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[Diagnosis] Newbie Needs Some Guidance
#1
Newbie Needs Some Guidance
History: Recently purchased Respirionics DreamStation Auto BPAP online.  Have not done a sleep study but know for sure I have apnea.  A while back did one of those at home apnea tests which came out negative because I was using tennis balls in back of my shirt and stayed off my back most of the night as was hoping that would solve my apnea problem.  My apnea is mostly positional and I cheat by subconsciously staying on my back.  Insurance would not authorize further study so I went out on my own and have been experimenting with some settings. So far I feel better as far as I have gone.  But for sure I don't know what a couple of the settings do. That is where I would very much appreciate some input from the forum members.  By the way, am impressed with this forum.  There seem to be a lot of nice people willing to help others. 

Attached are two OSCAR charts. One looks pretty good with AHI of 3.95 while the other one shows AHI of 11.23.  What I'm hoping is someone can tell me how some of the settings on my machine affect pressure and the results you see from OSCAR.  What seems confusing to me is concept of Pressure Support and how it affects the overall pressure in the system.  Thank you for any help you can provide. Thanks  

       
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#2
RE: Newbie Needs Some Guidance
Well, you did a pretty darn good job of self-diagnosing positional apnea, but I have a little different take on how to treat it other than tennis balls, and I think your settings need a makeover.

Starting with settings, I think your EPAP min of 8.5 looks pretty good, but your PS min of 0.0 needs to be increased to 4.0 and the PS max reduced to 5.0. That is going to reduce the flow limits and hypopnea we see, and should be pretty comfortable. Your obstructive apnea occur in very concentrated clusters, so as I said I have a bit different idea on why this happens. I think it has much less to do with sleeping on your back, and a lot to do with tucking your chin. Consider your pillow and any posture you sleep in that causes chin-tuck, and you may beat this problem, but the known good solution is a soft cervical collar. I'll link to a couple wikis for you to read, then we can discuss further.

Positional apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar http://www.apneaboard.com/wiki/index.php...cal_Collar
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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#3
RE: Newbie Needs Some Guidance
Sleeprider,
You hit on the root cause of my apnea....the chin tuck.  Instinctively I have been sleeping on my side and tucking part of the pillow under my trying to keep my mouth shut and from drying out. Thanks for the links: ordered a cervical collar to help keep mouth closed. 

Attached in another OSCAR screenshot. Not shown are the 90% values from DreamStation for IPAP (14.5)  and EPAP (11.0).  I did try setting the PS Min to 4 but that caused the pressure to ramp up and down which kept me awake.  Changed to around 2 or 3 to get accustomed to it. As you can see I played around with numbers trying to find something comfortable.  The large string of OA's early on were while I was on my back.  But fundamentally I don't know the settings impact on each other to achieve the desired therapy. 

Can you help me understand PS Min and Max and how it relates to the IPAP and EPAP values?  During therapy, the machine shows the EPAP value and then shows the value of EPAP plus PS Min. 

If one sets the PS Min to 0 (which stops the annoying pressure surges) does that defeat the therapy needed for hypopnea? 

In theory, should one set the machine to the 90% value for at least the EPAP value. While the IPAP value is one that needs to be kept high enough for the machine to open the airway under different circumstances? 

Thank you again and anyone else who would like to chime in on the situation.

   
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#4
RE: Newbie Needs Some Guidance
BiLevel 101:
Pure CPAP delivers a single constant pressure.  This pressure is what splints open the airway.  APAP (AutoSet) is what we prefer to see as it can vary the pressure to suit the situation.  For now, let's forget about APAP.

Basic BiLevel delivers two fixed independent pressures, EPAP is Exhale Pressure and is what actually splints the Airway open, It is the equivalent of "Pressure" in a CPAP and does the same thing.  
IPAP or Inhale pressure is the higher of the two pressures.  Once the Obstructive Apneas are resolved with the Exhale pressure (EPAP), IPAP is used to resolve hypopneas, flow limits, RERAs, and UARS.
The difference in these pressures is called Pressure Support or PS.  PS is always added to EPAP by convention to get IPAP so IPAP = EPAP + PS
FYI if you were to set the EPAP = IPAP you would have a basic pure CPAP functionally.
The above info is derived from Titration guides.

So by setting PS=0 you are disabling the therapeutic effect of the PS and the treatment of flow limits, RERAs, Hypopneas, and UARS.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
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Attaching Charts

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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#5
RE: Newbie Needs Some Guidance
Well the increase in PS min helped, but wait until you see the results from a soft cervical collar. I still think you should take the PS min form 2 to 3 or 4. What is the point of bilevel if you don't use it? With the Philips machines, we have to tell them what to do, because the auto algorithm was written by a pendejo.
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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#6
RE: Newbie Needs Some Guidance-SUCCESS
THANK YOU SLEEPRIDER FOR SUGGESTION OF USING A SOFT CERVICAL COLLAR.  IT WORKED!


Comparison:
Friday night: AHI was 12.26; 57 obstructive events; 4 hypopnea events.  

Saturday night: AHI was less than 1: NO obstructive events; 1 hypopnea event. 

The difference.....wearing a $13 soft cervical collar from Walgreens thanks to the sage analys of the OSCAR data and suggestion of Sleeprider.  This colar stops chin-tuck obstructing the airway. Even after removing CPAP mask early Sunday morning was able to get back to sleeping on back without being awakened.  Even the "power nap" Saturday afternoon wearing the collar without mask did not abruptly stop in 10 minutes with a gasp.

Thanks Thank God for small favors.
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#7
RE: Newbie Needs Some Guidance
That's great news Aviator! Imagine what a big change a less than $20 aid can bring. Some new members are skeptical when we make this suggestion, and the medical community is still unaware of it.
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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#8
RE: Newbie Needs Some Guidance
(08-29-2020, 07:09 PM)Sleeprider Wrote: Well the increase in PS min helped, but wait until you see the results from a soft cervical collar.  I still think you should take the PS min form 2 to 3 or 4. What is the point of bilevel if you don't use it?  With the Philips machines, we have to tell them what to do, because the auto algorithm was written by a pendejo.

Agree and yes, I did as you suggested.  Changed the PS Min to 3 and PS Max to 4 last evening.  Turned off FLEX and set ramp speed to "3".  (That seemed to smooth things out.) The biggest problem I have with setting the PS Min above 0 (which I know I have to do and will adapt to it eventually) is that it feels like the machine is trying to breathe before I want to which then makes me feel like I'm hyperventilating.  This tends to keep me awake and I have to concentrate to try to keep slowing down my breathing and the machine then adapts to me instead of the other way around. 

My only wish is that I could get ride of the full face mask and go with a pillow or cushion.  But I seem to break the seal in my throat  and start blubbering when I relax.

Thanks again for some great advice.
Ron
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#9
RE: Newbie Needs Some Guidance
The timing of pressure changes with a Philips machine can be disruptive to some people.  In the image below, you can see that the BiPAP actually drops pressure below the set EPAP, then returns to the setting before inspiration begins.  This may be perceived as the machine triggering inspiration, but IPAP won't begin until you begin inspiration.  Also, pressure support with the BiPAP is a modified square-wave rather than the cresting pressure wave we see with Resmed.   Bi-Flex works on BiPAP mode and offers pressure relief at both inhalation and exhalation. The Bi-flex setting offers pressure relief at 3 areas - the transition from exhalation to inhalation, the transition from inhalation to exhalation and during the exhalation.  It does not strictly follow the user's respiration like Resmed, but consider the image below and think about how your sync problem works, then select the profile you think will work best.  A BiFlex setting of 1 or 2 may be helpful, and the best way to find out is to simply experiment.

[Image: Bi_FLEX_large.png?v=1550263935]

Resmed EasyBreath™ wave form from OSCAR

[Image: attachment.php?aid=26092]


Attached Files Thumbnail(s)
   
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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#10
RE: Newbie Needs Some Guidance
Ron, that is one of the reasons we tend to recommend ResMed over PR.
That sais there are individuals that get excellent therapy from PR machines (we still prefer ResMed)
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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