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DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
#31
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
So if the pressure support is really the difference between EPAP and IPAP how would the doctor’s prescription of 9-20 and PS of 5, and Sleepriders suggestion of 9-17 and PS of 5 work?  Or even the doctor dictating the report with IPAP of 25 but PS of only 5. 

That’s where I get so confused. So many variations of what PS should be and what it does.
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#32
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
They are effectively the same thing, with just the max pressure reduced, I haven't looked to see if the machine thinks you need more that 17 ipap, I would trust sleeprider to have looked

To me on your charts, the epap min has been set too low. I think the ps 5 will lift the ipap, so the epap isn't as big of an influence as it is now. Going by the sleepyhead chart median epap It needs a review later. I would review the settings after the ps 5 is applied. Ipap is normally what clears inhalation apnea. When they talk about raising epap for OA, they say to keep the same PS. This in effect raises the ipap, which I think clears the apnea.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#33
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
(01-06-2018, 07:09 PM)bluemom51 Wrote: So if the pressure support is really the difference between EPAP and IPAP how would the doctor’s prescription of 9-20 and PS of 5, and Sleepriders suggestion of 9-17 and PS of 5 work?  Or even the doctor dictating the report with IPAP of 25 but PS of only 5. 

That’s where I get so confused. So many variations of what PS should be and what it does.

Let me assure you that PS 5 means a pressure relief of 5 cm during exhale. Give it a shot and we can judge later. It should be comfortable, and feel effortless. PS 5 means 3/4 of the respiratory effort is done by the machine, but since exhale pressure is so much lower than inhale, this should also feel very easy.  As long as leaks are controlled, pressure is almost unnoticeable. What you "feel" is the difference between IPAP and EPAP.  In this case it should be very easy to exhale. Your titration study is what gives us assurance it will work and not result in central apneas.  Please give it a try, and relax. This is the medically verified titration.
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#34
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
Forgot I had a printout from the DME when I was looking at masks. I tried to add notes cause it's a little hard to read.

This shows the 11/10/17-1/1/18 when I started using the VAuto BiPap - Does this give any additional good information as to where the level of EPAP/IPAP/and PS should be?  I started with about 9-20 and then adjusted the EPAP up a little after a week or 2.  Started with a PS of 5 and started decreasing eventually down to about 1.6.  The AHIs were higher at the beginning.  To me the EPAP looks high but I don't know. Sure don't see any outstanding reason why I should be waking up in a panic, but I'm no expert.


**Note - was using various nasal masks trying to get humidity right - just a terrible struggle with this machine - either flooding (massive rainout) or way too dry.  The last couple of days was with the mask with the most rainout. So was not using the same brand mask every day.**


Thank you for any additional thoughts or observations you may have.


Page 1 - Shows IPAP/EPAP/Leak/Tidal Volume - Maximum/95th Percentile/ Median (Hard to tell the divisions)
IPAP lines kind of stayed around 14-18?
EPAP lines kind of stayed around 15?

[Image: SZVKfi9l.jpg]

Page 2 - Shows Minute Ventilation/Respiratory Rate/% Spontaneous Cycled Breaths/AHI & AI (Started at PS of 5 and quickly reduced to 3, then 2, then 1.6.  The AHIs were higher at the higher PS levels.

[Image: Q8R8sG9l.jpg]

Page 3 - Usage/Total Usage/I:E Ratio - shows I% at about 33% and E% about 66%
Used every night for about 8.5 hours average

[Image: brorjiYl.jpg]



[Image: mEI0MTUl.jpg]
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#35
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
(01-06-2018, 09:20 PM)Sleeprider Wrote:
(01-06-2018, 07:09 PM)bluemom51 Wrote: So if the pressure support is really the difference between EPAP and IPAP how would the doctor’s prescription of 9-20 and PS of 5, and Sleepriders suggestion of 9-17 and PS of 5 work?  Or even the doctor dictating the report with IPAP of 25 but PS of only 5. 

That’s where I get so confused. So many variations of what PS should be and what it does.

Let me assure you that PS 5 means a pressure relief of 5 cm during exhale. Give it a shot and we can judge later. It should be comfortable, and feel effortless. PS 5 means 3/4 of the respiratory effort is done by the machine, but since exhale pressure is so much lower than inhale, this should also feel very easy.  As long as leaks are controlled, pressure is almost unnoticeable. What you "feel" is the difference between IPAP and EPAP.  In this case it should be very easy to exhale. Your titration study is what gives us assurance it will work and not result in central apneas.  Please give it a try, and relax. This is the medically verified titration.


  Ok will do, Sleeprider - wish me luck tonight - will definitely give a good strong try - maybe the relax part will come in due time.  Thanks again!!
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#36
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
The clear airway recorded on the machine may increase. This was the initial reason I suggested you ask your doctor about lowering the PS to 3 on your other thread, because your chart looked ok to me. I missed the slightly slower breath rate as a possible problem.
The sleep study showed you had lots of events that weren't scored because there wasn't a 4% desaturation. My guess is that it could be your body adjusting your co2/o2 balance and waiting for the co2 to build up again.
Hopefully you have a comfortable night.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
Post Reply Post Reply
#37
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
(01-07-2018, 01:24 AM)ajack Wrote: The clear airway recorded on the machine may increase. This was the initial reason I suggested you ask your doctor about lowering the PS to 3 on your other thread, because your chart looked ok to me. I missed the slightly slower breath rate as a possible problem.
The sleep study showed you had lots of events that weren't scored because there wasn't a 4% desaturation. My guess is that it could be your body adjusting your co2/o2 balance and waiting for the co2 to build up again.
Hopefully you have a comfortable night.

This is our normal expectation, and it was a surprise to me to see the titration results showed higher events in CPAP and bilevel with lower pressure support.  I'm going by the results of the titration, and if CA is much worse, I guess the titration would be anomalous.  It's interesting, and I've come to realize many people respond differently that my expectations.  The sleep studies seemed like a well designed and conducted evaluation.
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#38
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
Made it through the night - Set at IPAP of 18/EPAP of 9/PS of 5.  Felt a little hard to breathe when falling asleep but felt ok until early morning when I was getting more restless.

Does the chart show the machine trying to go higher than 18, especially around 5 a.m. ?  Obviously things started going much worse around 5-6:40 for some reason with AHI going to 20 and then I got up to go to the restroom and fell back asleep.

I used a ResMed nasal and it seemed to fit ok and I didn't notice many leaks. The humidity behaved well for once - had it set on Auto and it felt ok last night. What's interesting is that Sleepyhead has said the same thing for days - that the humidity is set to 4, but I have had it on many settings and last night was Auto?

Anyway, all in all, less afraid of the BiPap now - just probably need to keep making adjustments. At least right now I don't feel as shaky and weird.


[Image: 7j1VUK9l.png]


[Image: iQ8tIsyl.png]

Again, thanks for all your help - I feel much more hopeful and appreciate your time!
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#39
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
The AHI is higher last night, entirely from OA events, and the proportion of CA and H events are unchanged or lower.  Interesting results, and the question is why are obstructive apnea higher?  

Last night, the median EPAP was 10.44, compared to 12.78 on the chart from 12/23/17, and IPAP was 15.44 vs14.38, so EPAP was lower, and IPAP was higher last night, and that is mainly a function of the PS.  We know that in bilevel therapy, the EPAP pressure is what controls obstructive apnea.   I think a higher EPAP and slightly less pressure support might work out pretty good. simply reducing PS to 4.0 instead of 5.0 would allow the exhale pressure to rise.  I would keep the same maximum IPAP pressure of 18, so at peak pressure you would be at 18/14 rather than 18/13.  I think it's worth noting that flow limitations are very low in your charts, and some events correspond to a snore, but overall your respiratory statistics are excellent, and some of the indicated apnea could be related to a relatively slow respiration rate of less than 10 breaths per minute.  That appears to be normal for you, and it might be interesting to zoom in on some of the OA events to see if they are real, or perhaps just a sigh or pause

The primary objective needs to be comfort, and I think I detect the PS of 5 as being a bit much for you.  Also, EPAP could be increased by setting a higher minimum, but since you're still not comfortable with the pressure, I think leaving EPAPmin at 9.0 is acceptable.
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#40
RE: DESPERATE & TERRIFIED-Need BiPap or Cpap HELP
Ok - thanks for looking at that.

I think for most of the night I got used to the pressure.

What might cause the AHIs to jump so much in the early morning?  Was the machine trying to go higher than the 18?

When you see on the graph the machine keeps bumping up against the IPAP ceiling of 18, does that mean I need to increase the IPAP?  It especially occurred during the worst of the AHIs and maybe it was trying to go higher to control them? (the 5-6:30 a.m. part). Just wondering if I should go back to at least 20 based on original prescription (and the sleep study recommendation of the really high 25). But I don't know if that would require me to adjust the PS somewhat also.
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