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Feedback Request for Sleepyhead Results
#1
Feedback Request for Sleepyhead Results
I have had a few pressure setting changes. Score has definitely improved. 

I feel like I'm at about 85% of the way healed from the pre-treatment. It's been 2 1/2 months. Hopefully a few more days/weeks will get me feeling 100%.

Symptoms: 

Foggy brain has started to fade; I still feel it slightly.

Droopy eyelids; Happens only once a day and not every day whereas it used to be all day until I napped in the afternoon.

Tightness in my chest; that has gone away this week.

Weight; I've lost 7 pounds since the beginning of treatment. I think mostly because my willpower is returning.

Please review my data and let me know if there's anymore info you'd like. 


   

   

Thanks in advance!
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#2
RE: Feedback Request for Sleepyhead Results
You're using the Philips BiPAP Pro at 14/10 pressure which looks pretty good. It appears you have tried pressures ranging from 19/15 (not so good), 11/7 (also not great), 15/11 and the current 14/10. PS 4 worked better than PS 5 and you seem to have arrived at a good solution, although you have not had a lot of discipline or more accurately, been systematic in your approach to optimize or fine-tune those results.

Looking at the current detailed chart, there are a number of meaningless centrals at the beginning of therapy while you are in ramp mode. The rest of the night is pretty quiet in terms of events. Philips does an amazingly poor job of knowing your inhale and exhale time, and that data looks truly wrong. Tidal volume looks a bit low for most males, but you have a somewhat high respiration rate, so the minute vent is fine. The more important data point is you're feeling better and have felt positive feedback from the therapy. With that and the low event rate, I don't see any changes to recommend.
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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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#3
RE: Feedback Request for Sleepyhead Results
So my breathing is shallow but fast, is that what you mean by low tidal volume but high respiration rate?
What do you think could cause the low tidal volume? I am obese by a couple of pounds of which I am working on losing. Think that will improve as I lost weight?

When you wrote that Phillips is poorly measuring inhale and exhale time, is that why some breaths have a weird shape?

This looks nice for flow:
   

This looks weird because it looks like there are pauses on the inhale:
   
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#4
RE: Feedback Request for Sleepyhead Results
Ok, I finally got to the part in the Wiki about looks of the wave on the flow rate chart. It's how I'm slowly pausing as I'm inhaling. And that the sharp drop is because I'm exhaling faster.

The one thing I can't find an explanation for is Time at Pressure graph in sleepyhead. I see some small hills at points but I don't get what they mean. My BiPAP isn't an Auto so the pressure doesn't change. Is this an unnecessary graph for my machine?
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#5
RE: Feedback Request for Sleepyhead Results
Don't worry about time at pressure, it's a worthless and inaccurate feature. Time at pressure is a graphic representation of the distribution of the time the machine is producing a particular pressure. In this case the Y-axis is time and the X-axis is pressure. The curve probably looks like a normal or skewed distribution. The apex of the curve is at the pressure used the most, and the tails on either side are less time at lower (left of apex) and higher (right of apex) pressure.

This image is classic flow limitation, and it is a major reason Philips machines improperly trigger IPAP too soon cutting off expiration. See the Flow Limitation wiki. http://www.apneaboard.com/wiki/index.php...Limitation Philips machines seem to trigger IPAP at the point where exhale returns to the zero flow line, but before you are ready to take your next breath. We can see expiration here is longer than inspiration, but the machine is cutting it off. Once again, Resmed follows breathing, Respironics predicts it.

[Image: attachment.php?aid=9863]

There is nothing inherently wrong with shallow faster respiration until it reaches extremes, and "hypoventilation" where you don't take a normal full breath is common with obesity. One solution is to increase pressure support to promote a larger volume of inspired air. Of course it's going to help if your machine does not cutoff expiration by triggering IPAP too soon. Kind of a vicious cycle. You can see in the Flow Limitation Wiki how EPR in a Resmed Airsense 10 can improve flow limitations and even hypopnea, and how the change from Philps to Resmed improves the results of individuals with this particular issue. Bilevel can further improve ventilation volumes. That is advanced stuff, and your concerns are probably to get the most out of the machine you have. We will work on that, but worth knowing why I keep saying the Resmed offers many more therapy options.

On your BiPAP Pro, it looks like an EPAP pressure of 10.0 is doing a pretty good job of controlling OA. To tirate out flow limitation and hypopnea, you want to make fine adjustments upward of IPAP. Just 0.5 cm per adjustment and observe results for a while. If CA events begin to take-over then back off on that pressure support. The idea is to support inspiration with a bit more pressure, but not to flush so much CO2 that you stop breathing. While you're at it you might want to change the machine and settings in your profile.
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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#6
RE: Feedback Request for Sleepyhead Results
I was just trying to find out about the Flex option in the Dreamstation.
I can only find a few posts that mentions vaguely that it's about the reduction of pressure when an exhale is detected.
Do you know if that's correct?
If so, what do the settings mean? Does the higher number mean a greater reduction of pressure during expiration?
How? Does it predict when the expiration will end and then taper off the pressure?
I am wondering if that setting will help the transition between Inspiration and Expiration.
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#7
RE: Feedback Request for Sleepyhead Results
Here is a little bit of reading for you.  This is what PR says about C-Flex, A-Flex, and C-Flex+.  I will be adding to this.
I would also listen to what SR says about how Flex seems to behave in real life and how it is different from ResMeds EPR.  

Flex, in all its forms, is based on Flex setting (0,1,2,3) and Patient Air Flow which means it can be different for each and every breath.  

http://www.apneaboard.com/wiki/index.php?title=C-Flex

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#8
RE: Feedback Request for Sleepyhead Results
Thanks for that information. 

I adjusted the Flex setting from 2 to 3. 
I also changed the Mask setting from 1 to Off since the Mask is a non-Respironics Mask.

Weird thing is, my AHI number went up to 3.89. But when I look at my data, there is a long clean uneventful(OA,CA,H) streak from just after midnight to 4:15am. 
Should I concentrate on nice runs like that, or getting the AHI number back down?

At 3:55am I remember waking up. I see a UF1 event at that moment on the graph. 
I see a single snore event at about 3:38am. Is it possible that snore brought me out of deep sleep?
I don't know what UF1 is supposed to represent. 
How is this wake or arousal different from RERA?

   
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#9
RE: Feedback Request for Sleepyhead Results
BiFlex is what you have in the BiPAP and my experience was that I did best a 1 and experienced more events at 2 and 3. There is literally no public documentation of what mysterious behavior BiFlex has or how it actually affects pressure received at the mask. Respironics claims it is a comfort feature that makes IPAP/EPAP transitions easier. Thanks anyway, but after using a Resmed which actually shows the pressure wave-form graphically, I'll never go back to mystery meat. Remember when computers went from a text to WYSIWYG user interface? Respironics is still stuck in the DOS user interface compared to Resmed's comparative iOS.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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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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#10
RE: Feedback Request for Sleepyhead Results
Thank you for your experience. I was looking at the data to see why I felt worse today with the changes than yesterday before the changes.
I notice that there are a lot of clustered UF2 flags where there's a cluster of shallower breathing. I looked at past days and don't have any clusters of UF2 flags like that in them.

   

   

I am going to change the Flex to 1, I haven't tried that setting yet. I'll reply back with results.


QUOTE: " One solution is to increase pressure support to promote a larger volume of inspired air. "

Concerning the volume of air. I think the Mask setting changes volume based on the mask type and mask size.
A couple of posts mentioned that if the Mask is not a Respironics Mask that the setting should be 0.
I had changed it from 1 to 0. I'm wondering if the UF2's are from a reduced volume of air. I think I will also set that back to 1 while trying the Flex at 1 as well...
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