Help for Bipap newbie

Further evidence to the "high pressures don't help" notion.

I've zoomed in on an area because I am wondering if anyone knows what is causing the pressure to ramp here? There are no significant changes in leak rate, snore detection, no events logged except that first central...

https://photos.app.goo.gl/azIqcDpRFG9unhlp1

We need to see the flow limitations as it is likely those were what pushed up the pressure

Can do: https://photos.app.goo.gl/dhoLgogD3eOBmEdu2

shadowwolf218 wrote: ↑

Wed Mar 21, 2018 10:03 pm

Is that not effectively what I'm doing with the machine now, by setting the PS to 0?

I don't disagree, though.

No. I mean set the mode to CPAP so auto pressure changes do not happen.
On March 1st you shared your file. I reviewed and responded a few times. To me it looks like your high pressure events are junk which causes increasing pressure, which just makes for more junk.

Auto is not helping you. Go back to basics (CPAP). You were titrated at 10 but I do think that maybe too low.
Set EPAP=IPAP=12 (no pressure support and no auto) and lets get a few days of data. Then do the same for a few days but use a pressure of 15.
As I said before, unfortunately your original data prior to bi-level was not in the file so I could not see it. So let's recreate it.
Please let me know if you are unclear as to what I am saying or you are unsure as to why.

TedVPAP wrote: ↑

Thu Mar 22, 2018 7:37 pm

shadowwolf218 wrote: ↑

Wed Mar 21, 2018 10:03 pm

Is that not effectively what I'm doing with the machine now, by setting the PS to 0?

I don't disagree, though.

No. I mean set the mode to CPAP so auto pressure changes do not happen.
On March 1st you shared your file. I reviewed and responded a few times. To me it looks like your high pressure events are junk which causes increasing pressure, which just makes for more junk.

Auto is not helping you. Go back to basics (CPAP). You were titrated at 10 but I do think that maybe too low.
Set EPAP=IPAP=12 (no pressure support and no auto) and lets get a few days of data. Then do the same for a few days but use a pressure of 15.
As I said before, unfortunately your original data prior to bi-level was not in the file so I could not see it. So let's recreate it.
Please let me know if you are unclear as to what I am saying or you are unsure as to why.

Got it. I'll start that tonight.

First night: I think I should lower the pressure instead of raise it. Thoughts?

https://photos.app.goo.gl/nQhhQnkPRyc3g8ns1

Please show 5 minutes of CA cluster.
How do you feel?
Yes I would go lower on pressure.

TedVPAP wrote: ↑

Sat Mar 24, 2018 12:50 pm

Please show 5 minutes of CA cluster.
How do you feel?
Yes I would go lower on pressure.

https://photos.app.goo.gl/up632z6UKk1JVXbB3

And last night:

https://photos.app.goo.gl/U9o7EIjuAxkPUX3h1

I'm exhausted as usual, but I also haven't slept more than 4 hours either of the past two days. Hooray work.

May I ask what it is you're looking for in the 5 minute clusters?

shadowwolf218 wrote: ↑

Sun Mar 25, 2018 11:53 am

TedVPAP wrote: ↑

Sat Mar 24, 2018 12:50 pm

Please show 5 minutes of CA cluster.
How do you feel?
Yes I would go lower on pressure.

https://photos.app.goo.gl/up632z6UKk1JVXbB3

And last night:

https://photos.app.goo.gl/U9o7EIjuAxkPUX3h1

I'm exhausted as usual, but I also haven't slept more than 4 hours either of the past two days. Hooray work.

May I ask what it is you're looking for in the 5 minute clusters?

Last night's data looks much better even though settings are unchanged. Both show no major OSA. I wanted to see a close-up of the CA to see if they looked like they were actually caused by OSA. They don't. They also look the same as the ones when your pressure was over 20.
Since you were originally titrated to a CPAP of 10 and this data is not showing major OSA, I suggest you go down to 10 and get a weeks worth of data.

TedVPAP wrote: ↑

Sun Mar 25, 2018 2:59 pm

shadowwolf218 wrote: ↑

Sun Mar 25, 2018 11:53 am

TedVPAP wrote: ↑

Sat Mar 24, 2018 12:50 pm

Please show 5 minutes of CA cluster.
How do you feel?
Yes I would go lower on pressure.

https://photos.app.goo.gl/up632z6UKk1JVXbB3

And last night:

https://photos.app.goo.gl/U9o7EIjuAxkPUX3h1

I'm exhausted as usual, but I also haven't slept more than 4 hours either of the past two days. Hooray work.

May I ask what it is you're looking for in the 5 minute clusters?

Last night's data looks much better even though settings are unchanged. Both show no major OSA. I wanted to see a close-up of the CA to see if they looked like they were actually caused by OSA. They don't. They also look the same as the ones when your pressure was over 20.
Since you were originally titrated to a CPAP of 10 and this data is not showing major OSA, I suggest you go down to 10 and get a weeks worth of data.

So I'm collecting data, but I also keep lowering the pressure because my OSA is < 1 and my CA is staying pretty high. Do you have any suggestions for this?

https://photos.app.goo.gl/fEhf8VVOna04Fktw2

Zoomed in on a cluster.

https://photos.app.goo.gl/9q4kUKg4hmrFCM4s1

Wow that is ugly.
I am sorry that I have not been able to help you. Maybe someone will chime in that can help. Until then, I'll tell you what I would try next.
Now that you have demonstrated the ability to generate ugly numbers at high pressures and at low pressure, I would now try adding some exhalation relief to see if that may help. It certainly didn't help at high pressures but I don't think you have tried it at low pressure.

Correction: I went back to some of your older data and you did try IPAP of 9 with exhalation relief and it still showed crazy CA. Your numbers are all over the place.
Your best AHI results (~8) were from 2/7/2019; min EPAP=15, max IPAP=25, PS=0.
I would try a week of that and then set the min EPAP to 20 and try a week.

I am wondering where the obstructive diagnosis came from.

I think I would really back things up and see at what pressures (lower) the obstructives rear their head and then see how many centrals need to be dealt with.

Regardless of how this goes, I want you guys to understand that you have provided more useful feedback and helpful advice than any of the four sleep clinics and three DME vendors I've dealt with during these last two years. I appreciate your efforts a lot, to put it mildly.

The obstructive diagnosis came from the home sleep study and the following in-lab titration (the earlier one) in Jan/Feb of 2017. In November I had my adenoids removed to clear up the airway a bit, then was titrated again in December. Both titrations were (as far as the results I was given) the same - 10 reduced AHI to near 0. But I strongly suspect they are omitting centrals from that measurement entirely. Can't get a clear answer on that from the second study, and the data from the first seems to show that the centrals were absent as well.

I'm going to keep dialing the pressure down until the obstructives actually appear again, then maybe try the pressure support again? That seems like the best course.

Are either of you familiar with the "trigger" settings in this thing on the bipap mode?

Oh, and while I'm thinking about it... My lowest AHI numbers are on nights that I am sick with an upper respiratory infection or when I am moderately drunk. I usually wind up at 5 and sometimes lower. I haven't got a clue why, so I've been treating that as a fluke, but I guess it doesn't hurt to mention.

shadowwolf218 wrote: ↑

Wed Mar 28, 2018 10:30 pm

Are either of you familiar with the "trigger" settings in this thing on the bipap mode?

Which model bilevel....DreamStation or ResMed AirCurve and which mode of operation?

It's been a long time since I used the ResMed Auto bilevel and I didn't play much with those various trigger settings.
Send Palerider a PM and ask him....he uses the same model ResMed but in the S9 model line so he is more familiar with those trigger settings.
It's been a few years since I have used that model and to be honest I never really messed with those fine tuning settings back then because I was good with the default settings.

It's mainly for comfort though...so whatever feels good is fine.

I would suggest that you are going to need an ASV machine to treat your symptoms the majority of you Apnea is central and without a bilevel with a backup rate or asv there is nothing we can do to reduce the events. You need to go backtoyour sleep doctor the bilevel us not helping