Bipap on the way,now what

[Hornnumb2]

Well first night didn't go as easy as I had planned. I tried the mask I wore in the study and could not get it to stop leaking everywhere. Second mask no good either, finally with the Pilario Q I got the leaking to stop but didn't like the feel of it but out of options. Other then the initial mask problems, it seemed like sleeping was ok. Here is the screenshot, not real sure what I am looking at yet. Thanks

[poppi2]

I also had a question about bathroom breaks,...

For me, Cpap therapy is worth it for eliminating bathroom breaks and snoring. After you get your therapy dialed in, you will be happy and healthier. Good luck, Earl

[Hornnumb2]

Well only had 2 breaks last night. I went and got a P10 to try tonight, didn't really want to pay DME price but when you need it now thats all you can do. $137 but can bring back within 30 days.

[palerider]

. Here is the screenshot, not real sure what I am looking at yet.

mostly hypos, I'd raise the minepap pressure by one... and re-evaluate.

[Sleeprider]

I agree. This shows a need for higher EPAP min pressure or a bit more PS. You can see all of those black marks along the top of the flow rate chart. Those are pressure increases to prevent centrals. There are a lot of them, and they are all breaths you've been missing up to now.

We talked about an EPAP min of 6.0 and I see this was a night at 5.0. So take it up to 6.0, and it might work out a bit better. There is nothing here to suggest obstructive apnea, and your leak rate looks great. Remember your CPAP titration study results:

6 obstructive apneas, 36 central apneas, 13 mixed apneas, 7 respiratory effort related arousals (RERAs) and 32 obstructive hypopneas, for a significantly elevated apnea-hypopnea index (AHI) of 16.5

You had a full night AHI of 9, mainly Hypopnea. That is actually a very good start, and you cut your AHI in half. The other thing I like is the Tidal Volume average at 490. That is a healthy ventilation rate for an average size person, and probably a lot more air than you've been getting. I also think the hypopnea activity will settle down as you adapt to the therapy. The sleep study identified your Hypopneas on CPAP as obstructive, and this confirms the need to increase EPAP Min.

Ignoring the graphs, you took fewer trips to the bathroom. How do you feel after one night? $137 is fine for the P10 with an easy return policy. I think you'll like the new mask.

[Hornnumb2]

Thanks for the feedback, I know I had epap min set to 6 not sure why it shows 5. I just went in and bump it one to 7 to see what that does. My poor dog was not to sure about my looks last night, lots of sniffing trying to figure out what's up. I only used a third of my distilled water, is it best to do fresh everyday? Thanks again. Michael

[Pugsy]

Remember I told you that SleepyHead and the 960 sometimes would act up?
That setting showing 5 min EPAP when the graph clearly shows 6 and you said it was 6 in the setup menu may be just part of SH "acting up".
Go by what the machine settings actually are and not necessarily what SH is reporting in that statistics column.
When I was using my 960 I would sometimes see minor discrepancies like that in the reported settings.
It would also tell me that my humidifier was not connected and it most certainly was connected and working just fine.

The actual leak, AHI, etc data always matched up to what Encore reported so the important stuff was accurate.
It's just sometimes the settings or statistics side gets a little whacko.

[Hornnumb2]

I did switch to the P10 last night but and bumped the epap min to 7.

[Sleeprider]

It would help to see a zoomed-in shot of the hypopnea events where the individual breaths and machine induced breaths is more visible. I'm wondering if the machine is running out of IPAP at the current max setting of 19. I thought you were going to set up IPAPmax at 25, but the closeup should show if you're not getting a complete breath.

[Pugsy]

Exactly what settings are being used? All of them.
Please refer to the actual machine settings that you see on the machine and not what SleepyHead is saying the machine is set at.

[Hornnumb2]

Max pressure 25
Epap min 7
Epap max 11
Ps min 4
Ps max 18
Bpm auto
Flex bi
Bi flex 2
Sy one resistance X1
Let me know what I need to change. Thanks Michael

[Hornnumb2]

I hope this is what you need.

[Sleeprider]

Actually that's perfect, but it's also beyond my expertise to suggest what to do with that periodic pattern....Pugsy?

[Pugsy]

it's also beyond my expertise to suggest what to do with that periodic pattern....Pugsy?

I am sitting here scratching my head too.
It looks PBish but doesn't appear to be flagged as such probably because it didn't meet the criteria for some reason.
Makes me wonder if the hyponeas are really obstructive or if they are leaning towards central.

Also makes me sort of wish we had Encore's waveform to look at. Along with the Encore graphs in general.

If these hyponeas are really obstructive it's quite possible that a significant increase in EPAP minimum is needed if I draw upon my own experience with the 960 and what my hyponeas did (very similar to this at 6 or 7 minimum EPAP) and I ended up needing minimum EPAP of 10 to get the hyponeas reduced to an acceptable level. Whether the OP here is in a similar situation as I was.....that's anyone's guess....and I don't like guessing when it comes to centrals.

One part of me says "be patient and give it time" and the other part says "time may not help"
I know what I would do if it were me but I often tell people "don't do as I do" because I am not a good role model because I don't always do as I say....plus I didn't have a problem with centrals particularly....my main issues were obstructive and not central.

http://www.isetonline.org/yahoo_site_ad ... 190318.pdf
see pages that start after all the various graphs...around page 20 and upwards

I just looked at the above guide again and tried to ascertain how these hyponeas may be factored in.
Perhaps the machine needs to be able to go further than the 11 cm max EPAP because it's EPAP that takes care of the obstructive stuff....but then when I was doing it myself I still had to increase the minimum EPAP despite having a wide range available for EPAP max when I was using min of 6.....so it took increasing both min and max EPAP to reduce my hyponeas.

[Sleeprider]

You know the CPAP study classified the hypopnea as obstructive. I am divided between an increase in EPAP and an increase in PS. Although a wide range of PS is in the settings, it only averages 5.0. For obstructive issues, I'd normally go higher EPAP, although H and RERA might respond to increased PS. I'm more inclined to move up the EPAP min on the presumption the study was correct. I also agree we're seeing incomplete centrals.

Pugsy, thanks for your willingness to discuss. Is there a better way to see the ASV pressure reactions to the H and CA?