Help for Bipap newbie

ajack · Post by **ajack** » Wed Feb 14, 2018 6:42 pm

I'd also use ps 4 to the min epap18, max epap to whatever the max will go to, 25/21?
Try and make the comfort better for you

Pugsy · Post by **Pugsy** » Wed Feb 14, 2018 6:50 pm

I would be careful with adding PS back in...watch for centrals.
Maybe it was just a coincidence that the centrals reduced a lot when you reduced PS...maybe it wasn't.
Just be careful with PS.

I know one woman who gets a truckload of centrals with PS of 4 and none with PS of 3...so she uses PS of 3.
Sometimes there is a fine line where the PS causes centrals and just a little less won't cause them...assuming the centrals are related to PS.

shadowwolf218 · Post by **shadowwolf218** » Sat Feb 24, 2018 4:12 pm

Good news: adding ps 2 didn't seem to increase the centrals at all. Yay!

Bad news: after a few weeks of back-and-forth with my insurance, DME vendor, and sleep doctor, we've come to the conclusion that I can switch the Respironics for a Resmed machine (refurb or used) from the DME. The sleep doc will drop me as a patient, though, because they only use the Respironics machines. (The old Resmed I had was prescribed by a different sleep clinic that is both further away and more expensive.)

Since my deductible reset for the year, any new docs I see will be pretty much out of pocket for the next few months. I'm not sure I want to deal with that at this particular moment. Fun stuff.

I'm averaging around an AHI of 9, but I can only stand to keep the bipap on for 3-4 hours a night. It hits max pressure every night and stays there from about 2 hours in until I wake up.

I'll be seeing the otolaryngologist March 5, and we'll discuss taking my tonsils out to try and lower the necessary pressures.

Any thoughts in the meantime? I remain perpetually exhausted, of course. Ugh.

Note: You guys have been fantastic, regardless of how resistant I seem to be to treatment. I really do appreciate it.

TedVPAP · Post by **TedVPAP** » Sat Feb 24, 2018 7:57 pm

shadowwolf218 wrote: ↑
Sat Feb 03, 2018 6:52 pm
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

It looks like this was your best result. I still don't understand why the pressure is broken - is it possible that your machine is defective?
It looks like you do best with no PS and keep the pressure limited to 15 and see how you do.

TedVPAP · Post by **TedVPAP** » Sat Feb 24, 2018 8:32 pm

TedVPAP wrote: ↑
Sat Jan 20, 2018 6:50 pm
Your sleep is extremely broken and you have very bad numbers. So it is hard for me to suggest treatment changes when it appears that your treatment is way off. Or your broken sleep issues is throwing false flags. I would want to see what the events look like on a scale of 5 minutes.
You may want to upload a copy of your SD card and share the location so others can download&import into sleephead and investigate.

If I were you I would copy your SD card to a shared area so the data can be interrogated. I would like to explore your older CPAP data. Seeing how the wave forms evolve provides more insight than just what the machine labels as an event.

shadowwolf218 · Post by **shadowwolf218** » Wed Feb 28, 2018 11:30 pm

Here you are:

https://drive.google.com/drive/folders/ ... sp=sharing

TedVPAP · Post by **TedVPAP** » Fri Mar 02, 2018 12:27 pm

shadowwolf218 wrote: ↑
Wed Feb 28, 2018 11:30 pm
Here you are:

https://drive.google.com/drive/folders/ ... sp=sharing

Thanks for posting your file. I downloaded it and examined. I am not an expert so hopefully a true expert will review (they seem to be very hard to fine). I do have my thoughts as to what I would do if I were you - take'um or leave'um.

The file you posted is with your Bi-level machine so it does not have your old CPAP data which is too bad.
You did try a few nights using straight CPAP but it is strange that the machine setting on 10/14 and 11/15 state a CPAP of Fixed 9 but the chart shows that the Pressure=EPAP=5. I do not understand this.
Looking at all your bi-level data, I see most events which look to me as junk associated with arousals. It is not clear to me that you need such high pressure when I discount what I think are false events.

Below is your first post. You state that you were titrated using CPAP of 10. I would go back to that setting. Run it in CPAP mode with no exhalation relief. Make sure you really are getting a pressure of 10. Get at least 5 days of data so that we have a good baseline. Keep track as to how you feel and any known awakenings. Your respiratory is slower and deeper than what I am used to seeing.

shadowwolf218 wrote: ↑
Wed Jan 17, 2018 7:52 pm
Hi all. My name is Chris, and I'm new to the notion of talking about this stuff.

I was diagnosed with moderate OSA almost a year ago. Since then, I've been on a cpap and recently upgraded to a bipap.
My AHI has never been below 8 for more than a single night, usually < 4 hours use. On the cpap, all of my apneas were "clear airway" (it was a ResMed AirSense 10.)

I've upgraded to the bipap to see if that would help with the mixed apneas. It has made them much worse. My AHI most nights is between 14-20.
I did a second sleep study to see about getting a bipap asv, but they were able to get my apneas under control using only a cpap setting of ~10cmH2O. That said, I found the second sleep study to be significantly less restful than the first.

In other words, I seem to have a large number of central apneas whenever I'm at home, but they don't happen (or happen far less frequently, anyway) in the lab. My doctor is under the impression that my insurance wouldn't cover a bipap asv as a result.

I'm interested in why the centrals happen, sure, but the biggest problem is that this treatment isn't working.
I don't know what to do, and I need help.

This is my latest sleepyhead data, and I'm happy to provide any extra information I might have left out. I'm up for any suggestions that might help, however outlandish, and thanks for reading either way.

https://photos.app.goo.gl/lu1QTjM3XrEziwr52

shadowwolf218 · Post by **shadowwolf218** » Thu Mar 15, 2018 1:49 am

Things have been quite hectic lately, but I've got back on track (sort of.) A few updates...

1) I am getting my tonsils removed in late May (to be sure I've met my deductible before then, yay insurance.)
2) My DME let me switch to a Resmed Aircurve 10 vAuto.
3) Because of #2, I lost my previous sleep doctor. I've since found a new one, but they basically ignored everything I said and set the machine to EPAP 15 with PS 5. I tried it for the sake of humor, and had an AHI of >25 with 95% centrals, so I promptly changed it back and I may or may not go to my follow-up appointment with them. "If you aren't using a PS of >4 why do you even have a bipap?"
4) Current settings on the Aircurve (which I am not at all used to yet) -

Min EPAP = 14 (I've been raising it slowly)
PS = 0 (I started at the 5 the doc set, and dropped by 1 every day or so. Tonight will be night 1 back at 0.)
Temp/Humidity both set at 1
Ramp was on, but I turned it off after a couple days of it making it hard to fall asleep
Triggers and such are on med. Need to read the manual and get a feel for what that does

Below is the longest I've used the new machine since I got it. I don't quite know what to make of it.

https://photos.app.goo.gl/kvBhGNf3Lk2dh5lc2

TedVPAP · Post by **TedVPAP** » Thu Mar 15, 2018 8:25 pm

Thanks for the update.
I would like to see some data with PS=0 and pressure somewhere between 10 and 15.

shadowwolf218 · Post by **shadowwolf218** » Sat Mar 17, 2018 5:35 pm

Working the pressure down slowly, it seems 14 is probably the sweet spot.
This one is 12, but I still spent most of the night at 14-15.

Way better than the old machine, so there's that, but it seems like the centrals are back for some reason.

https://photos.app.goo.gl/93LNQS0zNYvyNpWG2

TedVPAP · Post by **TedVPAP** » Sat Mar 17, 2018 5:54 pm

shadowwolf218 wrote: ↑
Sat Mar 17, 2018 5:35 pm
Working the pressure down slowly, it seems 14 is probably the sweet spot.
This one is 12, but I still spent most of the night at 14-15.

Way better than the old machine, so there's that, but it seems like the centrals are back for some reason.

https://photos.app.goo.gl/93LNQS0zNYvyNpWG2

Any chance you were stirring at the time of the cluster? Can you show 5 minutes of the cluster?

shadowwolf218 · Post by **shadowwolf218** » Sun Mar 18, 2018 9:40 pm

I really don't know. I've never had clear sleep/wake cycles, and for the most part some sleep = no sleep = good sleep = bad sleep, so it just blurs together.

I think this is what you meant, although it is a 10 minute section. Let me know if you were referring to a different sort of "zoom" so to speak.

https://photos.app.goo.gl/xZ8QXGfoWeWhsHmH2

shadowwolf218 · Post by **shadowwolf218** » Tue Mar 20, 2018 12:34 pm

And now I'm really confused.

https://photos.app.goo.gl/CJx5qKWLcOEJjHis1

TedVPAP · Post by **TedVPAP** » Tue Mar 20, 2018 7:41 pm

If I were you I would go back to the beginning. The data I have seen shows that high pressure and large PS does not help you.
Start again. Set to CPAP with a pressure of 12. You will do much better than just letting the machine run around. Get a few days of data.

shadowwolf218 · Post by **shadowwolf218** » Wed Mar 21, 2018 10:03 pm

Is that not effectively what I'm doing with the machine now, by setting the PS to 0?

I don't disagree, though.

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