, then 9, then 5, etc. Others see immediate results. You won't know until you know. For some of us, it takes a few days before our bodies become accustomed to a new pressure, so if you don't see a very low AHI immediately, don't be discouraged. The target for insurance is AHI below 5. The target for many of us here is below 2. Then there are those who get really low AHI's less than 1 all the time. You'll get there at your pace.
Also, AHI should not be taken as the only indicator as to how you should feel in the morning. You can feel better even if your AHI isn't that low yet. The key is progress. Try to determine how you feel just after you wake up, but before you read what your machine "says" you should feel. That's more important.
[Sorry for all the edits.]
Please remember to fill out your equipment profile.
Also, a little about your pressures would be good.

[danjfoley]

profile done:

pressure is: min 5, max 16

[Pugsy]

System One Resistance is set at zero. provider had it at 3.3, but she first fit me up with a full nasal mask, then changed to this. I think she forgot to change it. SO i looked up the settings. a lot of people say put it on zero. then some say according to the resporonics chart, their small pillows say to use 4x. From my understanding, this number will increase the output pressure to compensate for the mask's ventilation. So 4x would mean it's upping the output pressure by 4? I'm sure I understand what this should be on?

Resistance setting doesn't work like you think it works. Setting of X4 won't increase pressure output by X4.

Set it at zero....this is what Respironics says to set it for non Respironics masks.
You can use a setting of 4 if you wish...won't hurt anything but it won't make a miracle happen if a large leak occurs.

I tried all the settings with my nasal pillow mask. No change in leak line...no change in leak number...no change in how it felt to me and no change in pressure that I could see related to a leak.
http://systemoneresistancecontrol.respironics.com/

[jweeks]

Just got the machine. Using swift fx small nasal pillows. My settings are min 4, max 16, ps 4 (should i change ps to 8? i don't see why i shouldn't be allowed the max difference between ipap and epap).

Dan,

I haven't been following the discussions here very closely, so I might have missed what led to you to getting a BiPAP. Generally, you get a BiPAP for one of two reasons, either you need a very high pressure level, or you have issues with CA events (centrals). In both cases, the pressure numbers should be very carefully set based on a hospital sleep study (such as a 24 channel PSG). The lower number is usually the most critical. Its job is to be just high enough to hold your airway open (as a stent), but be as low as possible to prevent your body from being tricked into have a central event. Auto machines don't do a good job of finding these pressure levels.

If you were given an auto BiPAP just for the auto feature and not because you need a BiPAP, then you want this set up as much like an APAP as practical. That means a low pressure support number. APAPs normally run with a pressure support of 1 to 3 (often called exhale pressure relief). In APAP mode, the machine will start at the low number, then ramp up as high as needed (up to the max) in order to treat events. There are two issues with this. First, most people struggle to breathe on pressures less than 6, 7, or 8. Starting at 4 is probably too low, you might want to move that to 8. Second, it takes time for an APAP to ramp up to treatment pressure when you have an event. If you start too low, the machine might not be able to react quickly enough. As a result, once you start getting data on your pressure levels at run time, you will want to tighten up the range. For example, if your events are being treated at 12, you will want to run the machine in a range of perhaps 10 to 15. Finally, in auto mode, there is little benefit to having the upper number be anything less than the max pressure that the machine can produce.

Good luck on your first night. Right now, everything I wrote above is a moot point--your goal isn't so much excellent sleep tonight as it is to just make it a few hours. This is night #1 on a long and healthy journey.

-john-

[danjfoley]

Night one over.. I was able to keep the mask on all night....I woke up not feeling exausted like usual, but not feeling full of energy either..


i loaded up my results in sleep head.. here are the results:


AHI: 3.1
Flow Limit Index: .34
Min EPAP: 4
95% EPAP: 6.9
Max: iPAP: 10
95% IPAP 9.3
Average Leak 21.27

The machine is set to max ipap of 20. i guess it did not need to get that hight..

when i clicked on details i see under events:

clear airway apnea: 15
flow limitations: 4
hypopnea 7
obstructive apnea: 7
pressure pulse: 83
vibratory snore 7 events.

So are these good numbers? am i doing well?

If i just keep at it might i feel that high energy level that some people feel?

[danjfoley]

Also i have an auto bipap just for confort. Tried bipap before and couldn't take it.

[danjfoley]

Ok i am looking at events in sleepy head. When i see obstructive apnea events.. i only see the machine change the pressures up 2 times out of 7.. why would that be? Does the machine need the apnea to be of a certain length before responding? or something like that?

Same with clear airway events.. pressure doesn't (mostly doesn't) change.. what is a clear airway event anyways? I had 15 of them.

Flow Limitation: the pressure responded to every single one of these. what is this?

[Pugsy]

Flow Limitation: the pressure responded to every single one of these. what is this?

Flow limitations are minor reductions in flow that don't meet criteria for obstructive apnea or hyponea and yes..the machine will respond to these because they can be precursors to obstructive apneas or hyponeas. The idea is to prevent the apneas. The machine won't act like a ventilator and try to blow the airway open with pressure increase. Instead it tries to hold the airway open to prevent the events from every becoming a full blown obstructive event.

Clear airway events...the airway is open but breathing has stopped. Totally different from obstructive events where the airway collapses either fully or partially. These are "centrals" sort of and the machine will NOT ever respond to a clear airway cessation of breathing because increased pressure will not help reduce or stop a clear airway event. We loosely call the clear airway events centrals but to be a true central additional recording data is needed to know for sure...like EEG and thoracic effort. Some of the clear airway events may simply be a central that happens when we hold our breath turning over in bed or a central during sleep onset. These type of "centrals" are common and if we were in a sleep study the tech would discount those events and they wouldn't even be counted. The machine can't do that.
A few centrals...even the real deal...is a normal thing to have show up. What you had last night is a normal amount and nothing to be alarmed about.

If you happen to see a pressure increase within a time frame where a central is flagged..the pressure increase is for a possible obstructive precursor that is happening at about the same time as the clear airway gets flagged..so it is just a coincidence

If you see an obstructive apnea get scored...it will be at least 10 seconds in duration. That is part of the criteria. The machine is designed to try to hold the airway open and prevent the collapse of the airway. Once a collapse has occurred the machine won't try to force the airway open with a large burst of pressure. Instead it will let that event run its course and try to make better adjustments to prevent the next one more effectively.

Your report from last night is quite good and yes, keep it up and you are on your way to feeling better. Some people see a huge difference immediately..most of us have had to be patient and improvement was much more gradual.

[danjfoley]

Thanks for your answers and support. I have a lot more to talk about this, since i've only done it for 2 days now.

Last night: only slept a total of 7:30 hrs since I had to wake up early as my daughter was sick. I woke in the middle of the night took the mask off to use the matchine.. (according to my sleepy head status).. AHI was still 2.27 (good)..

However today i feel pretty crappy. If 10 is feeling amazing and full of energy, and 1 is you can't get out of bed.. my first night I woke up feeling maybe a 7.5 today i woke up feeling like 4 or a 5. My head is just "buzzing".. hard to really describe it. It's not a headache.. it's just that feeling Ihave in your head when I haven't slept well. Is with me all day long.

Now just some misc comments I have on this that i want to share and talk about.

- I have yet to get distilled water. I've been using water from the brita filter.. today i will get distilled as I am supposed to. However i do not think that has any effect. Thoughts?

- I don't get any data into my actual sleep architecture. I'd need a zeo for that. All this data isn't really telling me how much deep sleep i'm getting. I really wish I could get that data. But spending $100 bucks on a zeo isn't affordable right now. Do you know of any cheaper way to make this happen? I do have software on my android that measures the movements of the phone, but that doesn't really tell you much. I feel i must not be getting the deep sleep or I would feel refreshed. Am i correct about this?

- when i go to sleep, i put on the nasal pillows, and it feels mildy irritating every night. I just forge ahead, and hope that one night I won't notice it. Does this eventually happen? (it's not the pressure at all.. it's just the feeling of plastic up my nose and on my face and straps on me. No way to get over that then just to get used to it.

- I have taken klonpin to help me fall asleep for ages. Sleep dr. wanted me to get off it and gave me ambien. I tried that a week before i had this, and it was HORRIBLE, so i went back to klonpin. I took just 1/2 of it last night. Going to do so for a week, then go to every other day.. sound good? (he told me just to cold turkey it.. but i can't get to sleep...) My daughter is taking 3m melotonin to help her sleep (her dr. recommended it).. should i try that? Or should i just try to get off the klonpin? i've always had trouble falling asleep. Still according to my data takes me about 30 min to fall asleep.

- You'll have to read between the lines here, but I don't drink, i don't smoke *cigs* .. and i do something else ever so little. I wonder if that's messing with things. Told my sleep dr. about this, and he just thought about it, then brushed it off and said.. no i don't think that would be causing any sleep issues.

So there you go.. Again i really wish i could have the data on my sleep architecture every night some how.

[Pugsy]

Using tap water or some other water that is not distilled won't make any particular difference in therapy or how you feel. Distilled is suggested to limit mineral build up in the plastic tank.
Visually the mineral build up is rather yucky looking but doesn't really hurt anything. Using distilled water just lessens any work needed to keep the tank clear and sparkly clean.

You might add some Lansinoh ointment to your nostrils to help with the slight discomfort in the nostril area. Found in the baby section of Walmart and similar stores. This is the same ointment that is used my nursing moms to help with nipple discomfort.

Use your available software to evaluate your machine data. Of course it won't give you the level of sleep architecture that you want but evaluate what you do have available. Even ideal sleep architecture doesn't guarantee that we wake up feeling a 10 on your scale.

Fragmented sleep for any reason will mess with how you feel because it messes with the sleep architecture. When you take the mask off and sleep without the machine your body will tend to remember the "bad" part of the night instead of the good part...even if the "bad" part was only an hour out of 8 hours of sleep. It is just the way the body remembers stuff.

If you had a ZEO and it was totally 100% reliable and it showed decreased deeper sleep stages...what would you do differently than you are doing now?

Your sleep meds issues....will need to be sorted out before you can truly evaluate your scale of 1 to 10 on how you feel from cpap use because sleep meds themselves can impact sleep architecture and also how we feel the next day from "leftover" meds in the bloodstream.

Google Melatonin and its side effects to see if you want to try it. Some people have really good luck with it and others have some rather unpleasant side effects. In fact study up on all the sides effects of anything you are taking or considering taking. Especially the Klonopin.
Sometimes with meds....we are damned if we do and damned if we don't.

[danjfoley]

I am 100% going to get rid of the klonpin. Just working on it slowly. I'm already down to 1/2 mg a night. Going to try and not take it at all tonight and replace it with melotonin.

My goal is actually to take nothing at night and have a natural good night sleep. But since klonopin is addictive, i can't just cold turkey it.

Last night i woke up at 6am, the nasal pillows were chapping my nose so bad that i just took it off. Part of me is wondering if a nasal mask would work better as it doesn't touch your nose. However, according to my DME, my options with masks are:

1. If there is a problem with the one i am using i can get another.. (i guess there is a problem with this chapping)

2. ever 3 months i can have a new one.


I just wonder if i call in a problem with #1, so i get to keep the one i have or are they going to want it back. I guess i should call and find out. If i get another one then I can try both and use which one i want.

[Pugsy]

Use the Lansinoh...trust me..it will help the chapping... if your nostrils are raw...either wrong size of nasal pillows or straps maybe too tight.

If you like the nasal pillows really well...this would be a worthwhile comfort feature.
The barrel cozy.
http://www.padacheek.com/PACSwiftII_Barrel_cozy.html