Struggling for a year-Mom and her BiPAP

I use a Resmed machine so this may be a little different. I don't have an IPAP max setting. I have IPAP min and PS that like you stated when added together result in the IPAP max. IPAP + EPAP = IPAP max. So the limit on IPAP is the machine limit, but may be restricted at less than that by the EPEP and PS settings. Sleepyhead does not even list my machine settings.

It's been a while since I have looked into how the machine operates and remember I have only looked into the Resmed in detail. IIRC the machine does not try and clear an obstruction, but instead it tries to detect if the flow limit is obstructive or central and then if obstructive, it will make adjustments to try and keep it from happening again. To detect the apnea type the Resmed provide pressure pulses (1cm) and I am pretty sure that the PR1 system puts small pressure ramps into the flow, central and obstructive will react differently to these pressure changes.

PoolQ wrote:I use a Resmed machine so this may be a little different. I don't have an IPAP max setting.

Your ResMed machine is what I call a plain bilevel machine and not of the same model category as the machine in this discussion which is a bilevel ASV type of machine.
It's not going to have the same settings and it can't do the same thing
The ASV machines can and will treat centrals. Your machine can't and won't. That's why your machine doesn't have the same setting options. The AirCurve 10 in the ASV model line will have similar settings as the machine in question here.

So while your machine and the 960 in this discussion are both bilevel devices they aren't the same type of bilevel and they go about their respective jobs a little differently.
Treating the obstructive side of things is pretty much the same but the difference comes with treating the centrals.
Now sometimes your type of bilevel device is used in an effort to prevent centrals and sometimes it works quite well but it prevents in a different matter (tries to prevent the cause of the central which is usually related to some unstable breathing) and doesn't treat after the fact. The ASV machines will treat after the fact. If a person doesn't breathe on their own the ASV machine will step up and breathe for you...that's why they are called ASV (Adapto Servo Ventilation) which is a whole different animal from your machine.
Yours can't step up and breathe for you....ASV machines can as long as their little hands aren't tied.

Hey Pugsy, hope you are doing well.
Thanks for the education, as usual. I need to start remembering the different machine numbering systems

PoolQ wrote:Thanks for the education, as usual. I need to start remembering the different machine numbering systems

No problem.
Eventually you will get the different machines straight in your head but it will take some time.
It took me forever to get the differences in the plain bilevel and ASV bilevel straight in my head as well as understand how those difference potentially impact therapy.

Looking for some reassurance from those who have been there.....I finally spoke to dr. about sleep lab titration. (I still don't have report to post yet). Her recommendation is completely different than what we have been discussing in this forum based on her daily reports. I am in disbelief but trying to have faith.

She did not look at the daily screenshots I sent her. I asked about increasing EPAP min and explained that I can see that OAs are occurring at the the min of 6 and even 7. She said based on the titration that more events happened at higher pressures. Even though my mom didn't have REM sleep in the lab, she said the best pressure to try is:
IPAP of 10, EPAP of 6 and leave them constant.
Back up rate will be changed from 8 to 16.

She said my mom had more events at higher pressures.
She said in this study her OSA was moderate whereas it was characterized as severe in the first one. She also said there were mixed OA/CAs but no straight CAs this time.
She said if it doesn't work then we can discuss a TRACHEOSTOMY that would be capped during the day. I said since we haven't made any pressure revisions in the last year that maybe we could try some things if this change didn't work first.

Oh my...please tell me to trust the dr.

Telling you to trust a Doctor that we know little about, for me at least is difficult. I personally do trust my Doctor. You sound like an intelligent and reasonable person, what do you think? Maybe not about the technical, but about them as a person and professional. Is your Doctor listening to you, do they hear what you are saying? Do they give a thoughtful response? Do you feel that they truly care about your mother?

I changed my pressure, once. By 1 cm and my apneas went up by a lot. It did not of course kill me. But I decided that yes indeed my Doctor knew what he was talking about. He was quite kind at our next visit "I see you adjusted your pressure" with a smile. He recently told me I can adjust anything I want, but that he would not recommend that I change the pressure.

When I changed it, I looked at my graphs and changed it right back. No harm, no foul.

I can tell by reading what you posted that you are trying to make sure your mother has the best possible treatment and not in denial about her current condition, she has a lot going on as I am sure you know.

You have the report on the way. You could check into a second opinion once you have that. I doubt that much will go south in the next week at least.

While you are going down this path with your mother, please make sure you are also taking care of yourself and getting the support you need.