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Can’t get to sleep with the BiPAP machine.
#11
(09-13-2016, 06:14 PM)PoolQ Wrote: okay so what does using the machine feel like is going on? For me I was feeling like my inhale was being cut short. Try and describe what it feels like while you are trying to go to sleep.

PoolQ. The biggest thing is the BiPAP machine seems to wake me up no matter how tired I am before I put it on. That is different than the CPAP machine that I used for 3 weeks and was able to sleep with it. With the BiPAP machine, there is so much air and pressure. The breathing isn't natural or smooth. I think that is why I can't fall asleep. I lie awake for hours until I give up and take the mask off. I tried using ambien but I wake up with the mask off and the readings say I only had it on for 30 minutes. Ambien doesn't work for me as I do things like take my mask off without realizing it.
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#12
"The breathing isn't natural or smooth" some thoughts about this and settings that exist on BiPAP and not CPAP machines
I don't have the ST, so I can only go by what is on the model that I have:
TiMin sets a time that if you try and exhale before this time is up, the machine will keep blowing
TiMax sets a time that if you do NOT stop inhaling before this time, the machine will stop blowing. This for me was very disturbing.
Trigger determines how sensitive the machine is in detecting the start of your inhale. The more sensitive you set this the sooner the machine will ramp up the blower-extending your inhale
Cycle determines how sensitive the machine is in detecting the change from inhale to exhale, making this less sensitive extends your inhale.

So what is all this and what does it mean? You ever see or hear a machine where the gears don't quite mesh? Well your natural breathing is one gear and these setting define the other gear. If they are just out of sync, it will be dang annoying.

Given that I had no other health issues that my Doctor had used these setting to treat, mine were all set at default as are the two that you listed, I changed them one at a time until they no longer bothered me. It was easy to tell when I hade moved one in the wrong direction. I tale a long tome on my inhale, as per sleepyhead, so I personal set TiMax to as long as possible so it no longer cut off my inhale. the I set trigger to more sensitive and cycle to less sensitive, again to try and match my long inhale time.

The other issues I discovered is that my breathing, while not being the commonly understood periodic breathing, was instead repeating a pattern or compensating inhale with a drift to zero flow and then repeat for hours at a time. Quite disturbing. Some one on this forum suggested raising my minimum pressure and seeing if I could get this pattern to stop. Turns out that an increase of 1.2cm mostly stops it, you can still see a pattern, but it no longer go's to less than 50% reduction in flow.

Your mileage may very as might your machine settings. At least 2 of these settings and maybe all of them are on your machine. Look at your data, think about what it is feeling like when you can't sleep and make some slow adjustments if you decide to. My Doctor had given up and told me to go ahead and make any changes I wanted.
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#13
StrugglinginOhio

Generally where in Ohio are you struggling? I lived near Portsmouth, Ohio for 3 years and my parents lived in the Cincinnati area for 20 years or so. Just curious.

Generally, with plain bilevel machines like S mode machines, we tend to concentrate on getting the IPAP and EPAP adjusted correctly before we think about the other settings. With the ST mode, however, the IPAP and EPAP settings are a somewhat different animal. I do not have any direct experience with the ST mode. I use a Vauto. The way I see it is that the EPAP has to be set high enough to control any obstructive apneas and then the IPAP has to be set enough higher that if you do not initiate a breath within the back-up rate time limit, the IPAP will give you a figurative mild kick in the chest in an attempt to get you to breathe. As a result there must be reasonably large difference between EPAP and IPAP. That appears to me to be why yours has a difference of 6 cm H2O. Adjusting this or the rise time down may reduce the efficacy of the machine for central apneas. I do not think that the Ti max or min or trigger or cycle will help your problem with the pressure changes but you could give them a try if you feel so inclined.

I think that you need an upgrade to an ASV machine. It may be that is where your doc is headed. Some insurance require a failure with ST (or as they call it bilevel) before they will pay for an ASV. Talk to your doctor about this soon and keep trying but tell him that you are not getting significant sleep of any kind with this machine.

Best Regards,

PaytonA

Admin Note:
PaytonA passed away in September 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#14
SuperSleeper,
Here's an update. My doctor wont switch me to a SV unit at least until they try a couple of things. They adjusted my ramp (?) from 0 to 300 ms. I need to get a PAP map. Which I just got schedule for 30+ days from now. Crazy.

I met with my Respiratory Therapist to get the ramp changed. She also gave me a Fisher Simplus full mask to try.
I tried to take a nap when I got home with the Fisher mask but I forgot to change the mask type on the machine. The pressure was crazy high at first similar to what I am experiencing with the nasal pillows. But when I went to bed I changed the setting to full mask and the pressure was much less. I was actually able to fall asleep fairly easily. My AHI was 7.7 and I slept 6.3 hours. Not great up much better. I wonder if there is something wrong with the start up with the machine with nasal pillows.

Something weird did happen around 4 a.m. A alarm when off on the machine. The display panel lit up and there were a couple of sentences of text. I couldn't take the mask off and put on my glasses in time to read it. Any idea what is going on?


Lastly, I've down loaded both Sleepyhead and ResScan software. But my machine doesn't have a SD card. It communicates via cell. I'm set up with U-Sleep but that doesn't show incremental data like SleepyHead or ResScan. Any idea how to get access to the data? Thanks so much for your help.
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#15
(09-14-2016, 05:16 PM)PaytonA Wrote: StrugglinginOhio

Generally where in Ohio are you struggling? I lived near Portsmouth, Ohio for 3 years and my parents lived in the Cincinnati area for 20 years or so. Just curious.

I think that you need an upgrade to an ASV machine. It may be that is where your doc is headed. Some insurance require a failure with ST (or as they call it bilevel) before they will pay for an ASV. Talk to your doctor about this soon and keep trying but tell him that you are not getting significant sleep of any kind with this machine.

Best Regards,

PaytonA
Hi PaytonA,
I live the Cleveland area. Home of the Cleveland Clinic and University Hospitals.

My Doctor wont switch me to a SV until I try a couple of things. I explain that in another response here. Thanks -Ted
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#16
On your machine, look at the left side panel of the flow generator. There are 3-doors. The one at the upper-front is where your SD card hides. The lower door in near the back is for the air filter, and it flips down. The third door under the SD card is for a data port. Give it a try.

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#17
(09-13-2016, 08:55 PM)Sleeprider Wrote: Now that you're over 4 posts, you can post attachments and links. It would be interesting to see how that ST is responding to your needs, or failing to do so.

Last night was the best night I've had yet AHI 7.78. I was actually able to fall asleep with the new full mask. See attached Sleepyhead.


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#18
Thanks for posting the graphic! The results are interesting in that there are no obstructive events. As you can see the ST is acting as a fixed BiPAP at 18/12 with no large PS for central events. It relies instead on timed IPAP to encourage good volume. Your Tidal volume in fact is 640 which is right up with mine...and that is unusual. I would bet that the reason your sleep is disrupted, is that pressure support is so large, it's very stimulating. If I was to do it, I'd end up with dozens of centrals. The SV is designed to work with comfortable pressure support like 3-4, but to provide up to 15 when an apnea or hypopnea are detected and it also automatically increases and decreases EPAP as needed for obstructive events.

It would be interesting to see what would happen to your sleep, and event count if you maintained EPAP at 12 and tried 16 for IPAP. I think you'd find it much more comfortable, and at worst, you'd possibly see an increase in CA events, which I think your machine is labeling UA. If you zoom in on the flow rate line during the UA events, we could probably tell what they are. It would also be interesting to see what the flow rate looks like during a period of sleep. It's your choice, but if I was in an experimenting mood over the weekend, I'd try a night with lower IPAP.

Something else to consider is the iVAPS mode. You currently appear to be in ST mode. Here is how the two are defined;

ST (Spontaneous/Timed)
The device augments any breath initiated by the patient, but will also supply additional breaths should the patient breath rate fall below the clinician’s set “backup” breath rate.

iVAPS (intelligent Volume Assured Pressure Support)
iVAPS is designed to maintain a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and providing an intelligent backup breath automatically.

The iVAPS mode can provide an automatic intelligent application of pressure support to augment ventilation as needed, as much as needed. This is much closer to ASV treatment. So with iVAPS you can have a minimm pressure support of 3-4, and a maximum pressure support over 8, which is sufficient to act as ASV.


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#19
(09-16-2016, 04:04 PM)Sleeprider Wrote: iVAPS (intelligent Volume Assured Pressure Support)
iVAPS is designed to maintain a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and providing an intelligent backup breath automatically.

The iVAPS mode can provide an automatic intelligent application of pressure support to augment ventilation as needed, as much as needed. This is much closer to ASV treatment. So with iVAPS you can have a minimm pressure support of 3-4, and a maximum pressure support over 8, which is sufficient to act as ASV.

Do you know what machines have the iVAPS (intelligent Volume Assured Pressure Support) mode?
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#20
The Resmed VPAP S9 ST-A and I was thinking perhaps your Aircurve 10 ST. Have you ever looked at the clinician screens to see what's available? Manual may be available from the forum. Send an email to: apneaboard@gmail.com and put "Setup Manual" (without the quotes) in the subject line. Then, ResMed AirCurve 10 ST in the body of the message. You will get a clinician manual
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