[Treatment] Need help/advise after changing BiPAP Machine

[dnar82]

Hi Everyone,
After changing to Resmed I am very confuse.
Also my AHI from 0.5 to 2 have jumped to 20 after I change to the Resmed while I tried to keep everything the same.
I do not understand what I should set for the following configuration to match the same as my respironics.
TiMin: ?
TiMax: ?
Trigger: ?
Cycle: ?

Following is my existing BiPAP information:
Philips Respironics
DreamStation Auto BiPAP

Mode: AutoBiLevel
Min EPAP: 10.00 cmH2O
Max IPAP: 24.00 cmH2O
PS Min: 4.00 cmH2O
PS Max: 6.00 cmH2O
Auto Off: Off
Auto On: Off
Flex Level: 2
Flex Lock: Off
Flex Mode: Bi-Flex
Hose Diam.: 22mm
Humid. Level: 3
Humid. Mode: Adaptive (System One)
Humidifier: Connected
Mask Res. Lock Off
Mask Resist. 2
Ramp Time 0.00 Minutes
Ramp Type Linear

My New Resmed:
ResMed

AirCurve 10 VAuto

PAP Mode: VPAPauto

PS 6.0 over 11.0-25.0 (cmH2O)





Mode: VPAPauto

Min EPAP: 10.00 cmH2O

Max IPAP: 25.00 cmH2O

PS: 6.00 cmH2O

Antibacterial Filter: No

Climate Control: Auto

Cycle: Med

Essentials: Plus

Humidifier Status: On

Humidity Level: 4 

Mask: Pillows

Ramp: Off

Smart Start: Off

Temperature: 27 ºC

Temperature Enable: Auto

TiMax: 2.00 Seconds

TiMin: 0.30 Seconds
Trigger: Med

[Crimson Nape]

I would highly recommend that you download OSCAR and post a screenshot of your Daily screen.  I am guessing that the PS of 6 may be causing you to have CAs.  Until you get some data, I would advise you to set the PS to 4.   Leave Trigger, Cycle, and TiMin to their defaults.  You may wish to set the TiMax to at least 2.8 or 3.0.  This controls the maximum time before the VAuto will drop to EPAP pressure.  If it is too short for you, it can disrupt your breathing and cause sleep disturbances.   Having it set for a longer time than you need does not cause any problems.  

Please see the links in my signature, below, for help on posting images.

I almost forgot. Please update your profile's equipment listing.

- Red

[dnar82]

Hi Crimson,
Thanks for the advise. I will change the PS to 4 and test for one night before posting the data.
Cause I am testing for leak, which is strange as I do not face leaking issues with Respironic.

I suspect during my sleep the leak is from my nostril and out of my mouth as I test the mask fit and it was all green but shown high leaking from the resmed machine.

Have changed my equipment listing as well.

[dnar82]

Hi Crimson,
After your advise, my AHI have dropped to 9.
Seem like my mouth is leaking air as my mask before sleep and after sleep checking is fine.

---

Additional screenshot.
Not sure what is the issues here as using my previous respironics I do not face mouth leaking air issues before changing or respironics does not capture the air leaking properly?

[staceyburke]

You are having some of positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  There are not a huge amount but getting rid of as many as you can will lower your AHI.

Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

you can tell positional apnea by seeing clumped events of Oa,H,Ua.   You have several,,,

[dnar82]

Thanks Crimson and staceyburke.
Reducing the PS from 6 to 4 indeed helped me to sleep better. Somehow the pressure feel the same my existing BiPAP.
I have also switch back to my existing pillow brand/model (For my head not the nasal pillow) and my AHI have reduced to around 1-2.

Once again thanks for the help!!!

[Crimson Nape]

If you have the ability to set the Trigger (some models outside the U.S. don't have it), set it to high. This may help in reducing the CAs. Also, please use the F12 key (Fn+F12 for Mac) while in OSCAR to take the screenshots.

- Red