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Failed CPAP, APAP, now on to BiPAP... help please!
#11
RE: Failed CPAP, APAP, now on to BiPAP... help please!
UARS.DDS, you are starting to really dial this in and an AHI of <1 is a great result. Yes my settings are:

Ti Max 2.6s
Ti Min 0.3s
Trigger: High
Cycle: Very Low

Your thinking about the P30i makes sense to me. Having the hose run from below your nose with a pillow mask has one major issue for leaks and that's the ability to pull it off your nose as you roll onto the hose. Your major leaks between 4.20 and 5.00 suggest that this might be the case here, it could also be mouth breathing. There are people on this forum with much better ability to read your data than me.

For me, as restless sleeper, having the hose come out of the top of my head has two distinct advantages. The first is that it is out of the way and I can rotate as much as I like. The second is that this configuration pulls the pillows up against my nose and no matter how much I move, I can't pull on the hose. I have the P30i and love it. The Dreamwear is also very good (used it for two years) but Resmed have taken that concept a couple of steps further IMO.

Best wishes for further improving your therapy.
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#12
RE: Failed CPAP, APAP, now on to BiPAP... help please!
(04-11-2020, 05:16 AM)holden4th Wrote: For me, as restless sleeper, having the hose come out of the top of my head has two distinct advantages. The first is that it is out of the way and I can rotate as much as I like. The second is that this configuration pulls the pillows up against my nose and no matter how much I move, I can't pull on the hose. I have the P30i and love it. The Dreamwear is also very good (used it for two years) but Resmed have taken that concept a couple of steps further IMO.

Thank you Holden4th, I'm going to purchase it soon.

Here are the past couple of nights attached...

   

   

Zoom-in view on the cluster of obstructive apneas:

   

:/
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#13
RE: Failed CPAP, APAP, now on to BiPAP... help please!
Hi,

Some observations,  suggestions, and questions, if I may:

_ leaks are detrimmental; you would have to work out;

_ you have been arousing/awakening too many times leading to poor night sleep. Causes of this would be respiratory effort-driven arousal/aw, still unresolved. Need adjusts of settings;

_ your main efforts could be associated with REM stages;

_ at least great part of OA look false events; likely you were awoke. Have you noticed snores during periods of OA

_ are you a side sleeper dominantly? or supine?

_ do you use soft neck collar?

Suggestions: start all over again your therapy, with settings as per Resmed titration protocol for S-Mode; easy breathing....default parameters: 0.3/2.0....cycle and trigger med. Careful notes and observations on progress, daily

all the best



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#14
RE: Failed CPAP, APAP, now on to BiPAP... help please!
(04-13-2020, 07:32 AM)mper6794 Wrote: Hi,

Some observations,  suggestions, and questions, if I may:

_ leaks are detrimmental; you would have to work out;

_ you have been arousing/awakening too many times leading to poor night sleep. Causes of this would be respiratory effort-driven arousal/aw, still unresolved. Need adjusts of settings;

_ your main efforts could be associated with REM stages;

_ at least great part of OA look false events; likely you were awoke. Have you noticed snores during periods of OA

_ are you a side sleeper dominantly? or supine?

_ do you use soft neck collar?

Suggestions: start all over again your therapy, with settings as per Resmed titration protocol for S-Mode; easy breathing....default parameters: 0.3/2.0....cycle and trigger med. Careful notes and observations on progress, daily

all the best

Hi mper, thank you for your thoughts.

No snores at all. I usually sleep on my side or prone, and use a soft neck collar.

Why do you say the OA look like false events? I'm curious about your thoughts.

I bumped EPAP up to 14.6 last night and got these results...

   
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#15
RE: Failed CPAP, APAP, now on to BiPAP... help please!
Your leaks were better controlled on this latest chart. Event flags were way down as well. Congrats on that victory. Now the tell: how did you feel?
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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#16
RE: Failed CPAP, APAP, now on to BiPAP... help please!
(04-13-2020, 09:58 AM)UARS.DDS Wrote:
(04-13-2020, 07:32 AM)mper6794 Wrote: Hi,

Some observations,  suggestions, and questions, if I may:

_ leaks are detrimmental; you would have to work out;

_ you have been arousing/awakening too many times leading to poor night sleep. Causes of this would be respiratory effort-driven arousal/aw, still unresolved. Need adjusts of settings;

_ your main efforts could be associated with REM stages;

_ at least great part of OA look false events; likely you were awoke. Have you noticed snores during periods of OA

_ are you a side sleeper dominantly? or supine?

_ do you use soft neck collar?

Suggestions: start all over again your therapy, with settings as per Resmed titration protocol for S-Mode; easy breathing....default parameters: 0.3/2.0....cycle and trigger med. Careful notes and observations on progress, daily

all the best

Hi mper, thank you for your thoughts.

No snores at all. I usually sleep on my side or prone, and use a soft neck collar.

Why do you say the OA look like false events? I'm curious about your thoughts.

I bumped EPAP up to 14.6 last night and got these results...
....It looks to me your main problems are unresolved RERA's (flagged or not), and your events, both CA and OA, look false closely associated with arousal/awakenings, an often phenomena, common to many guys. 

.....it looks to me you would not need such high EPAP's. Main issue would be unresolved FL/RERA/awakening (flagged or not). My first hyphotesis is that as soon as you work out FL/RERA your events would disapear.

all the best



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#17
RE: Failed CPAP, APAP, now on to BiPAP... help please!
(04-13-2020, 11:16 AM)mper6794 Wrote:
(04-13-2020, 09:58 AM)UARS.DDS Wrote:
(04-13-2020, 07:32 AM)mper6794 Wrote: Hi,

Some observations,  suggestions, and questions, if I may:

_ leaks are detrimmental; you would have to work out;

_ you have been arousing/awakening too many times leading to poor night sleep. Causes of this would be respiratory effort-driven arousal/aw, still unresolved. Need adjusts of settings;

_ your main efforts could be associated with REM stages;

_ at least great part of OA look false events; likely you were awoke. Have you noticed snores during periods of OA

_ are you a side sleeper dominantly? or supine?

_ do you use soft neck collar?

Suggestions: start all over again your therapy, with settings as per Resmed titration protocol for S-Mode; easy breathing....default parameters: 0.3/2.0....cycle and trigger med. Careful notes and observations on progress, daily

all the best

Hi mper, thank you for your thoughts.

No snores at all. I usually sleep on my side or prone, and use a soft neck collar.

Why do you say the OA look like false events? I'm curious about your thoughts.

I bumped EPAP up to 14.6 last night and got these results...
....It looks to me your main problems are unresolved RERA's (flagged or not), and your events, both CA and OA, look false closely associated with arousal/awakenings, an often phenomena, common to many guys. 

.....it looks to me you would not need such high EPAP's. Main issue would be unresolved FL/RERA/awakening (flagged or not). My first hyphotesis is that as soon as you work out FL/RERA your events would disapear.

all the best

So your thinking is that the high pressures are causing the arousals, which look like CA/OA?

Would lower pressures decrease or increase FL? Or does pressure have any effect on FL?

Thanks in advance, learning a lot here.
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#18
RE: Failed CPAP, APAP, now on to BiPAP... help please!
(04-13-2020, 10:09 AM)SarcasticDave94 Wrote: Your leaks were better controlled on this latest chart. Event flags were way down as well. Congrats on that victory. Now the tell: how did you feel?

Not anxious or emotional. Teeth didn't feel sore in the morning (no grinding). No elevated heart rate.

However I'm still tired... my sleep hygiene is poor, gotta go to bed at 10 instead of midnight and try to get a full 8 hours.
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#19
RE: Failed CPAP, APAP, now on to BiPAP... help please!
I am not expert, but here is my take on it. Your flow limitations are actually quite good. You are always under 0.3 at the Max and usually at 0.0 at 95%. There will be a line of people who will gladly trade their flow limitations with yours and I'm one of them.

There is an elephant in the room that is not serious right now, but is something you should understand. I've had central/complex/clear airway apneas for many years. The index would range from 1.5 to 3.5. I'm now on an ASV machine, but that is a different subject.

The way these things generally seem to work is that the more pressure support (IPAP-EPAP) the more central/clear airway apneas; but fewer obstructive and hypopneas. The less pressure support, the fewer the central/clear airway but the obstructive and hypopneas suffer. Granted your charts are generally just one night at different settings, but if you go back and look, there is a trend.

You also have some leaks that might be causing some issues.

I think you need to find a pressure that will give you a happy medium for now. It might be a PS of 4, 5, or 6. It might be an EPAP of 13, 14, or 15. You'll have to decide by how you feel. I chose to keep my obstructive/hypopneas at a total of 1 and let my centrals run at 1.5 or so. I did that until my centrals started to spike way up and then I went to an ASV, but that took a number of years for me.

John
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#20
RE: Failed CPAP, APAP, now on to BiPAP... help please!
(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



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