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BiPAP new therapy
#11
RE: BiPAP new therapy
My impression of the flow limits was that they were positional.
Once the positional aspect is managed you would likely need the higher PS of the BiLevel VAuto to lessen the flow limitations.

As Sleeprider has said the move to a BiLevel is a continuation, not a start over. Positional first.
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#12
RE: BiPAP new therapy
(01-25-2023, 07:01 PM)Gideon Wrote: My impression of the flow limits was that they were positional.
Once the positional aspect is managed you would likely need the higher PS of the BiLevel VAuto to lessen the flow limitations.  

As Sleeprider has said the move to a BiLevel is a continuation, not a start over.  Positional first.

I am not arguing the matter. I understand what you are all saying.

As far as managing the positional aspect, I think I did the most that could be done with semi-rigid collar.
It did improve the results, but not that much.

Then I started using a mandibular advancement device (MAD) which did bring much improvement.

All that, was discussed before and the conclusion, as Sleeprider once wrote, was that the only improvement would be a transition to a BiPAP (Resmed AirCurve 10 vAuto).

Since then, I have been fighting my "lung specialist" and PAP machine supplier to get my hands on the AirCurve.
After some months of discussions going nowhere, I decided to take the matter in my own hands, dump them and finally got the AirCurve within 2 weeks after order.

So now I am just trying to properly set up the machine and get on with the therapy.

I am not bitching, complaining or whatever. On the opposite I am so glad to have you guys here to coach me.
English is my second language. At home and the city where I live, we are French.

So please forgive me if sometimes my writing sounds offensive or not understanding what I was told.  It does happen without ill intent.

So, tonight I will set the BiPAP with the last numbers Sleeprider recommended.
I will wear the cervical collar and the MAD to have the same conditions as for my last session with the CPAP.

Tomorrow I will come back here with the results.

DanEm

"If life hands you lemons, make lemonade! Words to live by, especially when you keep in mind that the only way to make them into lemonade is to squeeze the hell out of them."
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#13
RE: BiPAP new therapy
I made the parameters changes and had one night sleep.
Except for the new machine, everything else was exactly the same as with the CPAP.

Nice improvement from the two previous nights.

The results show that I am back where I was with the CPAP.
Flow limitation is still higher than what I was told it should be (< 0.1).

  1. Could the collar not be efficient enough?  Should I look for a different one (rigid)?
  2. What could be the cause for hypopnea appearing at the end of the second session?  Is it related to position?
Any suggestions?????


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DanEm

"If life hands you lemons, make lemonade! Words to live by, especially when you keep in mind that the only way to make them into lemonade is to squeeze the hell out of them."
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#14
RE: BiPAP new therapy
In your case, flow limitation is mainly positional, and with the bilevel, we can use pressure support to mechanically assist your inspiratory effort to help increase flow. There is not guarantee that we can get the 95% flow limitation below 0.1, but the odds are certainly better that we can effect an improvement. With this baseline, we can move to the next step of increasing pressure support. Leave everything the same, but change pressure support from 4.0 to 5.0.
Sleeprider
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#15
RE: BiPAP new therapy
OK I will do that tonight.
Back here tomorrow for the next step.

DanEm

"If life hands you lemons, make lemonade! Words to live by, especially when you keep in mind that the only way to make them into lemonade is to squeeze the hell out of them."
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#16
RE: BiPAP new therapy
The cluster of hypopneas at the end of the night might be in a period of awake breathing. If it persists post a 5 minute zoom of that area. As a rule ignore events that close to either the start or end of the night unless the are persists and a closer view indicate they are of concern.

Agree with boosting PS s SR suggested.
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#17
RE: BiPAP new therapy
DanEm, I have a request for your charts. I'd like to see leaks and inspiration time instead of snore and AHI. Flow limitation is all about achieving a full breath in a shorter period of time, so that is a useful graph to see. Also, your earlier charts showed that increased flow limitation was often paired with increased leaks.
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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#18
RE: BiPAP new therapy
Quote:Gideon
The cluster of hypopneas at the end of the night might be in a period of awake breathing.

If "awake breathing" means being conscious and just staying in bed, it would not be my case.  When I wake up, I get up.
Thread Review (Newest First)

Quote:Sleeprider
DanEm, I have a request for your charts. I'd like to see leaks and inspiration time instead of snore and AHI.
 
OK, the snapshots have been modified. I have included the new view for yesterday's.

I think the results last night are the best I ever had  Coffee

Flow limitation is down (0.16). 
Do you think if I increase some more the PS the flow limitation could go further down?

There is one rare thing that happened. I did not wake up in the middle of the night. Smile


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DanEm

"If life hands you lemons, make lemonade! Words to live by, especially when you keep in mind that the only way to make them into lemonade is to squeeze the hell out of them."
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#19
RE: BiPAP new therapy
I agree this looks like good progress. You probably already know that I want to repeat these settings, probably through the weekend before making any further changes. You slept through the night! Wow! That can add up to actually feeling better. The inspiration time did not increase during the remaining clusters of flow limitation, so that satisfies my curiosity about that aspect. Next time we may want to look at minute vent instead. Any future changes will be smaller and will probably be something like PS 5.4.
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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#20
RE: BiPAP new therapy
OK Sleeprider

After all the slow responses from my lung specialist and the fighting to get the BiPAP machine, I feel pretty good with those last results.
I will do as you suggest and wait until Monday to show you the results unless something tells me otherwise.

One next step I think I could also take (in a while) is to see if I can forget the collar.
The one I am using is getting old and maybe is not so efficient anymore.
If I could get rid of it, it would be a plus.
But if I need to keep it, I won't mind.

If no other post from you, have a great weekend.

DanEm

"If life hands you lemons, make lemonade! Words to live by, especially when you keep in mind that the only way to make them into lemonade is to squeeze the hell out of them."
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