Data from me :)

Does anyone want to take a look at my data for me and tell me if there's anything interesting I should know? Hopefully my leaks are now under control.

FYI, about 30 minutes at the start of each segment is me trying to fall asleep.

Link: http://www.scribd.com/doc/9232479/Doo

Thanks!

Grace, I'm not a doctor. But looking at that data and seeing how often the EPAP has to go up, if it were me, I'd change the present min EPAP 5, max IPAP 12 to this:

min EPAP 9
max IPAP 20
max press sup (called "PS" on the non-M machine) 8

With those settings, the machine will start out each night using EPAP 9, IPAP 11.

Here are links to my understanding of the Maximum Pressure Support setting -- like two dogs on a leash.

That setting is called "Max Press Sup" in the M series BiPAP Auto.
It's called "PS" in the older non-M series BiPAP Auto.
Same thing.

viewtopic.php?t=22099
Jul 14, 2007 subject: What is 'Max Press Sup'

viewtopic.php?t=15666
Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006

And, some links to my thoughts about why setting the minimum pressure is the important setting to "get right" when using any kind of autotitrating machine... the min EPAP for auto bilevel, the EPAP for bilevel, or the minimum pressure in the range for an autopap.

I think it's best to have the minimum pressure set high enough to prevent most events (especially apneas) from the start. Just my opinion.

BiPAP (EPAP) and BiPAP Auto (min EPAP):
May 2008 - discussion with RonS about importance of EPAP setting.
viewtopic.php?p=265020#p265020

February 2008 - EPAP is generally lower than the single pressure from a "CPAP" titration.
viewtopic.php?p=245757#p245757

December 2007 - my understanding of how a bipap titration is done.
viewtopic.php?p=231786#p231786



Autopap (minimum pressure):

November 2008 Just got an APAP (topic started by turbosnore)
viewtopic.php?p=319619#p319619

October 2008 Turning off Aflex and Cflex (topic started by DoriC)
viewtopic.php?p=307265#p307265

September 2008 New Guy - Need Help w/Settings (topic started by alanhj13)
viewtopic.php?p=294319#p294319

December 2008 Why adjust APAP. Isn't it auto? (topic started by oxygenium65)
viewtopic.php?p=323218#p323218
Wulfman, DreamStalker, and ozij explain that autopaps make changes slowly

Your AHI is 6.8 with an average of 7 showing on your summary page. An AHI of less than 5 is considered normal...mine runs less that 1.0. You should check the rated leak for your mask (found in the user manual for your mask)...excessive leakage could account for your above normal AHI.

Thanks for the info! Two quick questions: First, what should my graph look like? You said that the EPAP needs to keep going up to prevent apneas; how do you read that from the graph? Also, the EPAP/IPAP on my data is already adjusted from 5 E and 9 I. I just worry that the higher up I go the less I'll be able to tolerate it. Any thoughts?

Thanks!
-Grace

Snoredog posted a graph that explains the relationship of epap and ipap pressures to apneas and hypopneas



Looking at your data it appears that you are running out of room at the top, max ipap pressure. Your machine can't go high enough in pressure to deal withe hypopneas you are having. I agree with RG that you need to increase both the epap and ipap pressures. I your are worried about too much pressure bothering you you might try setting epap at 7 instead of 5 and seeing what that does. In any case I think you need to raise your ipap pressure. RG is very experienced with this and I have always benefited from her advice.

Dale

Your FL is really high, are you having congestion troubles, I use OTC decongestants to help mine, I was also wondering why are so many people using BiPAPs at fairly low pressures. I believe in KISS treatment. Jim

Thanks for the graph, now I understand it a bit better.

I attribute my high AHI to the fact that it takes me a while to fall asleep and I've been advised that a lot of false positives are showing up because of that. The graphed events towards the beginning and end of each segment is just me being awake.

And yes, I am getting over a cold! That's probably impacting the FL.

lking wrote:You should check the rated leak for your mask (found in the user manual for your mask)...excessive leakage could account for your above normal AHI.

Good point to always check that, lking. Regardless of what ciounoi's mask leak chart shows for various pressures, that looked like a very nice low leak rate on that one night's data. Especially considering how many times the pressure was climbing. I really think EPAP being set too low was what was causing the pressure(s) to have to go up so many times.

Most of the time it looked like the EPAP increases were shoving IPAP up -- to keep that built-in 2 cm difference as the closest that EPAP/IPAP can be to each other when that machine is set for "auto bilevel" mode.

RestedGal, I followed your advice and upped the pressure a bit. I think I originally tried 12 E 16 I, but the pressure literally blew the mask off my face, so I figured I'd have to work up to that pressure! Instead, I tried 9.4 EPAP and 13.5 IPAP. Here are the results: http://www.scribd.com/doc/9268987/More

It definitely seems to have helped! I can see that I'm certainly preventing many more hypopneas at that pressure. Any suggestions for pressure changes, or should I stick with this setting for a while first?

In fact, only problem seems to be the leak rate. Can anyone tell me why it seems so nice and even but when I have a leak, it's a BAD leak? Is the leak rate artificially inflated because of the big leaks?

Thanks for the help!
-Grace

That looks muchhhhhh better, Grace.

What do you have the Max Press Sup (called "PS" in the non-M series BiPAP Auto) set at?

If you've put a leash on that setting, I'd run that setting up as much as it will allow. What it will "allow" you to set it at depends on how far apart the "min EPAP" and "max IPAP" settings are. It won't allow itself to be set for more than the difference in min EPAP and max IPAP. In any case, it won't allow more than an 8 cm gap to be set.

Your leak rate still looks very good to me. That huge spike was probably from the mask getting dislodged badly, but it was for a relatively short time, so I wouldn't worry about it.