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BMC Bpap RESmart GII settings
#11
RE: BMC Bpap RESmart GII settings
Using the BMC ST to treat what appears to be predominantly central apnea will be challenging without data. The preferred technology is ASV, but we have seen ST used to maintain respiration rate. It’s just not ideal in that application.
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#12
RE: BMC Bpap RESmart GII settings
(08-10-2020, 03:27 PM)Sleeprider Wrote: Using the BMC ST to treat what appears to be predominantly central apnea will be challenging without data. The preferred technology is ASV, but we have seen ST used to maintain respiration rate. It’s just not ideal in that application.

Got it. Thank you. I might not need it at all my AHI dropped with CPAP setting of 6-6 and 7-7. Sorry for not getting back to you yesterday was pretty busy. I'm posting 10th and 11th. I've also bought a card reader. I'm posting an overview for the last 6 month as well. Thank you again for you time and useful insights. That is so kind of you to spend your time helping people! 

   

   

   
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#13
RE: BMC Bpap RESmart GII settings
Looks better, and I suspect we could get it to near-perfect in time. You are sensitive to pressure support (difference between IPAP and EPAP), so the BMC ST may be a hard choice because it is all about pressure support. It will do CPAP mode, but as soon as you go to S, T, ST or AVAPS mode, you will be relying on the machine to trigger breaths from the resulting central apnea. This will require pressure support of 8 to 12 cm which is not going to be a very comfortable or effective therapy for you. We can continue with CPAP mode and your AHI around 2 is actually pretty good and tolerable.

You are probably a good candidate for Enhanced Expiratory Rebreathing Space (EERS) http://www.apneaboard.com/wiki/index.php...ace_(EERS) This DIY aid moves the vent away from your mask and relocates it 6 to 12 inches up the tube. This creates a small volume of expired air that increases the CO2 you rebreathe. For most people with treatment onset central apnea and hypopnea, the root cause is the the increased ventilation from CPAP reduces the CO2 in your blood. This reduces respiratory drive and results in the occasional CA event and lower than expected tidal volume. When we add a small amount of rebreathing space, that respiratory drive is restored as well as better tidal volume (deeper breathing). In addition, we can usually add back EPR or pressure support as that will be tolerated, once the effects of over-ventilation are resolved. It's entirely a personal choice because your therapy look good here, but if you want to virtually eliminate the CA events and improve your respiratory statistics, be aware there is a technique for that. I don't recommend that you use the BMC in anything but CPAP mode based on this trial.
Sleeprider
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____________________________________________
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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.
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#14
RE: BMC Bpap RESmart GII settings
(08-12-2020, 07:53 AM)Sleeprider Wrote: Looks better, and I suspect we could get it to near-perfect in time.  You are sensitive to pressure support (difference between IPAP and EPAP), so the BMC ST may be a hard choice because it is all about pressure support.  It will do CPAP mode, but as soon as you go to S, T, ST or AVAPS mode, you will be relying on the machine to trigger breaths from the resulting central apnea. This will require pressure support of 8 to 12 cm which is not going to be a very comfortable or effective therapy for you.  We can continue with CPAP mode and your AHI around 2 is actually pretty good and tolerable.  

You are probably a good candidate for Enhanced Expiratory Rebreathing Space (EERS) http://www.apneaboard.com/wiki/index.php...ace_(EERS)  This DIY aid moves the vent away from your mask and relocates it 6 to 12 inches up the tube. This creates a small volume of expired air that increases the CO2 you rebreathe.  For most people with treatment onset central apnea and hypopnea, the root cause is the the increased ventilation from CPAP reduces the CO2 in your blood. This reduces respiratory drive and results in the occasional CA event and lower than expected tidal volume.  When we add a small amount of rebreathing space, that respiratory drive is restored as well as better tidal volume (deeper breathing).  In addition, we can usually add back EPR or pressure support as that will be tolerated, once the effects of over-ventilation are resolved.  It's entirely a personal choice because your therapy look good here, but if you want to virtually eliminate the CA events and improve your respiratory statistics, be aware there is a technique for that.  I don't recommend that you use the BMC in anything but CPAP mode based on this trial.

Thanks for replying so quickly. 

I've understood everything you said about EERS and the article. Seems very logical to me. Unfortunately our small country on total lockdown due to covid. For now it is pretty difficult to get the parts. What I can try is reduce room ventilation, and rise a bit CO2 levels in the room. I have a gadget with a CO2 sensor and I can program my ventilation based on the CO2 readings. Now it keeps CO2 at 450-550 ppi which is close to the outside air. What do you think, should I try that? 

I would prefer to continue with the CPAP mode for now. What would you suggest to improve? I wonder why in early May I had nearly none existent AHI. Could you please have a look? I've attached three May days. Also talking of pressure support, I've only used it a couple of times. The entire overview chart is whith EPR off. But the AHI was not that good. Thank you.


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#15
RE: BMC Bpap RESmart GII settings
I see you did pretty good with Autoset For Her mode at 7.0-13 pressure, however CA events were inconsistent, and that is actually the only consistent thing about CA. The use of fixed pressure without EPR tends to affect ventilation volumes less than variable pressure or especially EPR. I think it is fine to experiment with small ranges of auto-pressure and perhaps up to EPR 1 and observe how you feel. I think you understand the mechanism of central apnea and hypopnea in your case is increasing ventilation, so working with that background you should be able to safely observe how small changes help, or stimulate CA. Your current results look quite good as-is, and should not be a concern. Go by how your feel.

I am not familiar with the manipulation of CO2 using the sensor you have and so I can't recommend or offer an opinion. The apneic threshold in some people is very sensitive to increases and decreases in respired CO2. The manipulation of CO2 using EERS is so simple, and simply involves a segment of 22 mm tubing and the Whisper swivel or similar CPAP vent, to create the rebreathing space.

We started this thread with the objective of considering the suitability of a BMC BPAP ST in your therapy, and I think we have reached the conclusion that it is not ideal. I especially think you need the benefit of data to manage your therapy.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#16
RE: BMC Bpap RESmart GII settings
(08-12-2020, 10:18 AM)Sleeprider Wrote: I see you did pretty good with Autoset For Her mode at 7.0-13 pressure, however CA events were inconsistent, and that is actually the only consistent thing about CA.  The use of fixed pressure without EPR tends to affect ventilation volumes less than variable pressure or especially EPR.  I think it is fine to experiment with small ranges of auto-pressure and perhaps up to EPR 1 and observe how you feel.  I think you understand the mechanism of central apnea and hypopnea in your case is increasing ventilation, so working with that background you should be able to safely observe how small changes help, or stimulate CA.  Your current results look quite good as-is, and should not be a concern.  Go by how your feel.

I am not familiar with the manipulation of CO2 using the sensor you have and so I can't recommend or offer an opinion.  The apneic threshold in some people is very sensitive to increases and decreases in respired CO2. The manipulation of CO2 using EERS is so simple, and simply involves a segment of 22 mm tubing and the Whisper swivel or similar CPAP vent, to create the rebreathing space.

We started this thread with the objective of considering the suitability of a BMC BPAP ST in your therapy, and I think we have reached the conclusion that it is not ideal. I especially think you need the benefit of data to manage your therapy.

Thank you very much! I'll continue with CPAP for now, and see how it goes. Then I plan to get back to Autoset and see how it goes. I think that I should start chasing AHI level as low as possible to see if I get better sleep. I might play with ventilation CO2 levels in a healthy CO2 range, see if it makes any difference. When the borders are open I might try the EERS. Does it work with Nasal Pillows as well? Can I post an update and ask for your advices here? Or should I start another thread? I really appreciate your inputs, and you reminded me how it is important constantly monitor the data!
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#17
RE: BMC Bpap RESmart GII settings
EERS is easier with nasal pillows. Just plug the mask vent, add Corr a Flex and a vent. No need for antiasphyxiation valve.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#18
RE: BMC Bpap RESmart GII settings
Got it. For now I'll use 6-8 CPAP mode, EPR-off and see what results will I get. Thank you very much for you inputs and knowledge!
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