phopap wrote:Ok, I bought and cleaned the $45 Resp. 700M bi-level. What settings should I try in the effort to not receive inhale pressure until I initiate inhaling (if that's what I need to avoid the suffocation response). Bi-flex off? Comfort rise set to what? Straight bi-level or auto bi-level? (Remember that I'm diagnosed for 6cm.)
As someone when through a lot of what you are dealing with I would suggest the following:
1)
BiFlex OFF. BiFlex definitely does a partial increase in pressure during the exhalation stage. So my guess is that you won't want BiFlex.
2)
Rise Time = 3. That is the "slowest" setting for Rise Time. In other words, while the pressure change to IPAP is still pretty rapid, it's slower than it would be with Rise Time = 1 or 2.
3)
Pressure Settings.. This is a bit harder. I think if I were you, I'd "practice" with the machine for at least 15-20 minutes with
each of the following settings to see if one is substantially more comfortable than the others:
- EPAP = 4, IPAP = 6
- EPAP = 4, IPAP = 7
- EPAP = 4, IPAP = 8
Pick the setting that seems most comfortable (or least uncomfortable) for you as long as it is more comfortable (less uncomfortable) than breathing with the S9 feels. You might also want to use the S9 for about 15-20 minutes
before you start "practicing" with the M-Series so that you know exactly what the S9 is doing that's bugging you so much. If all the settings are more comfortable than the S9 with EPR=3, then you could just switch to BiPAP Auto with min EPAP = 4, max IPAP = 8, max PS = 4. (There is no min PS setting on the M-Series; min PS = 2 in BiPAP Auto mode.)
4) There may be a "BiFlex/Rise Time test mode" on the M-series. (This is a feature on the System Ones.) If there is, that would let you do a direct comparison of Rise Time = 1, 2, and 3 in real time with the mask on and switching between the Rise Time settings without having to turn the machine off and changing the settings before turning it back on.
5) To get a feel for what BiFlex is going to feel like, you may need to have EPAP set to 4.5 or higher. If you want to see what BiFlex feels like, try setting EPAP = 5, IPAP = 8, and then try all three BiFlex settings. The thing about BiFlex is that the additional exhalation relief over just the drop to EPAP that BiFlex provides is about the same regardless of the BiFlex setting---the differences in the setting are how the machine "rounds" the exhale relief and how the machine "rounds" the pressure increases back to full EPAP and also how the machine "rounds" the pressure all the way back to full IPAP once the inhalation is detected.
6) After settling on the pressure setting that seems most comfortable (or least uncomfortable) to you, try sleeping with the machine for a few days to a week or so. The machine only has a 7-day average AHI on the LCD as I recall, so after 2 or 3 days worth of data, there might not be much daily change in that number. And that daily figure is updated at Noon GMT (Greenwich Meridian Time) regardless of what your local time zone is. Still it's better than nothing for tracking the efficacy of the settings. If you are more comfortable with the M-Series than you are with the S9 after spending a week with the M-series, you can then start working on tweaking the pressure settings to optimize your therapy while also tackling the issue of how to convince your doc to prescribe a bilevel machine so that it is easier to upgrade to a BiPAP that is compatible with SleepyHead and that does not require a special card/card reader.
Final note: Since the M-Series has a broken humidifier, you have to be very careful about evaluating whether discomfort continues to be mainly an "I can't exhale properly" problem or starts to become "I'm so dried out that I can't get comfortable." Be kind to your nose while using the M-Series: Use the humidifier in "passover" mode----i.e. put water in the humidifier tank even though the humdifier doesn't work. And lots of daytime use of a saline nasal spray may help keep the nose from getting too dried out.
