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APAP Discussion
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pdeli Offline

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Posts: 71
Joined: Mar 2013

Machine: Philips Respironics, BiPAP Auto, Bi-Flex, 760P
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: System One
CPAP Pressure: 6.0 - 9.5 cmH2O
CPAP Software: SleepyHead

Other Comments: Type II Diabeties

Sex: Male
Location: West Sacramento, CA

Post: #31
RE: [split] APAP Discussion
Robysue,

When I first put the mask on at night the machine says 6 IPAP, 6 EPAP. I do not use the Ramp.

My reference to “sensitivity” was not in terms of anything I can actually feel or am consciously aware of, but rather a hypothesis that whatever the settings are, they don’t seem to actually activate the pressures to change very soon. If I wake up in the middle of the night, I can sometimes see a higher IPAP than 6, and that number will stay up for a while as long as I feel like staying awake to watch it. But staying awake of course not what I’m trying to accomplish here.

I don’t mind changing my own pressures, but I first want to understand what I’m doing.

One thing that is still not clear to me is the min PS concept. Is that the difference in my case of 16-6, or 10?

As far as upsetting the Doc, I don’t think that’s a big problem, but if it is, so be it. He after all was the first one who told me that it was possible for me to make changes (C-Pap), and that ultimately led me to Apnea Board.

My C-Pap settings were 7.

Plus, how do you answer so fast? I’ve been trying to get dressed and get my day going for the last two hours, but …….

Thanks again,

Phil
12-15-2013 01:52 PM
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robysue Offline
Wiki Editor
Advisory Members

Posts: 1,233
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #32
RE: [split] APAP Discussion
(12-15-2013 01:52 PM)pdeli Wrote:  When I first put the mask on at night the machine says 6 IPAP, 6 EPAP.
This indicates that min PS = 0. More on this in a bit.

Quote:My reference to “sensitivity” was not in terms of anything I can actually feel or am consciously aware of, but rather a hypothesis that whatever the settings are, they don’t seem to actually activate the pressures to change very soon. If I wake up in the middle of the night, I can sometimes see a higher IPAP than 6, and that number will stay up for a while as long as I feel like staying awake to watch it. But staying awake of course not what I’m trying to accomplish here.
If there are no events (OAs, Hs, RERAs, snoring or FL) during the first 18-20 minutes after you first turn the machine on, the Auto algorithm is not going to increase either the IPAP or the EPAP. About 18-20 minutes after the machine is turned on, the Auto algorithm should do its first test pressure increase in the IPAP as part of the proactive "search" routine. Over the course of about 4 minutes, the machine will increase the IPAP pressure by 2cm (at a linear rate of 0.5 cm/minute) while it studies the shape of the inhalation parts of the wave flow data. If no improvement is found during the test pressure increase, the machine will lower the IPAP pressure back down to its original setting over a one minute period. If there's nothing in terms of OAs, Hs, RERAs, snoring, or FL that is being detected, the "search" algorithm will typically kick in about every 10 minutes or so. Here's an example of what those test pressure increases look like when there's no improvement found:
[Image: test_increases_medium_shot_zpsa652d10f.jpg]
Each of those bumps in my IPAP graph is one cycle of the "search" algorithm. If the peaks in your IPAP graph look like these, all it means is that the machine is managing your OSA very well and there's nothing the machine can find in the wave flow that justifies increasing the pressure.

When improvements are found, the IPAP pressure continues to increase at a rate of about 0.5 cm/minute until the machine can detect no further improvements. In the next shot, we see my pressure curve for the whole night:
[Image: search_algorithm_zpsba81edeb.jpg]
all the green ovals are around "test pressure increases" that resulted in no improvement in the wave flow; the purple ones are around test pressure increases that did show improvement. The uncircled increases in IPAP or EPAP are due to other things like FL, snoring, OAs, RERAs or Hs.


Quote:One thing that is still not clear to me is the min PS concept. Is that the difference in my case of 16-6, or 10?
For any individual breath, PS = IPAP - EPAP The min PS setting determines how close IPAP and EPAP are allowed to get to each other. In your case it appears min PS = 0 since you report that at the beginning of the night both IPAP and EPAP = 6 = min EPAP.

The max PS setting determines the largest difference that is allowed between IPAP and EPAP. In other words, the max PS setting sets up the following inequalities:

On any given breath: EPAP + min PS <= IPAP <= EPAP + max PS.

Let's look at how different min PS and max PS settings will affect your pressures, given that min EPAP = 6 and max IPAP = 16.

If min PS = 0 and max PS = 8, then your pressures will always be in the following ranges:

IPAP: 6 <= IPAP <=16 since min IPAP = min EPAP + min PS

EPAP: 6 <= EPAP <= 16 since max EPAP = max IPAP - min PS.

And if EPAP = 7 at a given point in the night, the corresponding IPAP must satisfy: 7 <= IPAP <= 15 since 7 = EPAP + min PS and 15 = EPAP + max PS.

But if we set min PS = 2 and max PS = 8, then your pressures will always be in the following ranges:

IPAP: 8 <= IPAP <=16 since min IPAP = min EPAP + min PS

EPAP: 6 <= EPAP <= 14 since max EPAP = max IPAP - min PS.

And if EPAP = 7 at a given point in the night, the corresponding IPAP must satisfy: 9 <= IPAP <= 15 since 7 = EPAP + min PS and 15 = EPAP + max PS.

Since you say:
Quote:My C-Pap settings were 7.
You might be more comfortable setting min PS = 1 which would mean that your starting IPAP = 7 = your old CPAP setting.
(This post was last modified: 12-15-2013 04:18 PM by robysue.)
12-15-2013 04:12 PM
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pdeli Offline

Preferred Members

Posts: 71
Joined: Mar 2013

Machine: Philips Respironics, BiPAP Auto, Bi-Flex, 760P
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: System One
CPAP Pressure: 6.0 - 9.5 cmH2O
CPAP Software: SleepyHead

Other Comments: Type II Diabeties

Sex: Male
Location: West Sacramento, CA

Post: #33
RE: [split] APAP Discussion
I need to study and absorb all this, but now we're off to a christmas dinner so that that takes care of today.

increasing the IPAP to 7 seems to fit with my thinking at this point, but I will say that my patterns look much more erratic than what I see on yours.

I haven't previously attached or inserted any files on my posts , but hopefully I can figure it out and send a copy of what's coming up on my Sleepyhead file.


Phil
12-15-2013 06:06 PM
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Sleepster Offline
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Moderators

Posts: 4,994
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #34
RE: [split] APAP Discussion
(12-15-2013 12:42 PM)pdeli Wrote:  the bottom of my (month old) machine says "760P".

You have a BiPAP, not a REMstar. I was thrown off because you have REMstar listed in your profile.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
12-15-2013 06:16 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #35
RE: [split] APAP Discussion
(12-15-2013 06:16 PM)Sleepster Wrote:  
(12-15-2013 12:42 PM)pdeli Wrote:  the bottom of my (month old) machine says "760P".

You have a BiPAP, not a REMstar. I was thrown off because you have REMstar listed in your profile.
all PR machines have REMstar in the name without discrimination
12-15-2013 06:53 PM
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pdeli Offline

Preferred Members

Posts: 71
Joined: Mar 2013

Machine: Philips Respironics, BiPAP Auto, Bi-Flex, 760P
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: System One
CPAP Pressure: 6.0 - 9.5 cmH2O
CPAP Software: SleepyHead

Other Comments: Type II Diabeties

Sex: Male
Location: West Sacramento, CA

Post: #36
RE: [split] APAP Discussion
Sorry about that. I just corrected a couple of profile entries, but I'm bouncing along in the car trying to answer this, but it's rather tough. I'll fix it all later and maybe put in a more mature avitar.

Phil
12-15-2013 07:04 PM
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pdeli Offline

Preferred Members

Posts: 71
Joined: Mar 2013

Machine: Philips Respironics, BiPAP Auto, Bi-Flex, 760P
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: System One
CPAP Pressure: 6.0 - 9.5 cmH2O
CPAP Software: SleepyHead

Other Comments: Type II Diabeties

Sex: Male
Location: West Sacramento, CA

Post: #37
RE: [split] APAP Discussion
New related qyestion: Shouldn't my Doc be able to take the SD card from my machine and read it in order to make the necessary adjustments? Is there any problem with that idea?

Phil
12-15-2013 11:29 PM
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pdeli Offline

Preferred Members

Posts: 71
Joined: Mar 2013

Machine: Philips Respironics, BiPAP Auto, Bi-Flex, 760P
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: System One
CPAP Pressure: 6.0 - 9.5 cmH2O
CPAP Software: SleepyHead

Other Comments: Type II Diabeties

Sex: Male
Location: West Sacramento, CA

Post: #38
RE: [split] APAP Discussion
Okay, here is my last night's Sleepyhead info. Any Comments?

(We'll see how this works)

Phil
12-16-2013 12:40 AM
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robysue Offline
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Advisory Members

Posts: 1,233
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #39
RE: [split] APAP Discussion
pdeli,

The SleepyHead image is great. And I can use it to explain a lot about what you're seeing as far as the pressure increases in IPAP are concerned and the complete absence of any pressure increase in EPAP is concerned.

Here's a marked up version of your Sleepy Head data:
[Image: pdei-Sleepyhead_zps9d3b616c.jpg]

Other comments:

1) Your leak line is ugly, but still acceptable. It's important to know that the PR machine you are using reports total leaks, which include the intentional leak rate for your mask at the pressure(s) you are using. For the most part the PR Series 60 machines start to flag official Large Leaks (in Encore) when the total leak rate hits about 70-90 L/min. The actual line for an official Large Leak on a PR machine seems to be fuzzy and depends on both the mask and the pressure you are using. Because PR has not published anything about how Encore (the official software) decides to flag a Large Leak, SleepyHead cannot show you where the official Large Leaks occur. That said, your maximum leak rate is a good 20 L/min below the smallest official "Large Leak" that I've seen in looking at lots of data---both of my own and of others posted at the forum sponsored by Vendor #1. If the leaks bother you, you ought to try to fix them. If the leaks are not disturbing you AND they don't get any worse than this night's leaks, you don't need to worry too much about them. (Keep an eye on them and if they start flirting with 70 L/min on a regular basis, then you know you will have to do something about them.)

2) The current settings are managing the OAs and Hs exceptionally well. The FL and snoring are also almost nonexistent. There are a large number of RERAs at the beginning of the night. They could be real, or they could just be how your System One is scoring some ragged wake breathing since you had mentioned that you are having some trouble getting to sleep at the beginning of the night, if I recall correctly.

3) While this night would indicate that you don't need an increase in the minimum IPAP, you've indicated that you're not comfortable inhaling at the beginning of the night. And your old CPAP was set to 7cm. If you were comfortable with the old CPAP, you may find that setting min PS = 1 will provide you with a bit more comfort. If min PS = 1, then at the beginning of the night your pressures would be:
  • starting EPAP = min EPAP = 6cm
  • starting IPAP = min EPAP + min PS = 6 + 1 = 7cm

4) Since you have previously used a straight CPAP in the past, it could be that the varying IPAP pressures during the night may cause additional restlessness. It doesn't happen in everybody, but it does happen in some people.

One question for you: Why were you switched from CPAP to BiPAP in the first place?
12-16-2013 11:58 AM
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robysue Offline
Wiki Editor
Advisory Members

Posts: 1,233
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #40
RE: [split] APAP Discussion
(12-15-2013 11:29 PM)pdeli Wrote:  New related qyestion: Shouldn't my Doc be able to take the SD card from my machine and read it in order to make the necessary adjustments? Is there any problem with that idea?

Phil

In theory, the Doc should indeed be able to take the SD card, read the data, and make adjustments that get written to the SD card and become effective when you stick the card back in the machine. And so there's no a priori problem with the idea of letting the doc make the changes after s/he looks at the data.

But in practice, many sleep docs do NOT routinely download the data and many who do only look at the compliance data---i.e. they look at how long you're using the machine each night.

So whether you have a problem with waiting for your doc to make the changes based on the data really depends on how hard it is for you to get a hold of the doc and whether s/he's interested in downloading and looking at the data.
12-16-2013 12:04 PM
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