Help with therapy on Dreamstation BiLevel S/T

[ajack]

Thanks for the spirited discussion all!

I've got a few nights of OSCAR data. Sleepyhead does not support this machine.

Which of the following graphs would be most useful for viewing? I can prob fit about five. Leaks are atrocious - time over leak redline was 106.4% last night

Event Flag
Flow Rate
Pressure
Leak Rate
Resp. Rate
Tidal Volume
Pat. Trig. Breaths
Insp. Time
Exp. Time
Test #1
AHI
Time at Pressure

If you go over to apnea board. They have very good advice on mask fit. It is the first job.
It is a shock to go from apap to bpap st.
If you do make any changes, and I would put it past your doctor. epap10, ipap20, and see what apnea number you get. I wouldn't change the PS10.

The issues they are scaring you with are associated to Intubated ventilation. Not home non invasive, scripted by a doctor. PS10 really isn't a concern, as your doctor will tell you.

Once the leak is fixed and I would also look at physical obstructing the airway, like tucking your chin to your chest. I don't know, but I think you may be able to lower your epap and still keep the PS10.
The tidal volume and minute vent chart are worth including in the chart. You can also post 2 charts to include the ones mentioned.

[Pugsy]

FWIW.....I am NOT suggesting 4 cm PS at this time.
Right now I am ONLY trying to figure out how much PS can be handled at this time comfortably. That was the ONLY reason for the suggested experiment.
A person has to be comfortable and able to fall asleep before any of this stuff matters at all.

My idea was mainly to try to find a PS that was comfortable enough so she could actually get some sleep so that at that time the reports could be evaluated and at that time decide if more PS is needed.
The machine will flag centrals if they happen and sometimes people can get the centrals reduced with a lot less than 10 cm PS all night long. If a person has to start lower and work up to more PS then that's better than no centrals because of no sleep.

PS doesn't have to be 10 cm and get the job done....I have seen centrals reduce significantly with 4 to 6 cm PS as well.

Again....a person has to be comfortable enough to fall asleep first. If a person can't sleep then all this crap is moot.

[ajack]

I would double check, I know resmed doesn't tag CA on ST and I would think the Philips ST would be the same. It will tell you how many breaths were spontaneous and how many were timed. It will also tag apnea as UA. I can see no reason to even consider PS4, it can't treat CA. You seeing CA treated with 6, what was the tidal volume of the breath? I've seen machines choked down that much it does nothing, but won't show a CA in the AHI as the machine sees the timed breath.

Lowering epap, keeping PS10, till the obstructive become unacceptable is an option, I would ask the doctor about.

A PS of 10 actually makes breathing very easy and requires little effort. It's just the shock of pressure. If there are no other issues, the worse of it is over in a week. If the mask is kept on all night.

[palerider]

A PS of 10 actually makes breathing very easy and requires little effort.

See, ajackass, statements like this are why people tell everybody to ignore you.

A PS of 10 hyperinflates most people and causes hypocapnia, which very typically exacerbates central apnea

Go back to your booze, stop posting, maybe even go somewhere that your posts are welcome.

[ajack]

My little troll, how have you been? I'm sure the doctor isn't as clueless as you are. In the US system of suing everyone. Even the doctor would have had evidence that 26/16 was the right number for the script, and no provider would issue the machine without a script. But by all means, you clowns continue your delusion that you know anything.
What ever you guys do, please don't tell them to increase the min Ti, so that they are breath stacking and haven't got time to breathe out, like you did to the poor man that listened to the nonsense.

[palerider]

My little troll, how have you been? I'm sure the doctor isn't as clueless as you are. In the US system of suing everyone. Even the doctor would have had evidence that 26/16 was the right number for the script, and no provider would issue the machine without a script. But by all means, you clowns continue your delusion that you know anything.

You're a dangerous maniac.

Simple little things like "doctors make mistakes all the time" which is why this forum exists.

What ever you guys do, please don't tell them to increase the min Ti, so that they are breath stacking and haven't got time to breathe out, like you did to the poor man that listened to the nonsense.

I've told people to leave TiMin set to default, you're obviously confused in your alcoholic stupor.

[halokittie]

As promised, here are the OSCAR screenshots.

Was so exhausted night before last that I slept for 7 hours without waking up! Made it just over 4 hours last night, but that was a good 30 minutes of awake time to make it to compliance.

Many thanks.

[halokittie]

Thought the bilevel titration study the sleep doctor based his decision on might be helpful - 7 pages

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[halokittie]

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[Pugsy]

What settings did you use last night and the night before?
Get them off the machine...not OSCAR.

[palerider]

What settings did you use last night and the night before?
Get them off the machine...not OSCAR.

Is it a St, or an avaps like Oscar says? (Ie, Oscar bugs on machine type?)

The varying ipap doesn't look st like.

[Pugsy]

What settings did you use last night and the night before?
Get them off the machine...not OSCAR.

Is it a St, or an avaps like Oscar says? (Ie, Oscar bugs on machine type?)

The varying ipap doesn't look st like.

OSCAR may not play nice with this model either...which is why I wanted all settings as shown from the machine setup menu.
Statistics look weird and nothing near what reported settings were.

Sigh.... I have a monumental headache right now...what with all the smoke coming out of my ears and now this.
I think I will go pour myself a shot of some high dollar brandy that someone in Australia sent me.

[raisedfist]

Oscar does not work well with the DreamStation...it's showing EPAP to be higher than IPAP. Take a photograph of your machine settings and upload it please. Your machine may work with Encore Pro - you can get that for free on Apnea Board.

[raisedfist]

It looks like the sleep tech went nuts for some reason...you weren't having problems with centrals until they decided to jack up the PS. And then they had to add a backup rate near the end because they washed so much CO2 out of you...treatment emergent centrals from the increased PS

Did you do a CPAP titration before? Wondering why they went to bi-level...I would have kept you at PS 4 and raised both IPAP and EPAP together until hypopneas and obstructive apneas were gone. Maybe I am missing the history...