Need a new plan for BiPAP / CSA

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Fri May 19, 2023 4:02 pm

Palerider -

"all of these" being pretty much nothing, except for the last post, and even that isn't in the "we should worry about it" stage.

That is reassuring to hear :) My anxiety has been getting the better of me lately, especially trying to get my therapy figured out. Thank you

More PS will drive down your CO₂, and depress respiration, and you seem (at first glance) to be sensitive to that, which makes me wonder why you were advised to get a machine that just (mainly) offers MORE PS.

I don't think anyone on the other forum could have predicted that I would react this way, especially since I never had any issues with CAs with my nightmarestation. It seems only a small subset of people get treatment emergent CAs and I guess I'm one of the lucky ones... :lol:

But I'm glad I got the Resmed regardless. Its just a much better machine, no comparison. My AHI was never as low as it is now with the Resmed and the settings/features are just plain better. Philip's FLEX is terrible compared to EPR, and I love having the Trigger/Cycle settings.

what people absolutely are sensitive to are the breathing issues that *cause* the pressure changes. (something certain youtubers don't seem to 'get'. fix the breathing issues, and the pressure changes won't happen as much, and sleep will be better.

So prevention rather than reaction. My EPAP at 9 seems to keep most of my events at bay so I'll roll with that for now. Unless you have other things in mind for me to try?

The FLs weren't even enough there for the machine to flag one... of course, you don't get as much good data from a philips machine as you do with Resmeds.

Yep theres no event markers for flow limitations with Philips machines. You also don't get a separate flow limitation chart either, unlike the Resmed. All you get that is that flow limitation index number thing.

--------------

Last night's chart

Image


Thanks!
Last edited by SwirlySauce on Fri May 19, 2023 4:55 pm, edited 1 time in total.

SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Fri May 19, 2023 4:54 pm

Rubicon -

Rubicon wrote:
Fri May 19, 2023 3:26 am

Speaking of which, of all the machine and settings changes, are there any where you feel truly rested (not sleepy)? You mention fatigue, but fatigue is not sleepy so what you're trying to fix may not be CPAPable. While you claim "good results" from the current therapy you also state you are "discouraged and I'm just mentally drained at this point" so need to clarify exactly what that means.
Apologies for being unclear in my initial post. I've been frustrated and discouraged with trying to get my therapy on track. Ie: I don't know what the hell I'm doing or should be doing :lol:

I can't really say I've ever noticed a huge difference with CPAP since I started therapy to be honest. I've always been a bad sleeper all my life; feeling like crap in the morning and having a hard time getting up, lacking energy throughout the day to stuff, etc. I've had lots of blood tests done over the years and everything always comes back good. Sleep apnea being the cause of my fatigue made the most sense.

Some people seem to have a night and day difference after starting CPAP but I never experienced anything like that. I got diagnosed with (borderline) moderate sleep apnea after an at-home sleep study. I can't remember the exact numbers but my AHI was somewhere around 14. Nothing too crazy but the respiratory therapist said it COULD potential cause my daytime fatigue. My father is a snorer and has sleep apnea as well so it runs in the family.

When the other forum brought up the Flow Limitations in my charts I thought it was worthwhile to pursue that. I then got my Resmed, cranked up the PS, and now I'm here trying to make sense of it all.

------

This is my thread on TOF: https://www.apneaboard.com/forums/Threa ... apy-Thread

I stopped posting in there a few weeks ago since I wasn't getting any responses any more, but theres lots of info there from the past few months.

-------

Rubicon wrote:
Fri May 19, 2023 3:58 am
In one of your images there is some funny stuff going on during expiration:

And those "FLs" are so flawlessly unwavering as to invite debate in re: where/why.
Hmm I never noticed that. I see it in last night's chart too (below), and my older charts as well. Any idea what thats about?


Image

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palerider
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Re: Need a new plan for BiPAP / CSA

Post by palerider » Fri May 19, 2023 6:12 pm

SwirlySauce wrote:
Fri May 19, 2023 4:02 pm
Last night's chart
Nothing to complain about with that one, let it ride for a while and see what it averages out to after a week.

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Re: Need a new plan for BiPAP / CSA

Post by palerider » Fri May 19, 2023 6:24 pm

SwirlySauce wrote:
Fri May 19, 2023 4:54 pm
This is my thread on TOF: https://www.apneaboard.com/forums/Threa ... apy-Thread
Oy vey, no wonder you're confused.

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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Sat May 20, 2023 3:51 am

SwirlySauce wrote:
Fri May 19, 2023 4:54 pm
I've always been a bad sleeper all my life...
Hence, the non-existent forum MySleepisFU will give you the most help.

Everything you've posted indicates that SDB is not the cause of your issue (at least most of it). Whatever was there is being effectively treated by your therapy (submit an image of the Overview and Statistics pages from Oscar).

TOF is renowned for their philosophy of the Magic Button Principle where somewhere on an xPAP machine there is a setting or set of settings that will miraculously solve anyone's sleep problems, and you have to just keep wingin' them dials around (DWing) till you find it.

Really need a copy of your sleep study. "Really" as in "critical". That's said, it's probably inadequate to help, but you ain't gonna get anywhere till you turn all the rocks over.

In the very first image you posted your assessment of "Bad Sleep" is confirmed by a parameter called VB. In the great majority of cases it equates to bad sleep.

If you can load up a couple nights data to SleepHQ a more precise looksee can be done if you are so inclined.

Need to review your sleep hygiene, especially all the medications you're on and for how long.
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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Sat May 20, 2023 5:19 am

Rubicon wrote:
Sat May 20, 2023 3:51 am
... especially all the medications you're on and for how long.
Although if you want to see a great magic trick, after you post the PSG (as long as it recorded sleep staging) and a couple SleepHQs, I'll tell you what medications you're on.
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SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Sat May 20, 2023 1:04 pm

palerider wrote:
Fri May 19, 2023 6:24 pm
SwirlySauce wrote:
Fri May 19, 2023 4:54 pm
This is my thread on TOF: https://www.apneaboard.com/forums/Threa ... apy-Thread
Oy vey, no wonder you're confused.
Well this doesn't sound good :lol:

SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Sat May 20, 2023 1:17 pm

Rubicon wrote:
Sat May 20, 2023 3:51 am
SwirlySauce wrote:
Fri May 19, 2023 4:54 pm
I've always been a bad sleeper all my life...
Hence, the non-existent forum MySleepisFU will give you the most help.

Everything you've posted indicates that SDB is not the cause of your issue (at least most of it). Whatever was there is being effectively treated by your therapy (submit an image of the Overview and Statistics pages from Oscar).

TOF is renowned for their philosophy of the Magic Button Principle where somewhere on an xPAP machine there is a setting or set of settings that will miraculously solve anyone's sleep problems, and you have to just keep wingin' them dials around (DWing) till you find it.

Really need a copy of your sleep study. "Really" as in "critical". That's said, it's probably inadequate to help, but you ain't gonna get anywhere till you turn all the rocks over.

In the very first image you posted your assessment of "Bad Sleep" is confirmed by a parameter called VB. In the great majority of cases it equates to bad sleep.

If you can load up a couple nights data to SleepHQ a more precise looksee can be done if you are so inclined.

Need to review your sleep hygiene, especially all the medications you're on and for how long.
Hey Rubicon,

Appreciate you helping me get on track, thank you so much!

I didn't have a PSG done - as in one of those where you go to a lab overnight. It was one of those at-home monitoring devices. I don't have the results of those handy at the moment, but I can probably call the sleep clinic to get a copy. I don't think there was anything remarkable on there from my recollection and fairly certain there was nothing on sleep stages.

Do you mean VB as in variable breathing/periodic breathing? If so, I've never been able to find a clear answer on that anywhere. TOF mentioned that its a normal part of a person's breathing pattern and not an issue. I think there was also a post by Pugsy somewhere as well saying that its nothing to be concerned about. Unless you're showing signs of CSR, that is a problem.

I wonder if me dial-winging (as you put it) so often is contributing to my unstable breathing patterns. Maybe my body just needs to get used to a set pressure and it will stabilize over time...

---

Never heard of SleepHQ before but I just made an account on there. This definitely makes things easier - hopefully the data will be of some use to you! I don't know if/how I can give you access to all my data on my account, but here are the last few days. Let me know if you want to see more.

https://sleephq.com/public/32586a1f-b5e ... 65b2bd5213
https://sleephq.com/public/ad2bcc63-5c1 ... 2264ab4793
https://sleephq.com/public/aaa84475-0f4 ... 5aae430d76
https://sleephq.com/public/30ac432f-1d1 ... aa56e3b838
https://sleephq.com/public/30ac432f-1d1 ... aa56e3b838
https://sleephq.com/public/0fe083da-5f8 ... 9c1aa9cc36
https://sleephq.com/public/8d3affd2-69c ... c595633bcf



---

Here is my OSCAR Overview, Statistics. Just a warning, my compliance is kind of shit. Most nights I don't get more than 5 hours with my CPAP machine but its getting better with the Resmed. I also found a much better mask a few weeks ago so thats been helping a ton.

Image

Image

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palerider
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Re: Need a new plan for BiPAP / CSA

Post by palerider » Sat May 20, 2023 1:24 pm

SwirlySauce wrote:
Sat May 20, 2023 1:04 pm
palerider wrote:
Fri May 19, 2023 6:24 pm
SwirlySauce wrote:
Fri May 19, 2023 4:54 pm
This is my thread on TOF: https://www.apneaboard.com/forums/Threa ... apy-Thread
Oy vey, no wonder you're confused.
Well this doesn't sound good :lol:
It starts out with "oh, your flow limitations are too high" when there there's barely any indication of FL's being flagged by the previous machine... and kinda goes downhill from there.

_________________
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Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Sat May 20, 2023 1:28 pm

Rubicon wrote:
Sat May 20, 2023 5:19 am
Rubicon wrote:
Sat May 20, 2023 3:51 am
... especially all the medications you're on and for how long.
Although if you want to see a great magic trick, after you post the PSG (as long as it recorded sleep staging) and a couple SleepHQs, I'll tell you what medications you're on.
Now that would be a great trick to see :D I'm only on two meds at the moment.

Current meds are Vyvanse for ADHD and Lexapro for anxiety. Vyvanse I've been on for the past 8 years, and been on some sort of SSRI for two decades. Vyvanse causes me insomnia every now and then, and dries out my sinuses at the end of the day

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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Sat May 20, 2023 1:35 pm

SwirlySauce wrote:
Sat May 20, 2023 1:17 pm
Do you mean VB as in variable breathing/periodic breathing? If so, I've never been able to find a clear answer on that anywhere. TOF mentioned that its a normal part of a person's breathing pattern and not an issue.
Well, it is specifically NOT a normal part of a person's breathing pattern but what do you expect...

Anyway, you can search this forum for comments on variable breathing (be sure to include "variable breathing" in quotes to reduce the hits to 900+ but this has a lot of stuff:
StillAnotherGuest wrote:
Tue Oct 16, 2007 4:08 am
6PtStar wrote:I thought I had it all figured out but I got Pro Analyzer and I am confused again. Can someone explain what Variable Breahing is and what effect it has on your condition. Breathing in and out seems to be variable but why do I care as long as I get enough air?
It may make more sense to view Variable Breathing (VB) as not necessarily related to variable breathing per se, but rather the machine has entered a different mode, and the algorithm has been taken over by the Variable Breathing Control Layer. But let's call it Variable Breathing Mode (VBM). It has seen some erratic breathing and has suspended titration mode.

Right, there's not a lot of clinical data about it, but I imagine you could have either some normal variation (REM sleep, normal wake periods) and/or abnormal variation (insomnia, repeated wake/1 transitions, arousals from non-respiratory events).

There are times, however, when seemingly "variable breathing" per se will not cause the machine to enter VBM (the algorithm hierarchy seems to say that if there are leaks, snores, or apnea/hypopnea, you can't enter VBM). Without this hierarchy, anyone with untreated SBD would undoubtedly be in VBM all night long.

The basic goal of VBM seems to move the patients back to the setting that was in effect before the onset of erratic breathing. In both APAP and AutoBiPAP, this is accomplished slowly, at a rate of 0.5 cmH2O/minute, up to 2.0 cmH2O (using IPAP in AutoBiPAP, affecting EPAP only if an IPAP change would necessitate an EPAP change because of PS restrictions). Also, pressure changes are tempered based on the presence or absence of snoring prior to the initiation of VBM.

Being able to analyze a patient's VB Mode more closely, like when it actually occurs, would be extremely helpful (but right now, you can't).

REM sleep in adults is generally pretty stable, at least stable enough that if you see 25% VB you shouldn't think it's all REM. I mean, there may be a little variation, but I think the point of considering VB in REM is that you don't want to poke at it at all with unnecessary pressure changes.

I would look for poor sleep architecture as the most likely culprit of abnormally high percentages of VBM.

In an edit of the VB algorithm:

Variable Breathing Pressure Control

Once the variable breathing controller has been granted control of the pressure support system, it takes some initial action based on the action the auto-CPAP controller is taking. After this initial action, it performs an independent pressure control operation.

A prior pressure that is flat will cause the pressure delivered to the patient to remain at that level.

A prior pressure that is increasing will cause the variable breathing controller to initially decrease the pressure delivered to the patient at a rate of 0.5 cmH2O per minute. The magnitude of the decrease is dependent on the magnitude of the increase in prior pressure. The pressure decrease is intended to erase the prior pressure increase that possibly caused the variable breathing. However, the total decrease in pressure drop is limited to 2 cmH2O. After pressure decrease, the variable breathing controller holds the pressure steady.

A prior pressure that is decreasing will cause the variable breathing controller to initially increase the pressure delivered to the patient at a rate of 0.5 cmH2O per minute. The magnitude of the increase is dependent on the magnitude of the decrease in prior pressure. The pressure increase is intended to erase the prior pressure decrease that may have caused the variable breathing. However, the total increase in pressure is limited to 2 cmH2O. After pressure increase, variable breathing controller holds the pressure steady.

The pressure curve is provided for 5 minutes or until the variable breathing condition clears. Thereafter, the pressure is controlled according to the following:

The pressure is either maintained at a constant value, or it follows a decrease and hold pattern. The decision to hold the pressure or to decrease the pressure is made by comparing the current pressure with the snore treatment pressure. It is to be understood, however, that this duration can be varied over a range of durations.

If there is no snore treatment pressure stored in the system, which will be the case if the snore controller has not been activated, the pressure is held constant. If there is a snore treatment pressure, and if the current pressure is more than a predetermined amount above this snore treatment pressure, such as more than 2 cmH2O above the snore treatment pressure, the variable breathing controller decreases the pressure to a level that is a predetermined amount higher than the snore treatment pressure and holds the pressure at the lower level. The pressure decreases to the snore treatment pressure +1 cmH2O.

The duration during which pressure is provided according to the paradigms discussed above for region is set to 15 minutes or until the variable breathing condition clears. It is to be understood, however, that this 15 minute duration can be varied over a range of durations.


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Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Sat May 20, 2023 1:39 pm

palerider wrote:
Sat May 20, 2023 1:24 pm
SwirlySauce wrote:
Sat May 20, 2023 1:04 pm
palerider wrote:
Fri May 19, 2023 6:24 pm
SwirlySauce wrote:
Fri May 19, 2023 4:54 pm
This is my thread on TOF: https://www.apneaboard.com/forums/Threa ... apy-Thread
Oy vey, no wonder you're confused.
Well this doesn't sound good :lol:
It starts out with "oh, your flow limitations are too high" when there there's barely any indication of FL's being flagged by the previous machine... and kinda goes downhill from there.
Yup! I guess that's the danger of getting advice on the Internet, everyone is an expert with a different opinion. Am I better off to just go back and see a sleep therapist? Seems so hit and miss from what I've seen with other users but maybe they can get me a PSG?
Last edited by SwirlySauce on Sat May 20, 2023 3:05 pm, edited 1 time in total.

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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Sat May 20, 2023 1:41 pm

SwirlySauce wrote:
Sat May 20, 2023 1:28 pm
Now that would be a great trick to see ...
Yeah well magic tricks are never really "magic". For example, I follow reddit.

What happened to the Adderall?

Anyway, all that stuff can (usually) destroys sleep continuity. Poor sleep results in erratic breathing. See the circle starting to form?
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Make each sensation a little bit stronger.
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Rubicon
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Re: Need a new plan for BiPAP / CSA

Post by Rubicon » Sat May 20, 2023 1:53 pm

Do you have the data "Changes to Machine Settings" from Statistics?
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SwirlySauce
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Re: Need a new plan for BiPAP / CSA

Post by SwirlySauce » Sat May 20, 2023 1:55 pm

Rubicon wrote:
Sat May 20, 2023 1:41 pm
SwirlySauce wrote:
Sat May 20, 2023 1:28 pm
Now that would be a great trick to see ...
Yeah well magic tricks are never really "magic". For example, I follow reddit.

What happened to the Adderall?

Anyway, all that stuff can (usually) destroys sleep continuity. Poor sleep results in erratic breathing. See the circle starting to form?
Never took Adderall. I started on Vyvanse and stuck with it since it. Would be interesting to see if that really is whats messing up my breathing patterns.

Does Resmed even report VB? I know theres a parameter/chart for it with Philips but can't see anything for Resmed. Am I missing something?