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Failed CPAP, APAP, now on to BiPAP... help please!
#21
RE: Failed CPAP, APAP, now on to BiPAP... help please!
8 hours of sleep may help you start feeling better faster. Sometimes, this sleep debt from apnea takes a while to pay back. Your FL would be affected by pressure, if it behaves like most others, but it may not be your biggest issue. I tend to agree with John on the CA issue. You may need to find best compromise pressure for lowest OA vs CA events. If CA cannot be controlled within reason, and you cannot gain restful sleep due to the CA, then you may need something like the ASV. I think you may be best served to wait a bit, build a trend after you get that best compromise on setting vs event counts. Factor in how you feel always. You may find an AHI of 3 makes you wake up well rested, but an AHI of 2.4 and you're not so good due to some event. It's not all numbers, it must gauge off how you feel with numbers helping tell us what to edit.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#22
RE: Failed CPAP, APAP, now on to BiPAP... help please!
(04-13-2020, 01:11 PM)mper6794 Wrote:
(04-13-2020, 12:10 PM)UARS.DDS Wrote: Would lower pressures decrease or increase FL? Or does pressure have any effect on FL?

Thanks in advance, learning a lot here.

---- no, what would be causing your arousals/awakenings would be an untreated UARS (flagged FL still high; lots of unflagged RERA)

..... you would be under inadequated combination of PS (looks too low) and IPAP (looks too high); not known tailored EPAP;

_ as I pior suggest, first  thingto try would be a systematic titration as per Resmed protocol; starting as you had not used CPAP ever;

all the best

Thank you for the advice.

Last night I went to sleep with S mode on, every setting back to factory settings, EPAP 4 and IPAP 8 (PS 4). Woke up after a few hours to use the restroom, which I don't have to do with higher pressures. I changed the settings and went back to sleep with EPAP 8 and IPAP 12 (PS 4). 

Attached are screenshots for the 3 hours at EPAP 4, a zoom-in of the flagged OA's leading up to my arousal at EPAP 4, and the 4 hours on EPAP 8.

   

   

   

Feeling pretty groggy today, unfortunately!
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#23
RE: Failed CPAP, APAP, now on to BiPAP... help please!
Your results look very good other than the OA events. There are zero flow limitations and the respiratory stats are normal, or excellent depending on your viewpoint. The leaks are gone here and this is a very good session until it isn't. The fact events cluster prior to your arousal takes me to a soft cervical collar and positional apnea. If you can stretch your therapy into a full night without the interruption, you have this beat.
Sleeprider
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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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#24
RE: Failed CPAP, APAP, now on to BiPAP... help please!
Thanks, Sleeprider. The flow limitations are at "zero" because ResMed doesn't record them when in S mode ... go figure.

I'm happy about things as well, except for the apnea/events during REM sleep. I wear a soft cervical collar already.

From my original sleep study (post #3) I seem to do better sleeping on my right than on my stomach/back, but I don't know how to control that in my sleep.
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#25
RE: Failed CPAP, APAP, now on to BiPAP... help please!
Forgot the S mode does not record FL. Easy fix is to use Vauto mode with EPAP 8, max pressure 12 and PS 4.
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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#26
RE: Failed CPAP, APAP, now on to BiPAP... help please!
Ah, genius!

Honestly, the one night I did PS 4.0 over 14.6-25.0 on VAuto is when my resp. rate held steadiest. No central apneas. AHI <2. I'm going to bump it up to EPAP 14.8 tonight and keep PS at 4.0 and see what happens.
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#27
RE: Failed CPAP, APAP, now on to BiPAP... help please!
Hi, UARS

---- I understand your anxiety to get there quickly; maybe not possible so quickly, as following Resmed titration protocol

_ I was trying to share my success experience with such titration (see attached), after loosing 10 months changing tweaking more or less arbitrarily..

_ hope you could succeed ..

all the best


Attached Files Thumbnail(s)
   
Mper
I am not a doctor. Nothing that I say here is medical advice
All my posts include only outcomes/learnings from my own/other therapies and medical literature



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#28
RE: Failed CPAP, APAP, now on to BiPAP... help please!
(04-15-2020, 07:50 AM)mper6794 Wrote: Hi, UARS

---- I understand your anxiety to get there quickly; maybe not possible so quickly, as following Resmed titration protocol

_ I was trying to share my success experience with such titration (see attached), after loosing 10 months changing tweaking more or less arbitrarily..

_ hope you could succeed ..

all the best

Thank you for this. Per their titration protocol, I have simply been raising minimum pressure to get rid of the cluster of obstructive apneas that I get during REM sleep. In January I started at a minimum pressure of 7.0 and have been slowly increasing it, but the obstructive apneas still remain. This is why I hesitate to go back to lower pressures... I already know that they don't do anything for my REM OA's.

After the OA's go away, then I will start increasing PS to get rid of RERA's, provided I don't start causing central apneas.

This makes sense, right?

Attached is last night at IPAP 14.8, PS 4.0. Slept for almost 8 hours straight and didn't feel like going back to sleep when I woke up!!  Smile


   

   
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#29
RE: Failed CPAP, APAP, now on to BiPAP... help please!
--- well, I would insist on following the Resmed titration protocol:

_ EPAP:4.0; PS: 4.0, IPAPmax:8.0 >> to confirm you would have OA or not, and collecting data;

_ EPAP: 5.0: PS:4.0 (constant), IPAPmax: 9.0, and so  on.... until eventual OA would be eliminated, should they exist; you would have your tailored EPAP (fixed from here on);

_Keep constant the tailored EPAP, increasing IPAP followed for whatever P.S comes.....until you would tame hypopneas (also quasi-hypopneas....)/arousals-aw, and RERA-aw (yours are unflagget, it looks; maybe some 24 of them this last night);

_ could you please, next posts, add TV and MV, with the median reference line, as well some ten-minute duration windows?

the best
Mper
I am not a doctor. Nothing that I say here is medical advice
All my posts include only outcomes/learnings from my own/other therapies and medical literature



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#30
RE: Failed CPAP, APAP, now on to BiPAP... help please!
Just my opinion, but it sounds like current settings are helping both in good therapy numbers and resulting in feeling better for therapy, UARS.DDS. I know mper6794 is trying to help, but why start over if you're gaining benefits now? It's your call on your therapy, but myself, I'm not interested in running down rabbit holes.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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