[Diagnosis] Awakened to strange inhalation problem

[Sleeprider]

Interesting, you had 2 CA events, then woke up, power cycled the machine and restarted therapy with a chain of another 7 CA, but I'm going to guess you were not asleep, so in terms of AHI, these don't count. Your sleep was disrupted and you perceived difficulty getting air. The machine should have been near maximum pressure. I'm not going to second-guess your perception, and suggest you discuss it with the DME if you have one. The machine appears to be on and operating correctly, recording events, and the graphs show you were at 23.5/18.5 before cycling and 17/13 after.

If you have not owned the machine long, ask to try the Resmed Aircurve 10 Vauto. You may not get it, but worth asking. Get your supplier's ideas. If your mask is old, replace it. Meanwhile, since the problem seems to occur near the maximum pressure setting, maybe we should try limiting maximum pressure to 20 and see if that helps.

[PaBlum]

Thanks, again. The mask is new. I'll alter the pressure.

I'll ask the DME about swapping machines. I'm not confidant they will do it but one never knows until one asks.

Paul

[Sleeprider]

There is a big difference in the way machines respond to us. If your former machine was a Resmed and it worked pretty good for you, then I would try to stick with that.

[PaBlum]

Lowering the IPAP max to 20 didn't fix the problem. Also, I kept hitting the ceiling. I'll up it back to 24. (I'm tempted to return to my old Auto CPAP but that is limited to 20.).

I attached two screenshots of last nights sleep FYI. To me, it looks a little different than the previous night, but what do I know?

I called the RT at my DME. (Lincare, if that is important). He said that if my ENT writes a new prescription specifying the Resmed Aircurve 10 Vauto, they could swap mine out. But he'd have to change the prescription settings since the Aircurve requires 3 settings while the Dreamstation requires 4.

If you would be kind enough to translate these settings into Aircurve language, I could pass it on to my physician. I'd appreciate it very much.

PaBlum

[Sleeprider]

I'd like to get a close-up look at the flow chart. A 2-minute segment that clearly shows the flow wave would be ideal. Your machine is reporting a normal inspiratory time of 2.3 seconds, but a very short 1.3 second expiratory time. It might help us to see what is going on up close. I'd rather be working with a Resmed Vauto because we can adjust trigger and cycle sensitivity. What BiFlex setting are you using?

[PaBlum]

Hi,
My BiFlex is set to 2. The Flow rate seems to change a lot. I attached 5 2 minute slices preceding the time when I was awakened. I chose these times because the wave forms were different.
PaBlum

[Sleeprider]

Your first couple of graphs are a study in flow limitation, and the last one is normal. BiFlex predicts your inspiration and raises pressure ahead of it, and in your case, I think it is missing the timing. I would turn it down to 1 or try off. I'd rather see the pressure following your lead, than trying to pace you. At the risk of being redundant, I kinda wish you were on a Resmed.

[PaBlum]

Hi,

I set the BiFlex off. I should have raised my Imax back to 24 cause I hit the 20 ceiling once during the night.

The good news is that all of my Indexes (Indices?) are down except the Flow Limitation Index which went from an average of 1.19 to 1.30 last night. I don't know if that is meaningful or not.

The bad news is that I woke up at 3:30 again. At least I was able to fall back to sleep. (Okay, I cheated and took Melatonin @ 3:30).

Yes, I plan to get the Aircurve. I took the first step Friday when I called the DME and got info on how to do this. My next step is to notify my ENT tomorrow to send the DME a new prescription specifying the machine and params. Here, I need your help. Since the Aircurve needs 3 params compared to the Dreamstation's four, can you please let me know what params I should ask the ENT to write on the prescription? Note that it takes a few weeks from prescription to delivery.

I've attached last night's Daily plus two 2-minute flow rate graphs. One is just before I awoke and the other shows the change from normal flow rate to the one leading to my awakening. (Awakening in a physical sense, not a philosophical one :-} ).

Thanks again,
PaBlum

[Sleeprider]

With the Aircurve 10 Vauto you will set the machine for essentially the same EPAP min, IPAP max and a fixed PS.  I would start at PS 5.0, due to the relatively high flow limitation we still see in your attached charts, and we can go from there.  I think reducing BiFlex helped you because the machine is not properly predicting your breathing. Although the machines sound similar, the ability to control trigger and cycle sensitivity and Ti Min, Ti Max (inspiration times) means you have closer controls over how the machine changes pressure.  Also, the Easy Breathe wave-form is completely unlike Respironics and the pressure looks changes feel completely natural and follow your lead.  For comparison, the first image below is how Respironics delivers flow, and the second image shows the Resmed:


The Resmed wave-form in the Vauto is identical to the Airsense 10 Autoset except for amplitude.  Here is what Easy Breathe looks like on my Vauto. I use less PS than you will.  This segment shows an arousal with irregular breathing just so you see how it behaves and understand, we all have some weird artifacts in our sleep-breathing. The important take-away is that in the Resmed, the IPAP peak is brief and mimics normal breathing wave-forms, and it follows your breathing timing rather than predicting when to trigger to IPAP or cycle to EPAP. The EPAP pressure on Resmed is absolute, and unlike BiFlex, the pressure does not fall below EPAP to adjust the pressure curve. Note how with BiFlex above, the pressure increases before inspiration begins.



This image shows the effect of adjusting trigger and cycle sensitivity:

[PaBlum]

Thanks, again. I'll start working on getting a replacement machine.

PaBlum