Bi-modal Respiration rate on BiPAP?

[YouTakeMyBreathAway]

Is it normal for respiration rate to jump between two values (in my case 15bpm and 8bpm) on ASV?

[palerider]

Look for a correlation between high PS on the mask pressure trace, and your lowered RR.

Likely the lowered RR is where the machine is doing the breathing work for you with higher PS.

[YouTakeMyBreathAway]

Makes sense - any risks from that happening for prolonged periods? 8bpm is below what is a healthy RR from what I understand.

[palerider]

Makes sense - any risks from that happening for prolonged periods? 8bpm is below what is a healthy RR from what I understand.

Depends on your SpO₂ levels.

[YouTakeMyBreathAway]

SpO2 levels are in the screenshot above, I assume those are OK?

[palerider]

SpO2 levels are in the screenshot above, I assume those are OK?

Your chart there is actually pretty interesting, in that it shows the ASV doing it's job very well.

If you look at the places after midnight (looks like you took the mask off briefly) you'll see where the PS gets higher like at 0:25-0:30, your RR drops, but your TV increases, which keeps your MV pretty stable. meaning you're breathing less often but the machine is making you breathe deeper, and your O₂ doesn't change much. While there's a bunch of spikyness later on, there aren't any dips below 88 which is the point where people start getting concerned.

Just curious, what oximeter are you using?

[YouTakeMyBreathAway]

I am using the Wellue O2Ring. Would love to get a different device to compare, but can't find any others that have proper recording support.

I do have more SpO2 dips (but to your point still above 88%) since switching to ASV, which makes me think my therapy is not fully dialed in yet or the device has really high variance/error above 88%. Before ASV I had gotten them to a point where I had a few days w/almost no drops:


(The high peaks Dec/Jan are from traveling to high altitude - so the device definitely does detect some stuff right...)

While my IPAP median is pretty close to where I was before, my EPAP on ASV is much lower, maybe that's the cause:



The problem is I can't really tolerate high EPAP on ASV well b/c I get aerophagia when it cranks the PS up fully on high EPAP baseline.

For the last two nights I used ASVAuto at default settings to help me understand how to dial in my settings, here's the recordings, please lmk any recommendations!




EPAP Median: 4.26 -> 4.52
Pressure Median: 8.36 -> 8.48
Pressure Support (Delta of above): 4.1 -> 3.96

EPAP 95%: 5.88 -> 5.72
Pressure 95%: 13.63 -> 12.79
Pressure Support (Delta of above): 7.75 -> 7.07

EPAP 99.5%: 8.68 -> 6.48
Pressure 99.5%: 18.06 -> 14.86
Pressure Support (Delta of above): 9.38 -> 8.38

I have seen people generally go w/ the 95% value as their default, so in my case that would be something like:

EPAP Min: 6.0
PS Min: 6.0 (that's the max allowed)
PS Max: 10.0

Does that sound right?

[palerider]

So, part of your problem may be that really low minEPAP that you've got.

In basic bilevel therapy, oxygenation happens with your EPAP, and ventilation happens with PS, (IPAP), so if your oxygen levels are low, increase the EPAP.

You might try inching your MinEPAP up by one every few nights. instead of 4, go to 5, then 6, but take it slow, and see what that does after a few days at each.