BiPAP S/T User: Machine & Data Questions

Hi all --

First time poster here, although I've been lurking and reading here since last July when I was put on CPAP. Last night was my first time at home on a BiPAP S/T, with higher pressures (20/16) than I'd been using on the CPAP (13). After looking at the data, I have some questions. I'm hoping some of you experts might be able to answer these and provide general advice. I know everyone says to give it time on a new machine and settings, but I'd love to hear from others about how they've made similar transitions and adjustments.


EARLY CPAP: CENTRAL APNEAS
The waveform reports from my CPAP showed lots of central apneas and hypnopneas, and about 18% of the night in periodic breathing on average. Some nights were much worse. As far as the aggregate index values go, they were: CA of 9.5, OA of 2.0, HI of 2.5, and RERA of 0.5, for an average AHI of 14.0. I honestly felt more tired after using the CPAP than without it (which contributed to me gradually stopping its use). In short, the CPAP seemed to solve the OSA, but a whole new set of problems came to the surface.


CURRENT SITUATION AND MY QUESTIONS
Since it was clear this wasn't working, I headed back to my sleep doc suspecting I needed exactly that which the latest sleep study suggested. As I mentioned in the first paragraph, they have my pressures set fairly high (20 IPAP, 16 EPAP). Based on suggestions on these forums, I'm now trying the FitLife mask. I have to strap it down pretty tight to get a seal. I logged about 9 hours last night. Without further adieu, let me dive into the questions.

1) My first question concerns BPM. The machine was set at 16 BPM, which made me feel like I was hyperventilating while trying to go to sleep. I notched it down to 10 BMP last night, but my respiratory therapist told me today that 16 BPM was indeed part of the prescription, and suggested I move my rise setting up from 2 to 3 instead. Interestingly, the data report report shows my average breath rate to be 16.0 BPM, with the average percent of patient triggered breaths to be 94%. So, what am I seeing here? Is the machine basically just identifying that my sleeping BPM actually is about 16, the same as was identified in my titration study? Do I just breathe a lot more when actually asleep than when laying there trying to go to sleep? What would you do if you were me? (Reading the next couple paragraphs may have some more pertinent information here). Since the whole point of the timed aspect was to give you a "backup" if you don't breathe, it seems to me that it ought to have a little bit of a fudge factor rather than being calibrated to what I normally do. But hey, I'm not an expert.

2) My Average AHI is 25.4. This is comprised almost entirely of hypopneas (CA 0.6, OA 0.0, H 24.9). I know this is really high. I don't entirely understand the implications, however. I did use an Ambien to get to sleep last night, which I know can exacerbate hypopneas, although there's just no way I can get to sleep with this thing (at least right now) without taking a sleep medication. Any comments, concerns, or suggestions? Based on reading some other posts, it sounds like some of you think this number may go down as I use the BiPAP more. Edit: I've moved discussion of this topic to a standalone thread -- viewtopic/t61719/BiPAP-ST-User-Needs-He ... pneas.html

3) I was accustomed to being able to view and print waveform reports while on my CPAP. There's no waveform option for last night, though, which surprised me given that both machines were made by Respironics and the BIPAP S/T is significantly more expensive. Is there a hidden setting or something I'm missing? Edit: Based upon further research, it appears the BiPAP S/T does not support waveform reports.

I'm sure I'll have more questions, but I figured it was time I started asking questions and engaging rather than just reading.

Thanks a bunch!

Dear BrianinTN,

you asked many questions. I'm not familiar with your machine, so in response to this question I'll ask one of you:

4) I was accustomed to being able to view and print waveform reports while on my CPAP. There's no waveform option for last night, though, which surprised me given that both machines were made by Respironics and the BIPAP S/T is significantly more expensive. Is there a hidden setting or something I'm missing?

Does your card record three files for each time you use the machine? If you examine the files in the folder on the card, looking on your computer, and the card has files that end with ".005" then you should have waveforms available through the EncorePro software (or waveform editors such as Audacity, or the online Onkor site). If the file was there, perhaps there was only an odd "glitch" that it didn't show up for last night when you looked in the software. Once I tried creating another name for myself (another patient set-up) in EncorePro and then loaded the data for a night that was otherwise not showing in my "real" patient file -- and it did show up in the new patient file.

As far as the high number of hypopneas, I'd want to bring that to the attention of my doctor right away. To me it is not "wait and see" when such a high AHI shows up -- to me it screams "needs attention."

--SleepyCPAP

There's a directory called /e which contains files with a *.004 format, and a /p directory that contains files of the format *.001 and *.002. I don't see anything with a .005 suffix. I pulled out the card I'd been using with my CPAP, and it indeed did have files with the .005 suffix.

So, I guess my question for those familiar with the BiPAP S/T is: how do I get it to begin creating these files again?

Just by way of update -- last night didn't record any *.005 files either, so it isn't a one night anomaly unfortunately. Sure do wish I could see those waveforms!