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Dreamstation Bipap user - Thanks, notes, and Followon questions
#1
First, I want to thank the members of this board for some invaluable insight into getting the most out of apnea therapy.  I'll push out some background and info in a couple posts, then will post some images from Sleepyhead for some feedback.

Background - home portable sleep study in February showed AHI of 27.1 - with 110 hypopneas and 88 Apneas (53 of the apneas were recorded as CA).  Followon Titration study was done one month later.  I wasn't digging CPAP for the study so I was placed on bilevel with a Dreamwear nasal mask.  At the end of the overnight titration study, a 12/10 pressure setting worked the best with both AHI and RDI at 6.5.  Hypopneas at 21 and 0 CA or OA.

Doc prescribed the Dreamstation Auto BiLevel DSX700H11 with humidifier and dreamwear mask.  Interestingly, though, he had the settings placed at Fixed BiLevel with pressure of 13/8, not the study pressure of 12/10.  Anyway, I got started the same night 3/30/2017.  As for most folks, the first few nights sucked as I was getting used to the machine, but I can say that my head felt clearer after the first night and continued to feel that way throughout the following week - so something was working.

That said, I was still missing something as far as the therapy was concerned.  Though the doc said CAs would increase with Bipap, i was getting CAs in the 200+ range for some nights and steady in the low-mid 100s for the first couple weeks.  OAs and Hypopneas were anywhere from 5-20.  Gradually CAs declined below 100, but were still roughly between 50-90 on average with OA and H  dropping to single digits.  So things were improving in the first 3 weeks, but AHI was averaging around 8-9 with CAs being the predominant.

Next post, I'll discuss more about how this board helped with adjustments.  Thanks for the patience as i get these posts out.
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#2
Post #2 - I'm the kind of person that will take something apart if its not working right for me.  Curious as to why my CAs were staying high, I searched all over and hit upon this forum.  Immediately, the amount and quality of info was apparent and I found some good insight into adjusting my settings.  Access to the clinician settings was absolutely the best.  One of the issues that I figured was contributing to my CAs was the difference in pressure, where after i exhaled, my inhalation would be met with mistimed support. this happened most as my body was transitioning to sleep breathing.  Anyway, I adjusted the settings to turn off biflex completely as suggested in some posts.  that helped some, but not quite. 

After scouring additional posts, the discussions about higher pressures contributing to increased CAs starting making sense so I adjusted the fixed BiLevel from 13/8 to 12/10.  Man, that resulted in near immediate relief and AHI dropped to its lowest, 3.94.  It was 12.92 the night before.

Thought I had turned the corner, but I was still getting those delayed timings of exhalation to inhalation as I was falling asleep.  So I changed to just straight CPAP at 12 thinking that would solve the problem.  Yes on the timing of inhale/exhale since it was same pressure.  Everything else went to $&!*.  So after three-four days on straight CPAP, I went to Auto-BiLevel 12/10 with Variable support - PS min 1 and PS max 2.  This has made a huge difference all around with inhale/exhale timing and CAs have gone to 0 in some nights.  Lowest ahi down to .4 with most nights barely above a 2.

Post 3 next
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#3
Good story and troubleshooting your therapy. So far, you've done what i would have suggested, which is to reduce pressure support to clear up the CA and work with a narrow range of BiPAP auto. The surprise is that operating in CPAP mode didn't work better.

Keep it coming.
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#4
Hi Joboo23,
WELCOME! to the forum.!
Great story, keep up the good work.
trish6hundred
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#5
Post #3

So, up until a few days ago, I was having regular nights below AHI of 1 - .4, .6, .8 with a few above 1.  Couple things I've noticed with Sleephead data.  I've started to have flow limitations, 2-4 on avg.  Never had those with previous settings.  Periodic breathing seems to be higher too, but that does vary.  Finally, it looks like I'm having significant mask leaks - most likely this is due to pressure forcing my mouth open since I'll have wake up with pretty bad dry mouth.

So, 2 months in and I've seen major improvements and I'm looking to continue to tweak things.  Not really interested in chasing AHI numbers, but would appreciate experienced eyes on my sleephead data.  The image below from 5/30/2017 shows my lowest AHI night

   
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#6
if it was my chart, knowing that the CA are pressure and will subside, I would use the bpap to try and improve my statistics
I would work with the advice of my doctor for the tidal volume and respiration rate.
...If you aren't mouth breathing and throwing your numbers out...
I found BPAP improved my inspiration expiration ratio to 1:2 
I would use the bpap PS, to try and get my ideal tidal volume in the hope of reducing my respiration rate. I would increase the PS, 
I would have 12 as my initial IPAP target because around that pressure is working well with your OA/H. I'd try an EPAP pressure of 6 and a PS of 6 giving an epap6 ipap12 and see where my tidal volume and respiration rate went to over a few days. It will probably initially blow the CA number, but I would expect that to come down in a month or I could reduce the PS back 1 to have epap10/ipap11 and increase it slowly, if you found the increased PS a benefit.

different brand but similar titration principles apply 
https://www.resmed.com/us/dam/documents/...lo_eng.pdf

this is a guide to tidal ventilation
[Image: stb4tZk.jpg]
new user http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or sleepyhead, set the min CPAP 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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#7
Thanks for the information.  I played with adjusting the pressure support a bit. CA's seem to be happening more often, regardless - usually after I wake in the early morning 4 or 5am.  As I try to fall back asleep, my breathing will be slower/ more shallow so that the machine kicks in a pressure pulse and increases pressure, or I have a temporary block as i transition from exhale to inhale.  It's odd, as I don't have these issues when I initially fall asleep in the evening.
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#8
It wasn't about the AHI and I would ignore the CA for a couple of months, as they will probably settle. (later if needed, you can move to an ASV) I was just suggesting more PS, or going back to your prescribed PS to get better ventilation. To see if it brings your breathing rate down. The median 19.4 BPM is too high for me and the tidal volume of 400 too low and the I:E ratio is out. This is perhaps why you were given the bipap? If it continues, I would go back to your doctor and discuss priorities in your treatment.

for the block, you may need more minimum epap
new user http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or sleepyhead, set the min CPAP 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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#9
Thanks, Got it.  Doc never discussed resp rate, tidal vol, etc.  Gave me bipap only because in my study I wasn't tolerating CPAP well.
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#10
Do you have a follow up appointment soon? He may do your setting adjustment, using the SD card then.
If it were me I'd go back to 13/8 and post some charts to see if it improves. you could use page 35 of the link to fine tune your pressures a bit, before switching to auto settings
new user http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or sleepyhead, set the min CPAP 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


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