CPAP user for 5 years, switched to BIPAP

[jaswilliams]

From the graphs you showed the minimum pressure produced by the machine was 5.8 but your settings had the minimum pressure as 8, your graphs showed a few snores and Hypopnoea which indicates the minimum pressure or epap is not sufficient to treat your obstructive apnoea the asv raises the epap after an event but that is too late, and then it drops it again later where you then have another snore and hyponoea. My aim was reduce those events at your lower pressures this requires raising the minimum pressure on the machine, as you have a BiLevel/ASV the pressure support provides for you to be able to easily breath and gives s difference between ipap and epap so there is no need/requirement to have the Flex setting of 2


Both of my suggestions, either to raise minimum epap or to turn off flex is an attemp to raise the minimum pressure up from its minimum pressure of 5.8 to reduce the snores hypopnoea

I hope this is useful


Jason

[cbombzzz]

Attached is the latest with Flex settings off and increase EPAP to 8.5.
My wife said that since I made these changes, my mask seems louder and making different noises. Not sure what that's about.
These changes don't see to have helped, from what I see. I'm getting solid numbers, just want to get the right tweaks in place before leaving the settings alone. Is that what you all do, find those settings and leave them alone or do you still have to track data and make changes from time-to-time?

C

[Sleeprider]

This looks very very good. You are not having any apnea, just a few hypopnea, and pressures are relatively tame. We can see the machine triggering a lot of breaths, but IPAP pressure stays pretty low. BiFlex is all about what makes you most comfortable and is very subjective. In Resmed, we understand what EasyBreathe is because we can see the mask pressure, but the Philips is a bit of a mystery. Run through the settings and make the choice that seems best, then stick with that. We're not going to learn more without zooming in on events or other areas of concern, but with these results there is no need to make any changes as long as you're feeling pretty good with the therapy.

As far as mask noise, if you're not using the Airfit P10, then you may hear subtle noise differences with settings, but I'm surprised your wife can. With the P10, I think any sensation of noise or air movement would not be present.

[jaswilliams]

I agree with sleeprider your AHI is less than 1 let's see how you feel after sleeping for a few nights

[cbombzzz]

you guys are truly amazing. With your help I am sleeping better than ever and waking up refreshed. I really like the ASV machine and feel you were right in your assessment. You pay more, but in my opinion, it's well worth it. 

I spent months reading on this forum, tracking my data and making adjustments. I was feeling very discouraged. My sleep doc was blown away with my knowledge and amount of data I provided him. My conversations with him, directed by you all, helped tremendously. And after I traded in the BIPAP ST for the ASV, I've finally reached a wonderful level. It took a bit to determine that I have complex sleep apnea and after all the research and your help, I see now what my specific issues were/are.

As a side note, another benefit to my sleeping quality has been testosterone. I wake up often times a little after 4:00 to start my day. I used to hear the alarm and snooze then eventually drag myself out of bed. Now I wake up refreshed and my feet hit the floor immediately after turning off the alarm. If anyone else is feeling beat up in the morning when the alarm goes off, I'd suggest getting hormone levels checked and speak with a hormone specialist.

Once again, I want to thank you guys for your help. I will give these settings a run for a few weeks and report back. 

Merry Christmas and Happy New Year.

C

[Sleeprider]

It took a long time to get you the right therapy, and that was not helped by your doctor's misadventure with BiPAP ST. It's been 2-3 weeks since you finally started ASV and it's rewarding that you are really feeling positive effects from the right therapy. It's not unusual for a member to struggle 7 months or longer with CPAP/BPAP/ST, but you stuck with it and worked through the issues. I imagine that if you were not a cash payer, it would have taken longer.

I think you will be surprised how well ASV works when you visit higher altitudes.

[cbombzzz]

All I can say is , without the help from the kind folks on this forum, I'd be in much worse shape. I probably would still be using CPAP and have no idea why I woke up each morning feeling like a truck ran over me.

By the way, what is considered higher altitude? I live at 7000 ft. Would expect lower altitude, say sea level, to give me better or worse AHI?

[Gideon]

High altitude is known to be a factor in apnea. I don't know if it impacted you but I would not be surprised if your apnea decreased at sea level. We have recommended individuals maintain two sets of settings in the past. One for altitude and another for "sea level".
Treatment is still a very individual thing so YMMV.

Fred

[Sleeprider]

Anything over 8000 feet is considered "high altitude", but you're close enough, and it probably accounts at least partially, for why CPAP failed in your case. Higher altitude will increase CA in sensitive individuals, but the effect is certainly not consistent. So your next getaway to Breckenridge or Leadville should be easy.

One problem for people that live at higher elevations like yourself is that sleep labs at lower elevations may not replicate your problems with complex or central apnea, and may not result in accurate titration for where you live. As long as the problems is plain obstructive apnea, it's usually not a problem, but as you know, in your case there were problems.

[cbombzzz]

Last night i tried sleeping without my collar. Hypopneas were elevated. Is that normal?
Also I believe the noise my wife is hearing is large leaks. I've had more of those lately. I loosened up the mask because of the massive indentations I get on my face, but maybe that is the problem. There is a fine balance between being too loose and too tight. Any guidance? I'm using GoLife nasal pillows. I bought several on closeout for a good price. They are fairly comfortable. I used to use the Swift FX, but that gets dislodged too easily, leaks a lot and wakes me up constantly. Unless I sleep on my back, which I have noticed increases my AHI.

That's a mouthful, but you guys are always so helpful.

Attached you can see the large leaks on a night without the collar.

Merry Christmas!

C