Now on bipap machine. AHI even worse!

[Uff Da]

I've been on my bipap for eight days, after going the past two months without any machine. I'm starting a new thread with my new machine, but if anyone feels a need to check back on previous posts from my ResMed APAP for any reason, here is the link. viewtopic/t171740/Over-a-month-on-CPAP-AHI-2053.html

Some general information:
Female, age 77 with various comorbidities: type 1 diabetes, osteoarthritis, osteoporosis, muscle/joint/inflammation problem doctors have been unable to diagnose, hypothyroid, hypertension and postprandial hypotension. On various meds for above, plus additional OTCs.

Sleep study March 2018 showed uncorrected AHI of 88.8. Six months on APAP not particularly successful, with repeated problems of being unable to find a mask that didn't leak excessively and problems related to excessive swallowing of air. Toward the end of APAP use, AHI was running between 10 and 30, though mask leakage may have made those figures inaccurate.

Second sleep study September 2018 resulted in doctor recommending bi-level machine. However, I had so much trouble with mask leakage during this test that I only got about two hours at the lower pressure (12/8) and one hour at higher pressures, so I question how valid conclusions were. I had no REM sleep and no N3 sleep during the test. Supine AHI in the test was 38.9.
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Counting all the masks I've tried in the sleep centers plus those with the previous machine, I'm now on my ninth mask. This one seems to give the best results to date, though I've only used it two nights. The "mask fit" on the machine is showing 96% and 100% for the past two nights, whereas the previous week with other masks it was around 66%. Looking at the charts from the last two nights, though, it shows 20-35% of time over leak redline, so I'm wondering how good the mask really fits.

Also, I just don't understand why I'm still getting such high AHI. The machine is set so pressure can go up to 25 if need be, but it rarely goes over about 15. So why doesn't it cut my AHI more than it has?

[Pugsy]

Can you do me a favor please?
Redo your graphs and only include these graphs
Events
Flow rate
Pressure
Leak

Omit all the others and make those 4 graphs larger. They are so tiny right now I can't tell much of anything from them.
We don't need those other graphs.

What sleeping position were you in with this night above?

The machine is going to 17.5 IPAP and EPAP if we believe the statistics. Disregard that time at pressure graph...it is a work in progress and a bit buggy. An after thought that wasn't followed through very well with the coding.

Disregard the time over red line leak statistic...it's based on a ResMed red line threshold which isn't what Respironics machines use.
Your leaks are NOT all that excessive. A few brief large leaks (see the LL line on the Events graph?? that's large leak) but no where near 35% of the night.
Instead the statistic reporting the % of time in large leak is based on a ResMed calculation number and that number won't work for your Respironics machine.
Open SH and go to Preferences and then the CPAP tab. SH Defaults to a red line leak threshold of 24 L/min which is a ResMed leak number...won't work with your machine. Your red line threshold number is more like 85 at your pressures...so change the 24 to 85 or just turn off that statistic by removing the check mark.

[Uff Da]

Does my machine even give a "flow rate" chart? I don't see it. And I miss it!

Will have to do the other changes after a trip to the store and after dinner. So will be later this evening.

[Pugsy]

There should be a flow rate graph as long as the SD card was in the machine all night.
It's the one data point that has to go directly to the SD card and isn't stored on the machine.
So check the graphs (lower right corner) and make sure all graphs are green and none are red (just click on it to change colors)...if red that graph is turned off and can't be seen..
and if it isn't red...maybe you didn't have the SD card in the machine all night????

Below is the only example of Flow Rate from Respironics machine that I have handy at the moment.

[Uff Da]

Okay, clicking on the triangle at the lower right does not show the flow chart. I have not been putting the SD disk that I've been using for Sleepyhead into the machine at night. The CRT at the DME advised me not to use their supplied SD disk in Sleepyhead, due to problems with the disk running into problems. And as you may recall, on my last machine I did end up with contaminated data which Palerider analyzed and advised me to format the disk. So what I've been doing is leaving the DME supplied disk in at night, then switching disks and using my own disk to copy the data from the machine to my Sleepyhead disk in the morning. So if I understand you correctly, there should be more data including the flow chart data on the DME supplied disk I had in the machine every night. I'm not sure if I copy that data to a computer file (without taking it directly into Sleepyhead) if I can then recover that extra data in Sleepyhead when that date has already been run from what was on the other disk. I just don't know enough about computers to know how all that works and if it will automatically re-write the file.

I'll check with my BF tomorrow and see if he can help me transfer the data from the other disk to the computer and see if anything more can be done with it in Sleepyhead. I'll see if that works before I re-order and copy the charts.

[Pugsy]

The flow rate graph is on the SD card that is left in the machine during the night.

Using SleepyHead with that SD card won't corrupt anything but it's not critical that we see the flow rate at this time. Handy but not critical.

Go ahead and redo the graphs so they are larger and only the other ones that I mention. When we have too many graphs in one image that makes them all so small we can't really tell much about any of them.

Again...what sleeping position were you in (if you know) during those ugly clusters?

What you can do though is copy the entire disk that is in the machine all night and then paste that copied data onto the SD card that you wish to use with Sleepyhead...

Or you can copy just the P0 folder for now. The P0 folder is the first data file folder and it's under the Pserial number folder.
As the machine gets used more and more and the P0 folder gets full then a P1 folder is added...then once it is full a P2 folder is added.

There is also a way to just copy the file that gives the flow rate graph but I don't remember which file that is... used to be the xxx.005 file on the System One machines. I don't know the file structure for the DreamStation.

If you don't understand what I am saying most likely your BF will.

[Uff Da]

Sleeping position was almost certainly supine. That's the only way I can sleep without causing big time mask leakage. Due to pain when lying on my side, I tend to sleep supine at least 80% of the time even when not using the mask. My last sleep study showed 100% supine.

I changed the redline on mask leakage to 85 L/min. and enlarged the requested charts. Short, interrupted sleep sessions as shown is typical of my sleeping patterns.

[Pugsy]

They put you on a bilevel device and set it up like an apap...they set PS 0.0 to 8 and the most it ever got to was 1.0.
So not much help if you have exhale problems with such little pressure support (difference between inhale and exhale).

So they pretty much set it up to run like an apap machine set at minimum of 12 and it seems to quit trying to do anything at a little less than 18 cm. It doesn't try to go higher for some reason or other...and obviously should go higher for all that obstructive stuff.
I don't know if it runs out of time because your sleep sessions are so short or what is going on.

Why did they give you a bilevel and not set it up for bilevel? Right now it's functioning like an apap with Flex exhale relief of about 1.
And what were your settings on the apap you had? Wasn't it more than the 12? If I remember you right...you needed more pressure on the apap.

You need more EPAP and more IPAP than you are getting...meaning your minimum EPAP probably needs to be up around that 17 cm mark...maybe even more.

[Uff Da]

I ended up setting my APAP machine with a minimum of 12 and maximum of 14. I'd tried higher pressures on IPAP and reached the conclusion I probably needed a max of 18, but due to mask leakage and pain from swallowing air, 14 seemed to be the best I could handle.

I'm not sure what my doctor tried to order for my settings originally, but it turned out that how she wanted it set couldn't be done on the machine she ordered. Apparently the DME and doctor went back and forth with communications and also with Medicare as to what they'd allow based upon the study they had me do and results before arriving at this machine and settings. At least that's my DME's excuse of why it took them almost three months to get the machine to me after the doctor originally ordered it.

It looks to me like when the pressure gets to 18 or close to it, I wake up. Part of that is likely that the higher the pressure, the more gas pains from swallowing air and I just have to get away from the machine an hour or two before I can tolerate it again.

How do I go about finding the instructions for over-riding the prescribed settings on this machine?

[Pugsy]

You can request the clinical/provider manual from the apneaboard which explains how to do the secret handshake so you can access the setup menu area.
https://www.apneaboard.com/adjust-cpap- ... tup-manual
You have this model...
Philips-Respironics DreamStation Auto BiPAP
and not the Pro model you seem to have selected in the equipment menu.

Adding in PS might enable you to use higher pressures without the aerophagia issues...I don't know where your trigger line is for below so and so pressure doesn't cause aerophagia and above it will.

My suggestion is to try auto mode
Minimum EPAP of 16
PS minimum 4...PS maximum of 4
and I guess let IPAP max be the 25....see how you do both in reducing the OAs and see what happens with the belly.
This would give you more pressure during inhale but the reduction during exhale might be enough to not cause the aerophagia issues to be so bad.
I know you need more pressure but I don't know if your belly can handle it.

[Uff Da]

Thanks for the advice, Pugsy. Am feeling a bit under the weather today, but will try to follow up on some of it when I feel more surely "among the living." With my problems with aerophagia, I'm not feeling very positive that I'll be able to make this thing work. I may well make a decision within the next month to give up on the whole bilevel thing. I just might be one of those persons who can't handle the machines. But I'll give it a few more adjustments to see if I can find some middle ground that works.