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[Equipment] BiPAP AVAPS vs. ST
#31
RE: BiPAP AVAPS vs. ST
Thanks to Fred for pointing out my typo. It was edited.

Sawinlogz asked how the machine detects central events. The Philips uses a 1-cm pressure pulse which is indicated by all those black vertical hash liners at the top of the chart, and the flow response is interpreted as central or obstructive. The Resmed uses FOT (forced oscillation technique) but it does not use it in advanced machines like the ASV because it is assumed a CA will respond to the pressure support.

I still want to see a chart that shows some closeups (2-3 minutes) of the respiratory flow rate with the mask pressure chart below.
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#32
RE: BiPAP AVAPS vs. ST
Here you go, SleepRider –– is this a good example of what you want to see? I can zoom in on other events if you'd prefer.

Will bring up increasing EPAP min and PS with doc. Help me out here: PS = IPAP - EPAP, and is a function of tidal volume by varying between min/max IPAP?

Re. increasing EPAP: My baseline is an abnormally low max expiratory pressure on spirometry –– either awake or asleep, I have weak exhalation (as well as inhalation). How does it help/not hurt to increase my EPAP min? 


Thanks, sawinglogz:
I used same mask, but pregnancy definitely increases nasal congestion, so that may be a factor with the hypopneas.


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#33
RE: BiPAP AVAPS vs. ST
That is a pretty good example of the period during events. Any chance you can post one from a period that does not have events for contrast?

The closeup image shows pressure support increasing from 8.0 to 11.0 cm assisting mostly spontaneous breaths. The flattened tops show considerable airway resistance which suggests the machine is doing most of the work. At 04:31 inspiration and expiration becomes poorly defined and this may be airway restriction in the form of chin tucking. The period of this screenshot is one I suspect of being attributable to positional apnea, and that is why I want to look at another part of your charts with fewer events to see if they look more like what we see at the end of this segment at 04:31:50.
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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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#34
RE: BiPAP AVAPS vs. ST
Here's the no event zoom in.

Does the fact that I'm regularly hitting max IPAP of 20 indicate that I may need higher max IPAP, or not, since this is an example of no events?

The hypopneas seem to be happening with EPAP so that's why I assume you suggested an EPAP change. But I don't understand totally what's happening with EPAP: does more EPAP pressure trigger me to exhale more or does it only create resistance (which I don't need, given my weakness) upon exhale?

I know this is basic but I realize I don't quite get it. I understand BiPAP vs. CPAP and why I need the bilevel pressure, but I'm not sure what's happening physiologically with increased vs. decreased EPAP. 

I also don't understand why my tidal volume is lower during this no event period.

Many thanks always,
KA


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#35
RE: BiPAP AVAPS vs. ST
The middle of that sequence shows fully supported spontaneous breaths, with timed breaths starting at 05:37:30. Just thinking out loud, the Max IPAP is capped at 20 cm and PS max at 11.0 cm. I just wonder if higher Max IPAP and max PS would provide a better tidal volume or faster inspiration time. BTW, those black hash marks next to the inspiration wave and mask pressure wave are timed breaths.
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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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#36
RE: BiPAP AVAPS vs. ST
(08-14-2020, 06:39 PM)KuriApollo Wrote: I know this is basic but I realize I don't quite get it. I understand BiPAP vs. CPAP and why I need the bilevel pressure, but I'm not sure what's happening physiologically with increased vs. decreased EPAP. 
Ok, Some basics.  CPAP can refer to almost any machine that helps your breathing.  
CPAP - single fixed pressure used to splint open an airway and allow easier breathing.  Used primarily for obstructive sleep apnea.
BiLevel - basic/spontaneous mode.  Similar to CPAP above but with 2 separate and independent pressures.    Used primarily for obstructive sleep apnea.
EPAP/Exhale pressure splints open the airway in the same manner as the fixed CPAP above. This is the basic 'starting' pressure of every breath.
IPAP/Inhale pressure
Pressure Support/PS is the difference between Exhale and Inhale/EPAP/IPAP so PS = IPAP - EPAP
PS is increased for the treatment of various obstructive conditions including Hypopneas, Flow Limitations, RERAs, and UARS
Increasing PS also tends to increase Tidal Volume and increase the efficiency of your breathing.
The Physics of it. Let's assume that you are not getting any drive to breathe. again the basics.
EPAP is the base pressure,  To inhale you need a higher inhale pressure, sufficient to inflate your chest/lungs.  This causes you to inhale, generally, higher PS values are more effective at this.  To exhale you just decrease the pressure to EPAP and the air escapes.
BiLevel - Timed.  This is to raise the PS at a set time to ensure that you breathe on a regular basis.  This is called a 'backup' rate, to backup your normal.spontaneous breathing.
Automation of the pressure settings may be enabled for any of these depending on specific model/mode.
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