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Help, Ive messed something up terribly [messed up bilevel settings]
#1
Help, Ive messed something up terribly [messed up bilevel settings]
Greetings, Everone.

Let me start by saying I suffer centrally caused sleep apnea, with maybe an obstructive reading here and there but rarely.

Second, I have had a terrible time since starting with my BIPAP, I am sure some if not most of it is my fault for changing settings and not writing down my original settings, though the reason I changed them after a month is because I was feeling way more tired than before I even start the BIPAP

I wear my mask every night, I dont find it uncomfortable and a fall asleep easy with it on with that being said here is my issue, it seems like when I get to REM sleep something changes because I wake up after about 3 hours to a tee.  Its been so hard on me, I am so tired I can hardly function to be honest fall asleep at work all the time, its been frustrating.  I do thankfully have an appointment next week with the sleep center that originally did my first sleep study.

I know what the original EPAP and IPAP was because I can see it in my medical files 18 IPAP and a 8 EPAP and a BPM of 16 but that is all the medical notes said, nothing about Ti or Rise Time or any of the other settings.

My question is simple.  What is the TYPICAL Ti setting, right now I have mine set at 1.5.  Also, could it be that my EPAP is way to high for someone that doesnt have obstructive sleep apnea though I do have some obstructives one in a while, usually 1 per night.  Most of what I am getting is Hypoapneas.

I am attaching a screenshot below, any help would be greatly appreciated as I am pretty sure this is killing me rather quickly.

EDIT:  I cant attach a screenshot of my graphs so I have attached a .csv of my last month worth of sleep

Thanks


Attached Files
.zip   SleepyHead_Username_Details_2017-12-06_2018-01-06.csv.zip (Size: 36.79 KB / Downloads: 6)
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#2
RE: Help, Ive messed something up terribly
Since your appointment is relatively soon, bring your machine with you to the sleep center and allow them to configure the correct settings for your condition. Also, you can post the images to Imgur and post the link.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#3
RE: Help, Ive messed something up terribly
(01-07-2018, 08:06 PM)srlevine1 Wrote: Since your appointment is relatively soon, bring your machine with you to the sleep center and allow them to configure the correct settings for your condition. Also, you can post the images to Imgur and post the link.

That is a good idea, here is a link to a graph out of sleepy head.  https://imgur.com/a/o0XqX
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#4
RE: Help, Ive messed something up terribly
The typical Ti setting is the default, but clearly that is not ideal for everyone. Mine is set to 2.2 , which works for those of us with more tidal volume. I would agree with srlevine, but the DME will only implement settings in a prescription, and are really not inclined, or permitted to make other changes. Most would have no clue what you're talking about. Do you have the sensation of inspiration pressure being cut-off? Why do you suspect this setting might not be ideal?

You have a lot of pressure support (7-cm) on your ST machine, and I presume you also have a backup BPM rate set. We would need a lot more information on your settings and what you sense as the problem to advise. Srlevine is experienced at self-titration on a machine with a backup rate, so his advise is valuable, but he didn't get his settings from a DME; they came from a careful and structured trial and error process. That is true for many of us. This is not something the doctor or DME normally will coach you through. Let us know what problem you are trying to solve, and we can at least give you our experience in dealing with it. You are waking up, and maybe, there is a clue in the data prior to the arousals; or maybe not. If you want to share, we can look and let you know if there is anything that seems meaningful, or support you in questions for your appointment.
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#5
RE: Help, Ive messed something up terribly
(01-07-2018, 08:41 PM)Sleeprider Wrote: The typical Ti setting is the default, but clearly that is not ideal for everyone. Mine is set to 2.2 , which works for those of us with more tidal volume.  I would agree with srlevine, but the DME will only implement settings in a prescription, and are really not inclined, or permitted to make other changes.  Most would have no clue what you're talking about.  Do you have the sensation of inspiration pressure being cut-off?  Why do you suspect this setting might not be ideal?

You have a lot of pressure support (7-cm) on your ST machine, and I presume you also have a backup BPM rate set.  We would need a lot more information on your settings and what you sense as the problem to advise.  Srlevine is experienced at self-titration on a machine with a backup rate, so his advise is valuable, but he didn't get his settings from a DME; they came from a careful and structured trial and error process.  That is true for many of us. This is not something the doctor or DME normally will coach you through.  Let us know what problem you are trying to solve, and we can at least give you our experience in dealing with it.  You are waking up, and maybe, there is a clue in the data prior to the arousals; or maybe not. If you want to share, we can look and let you know if there is anything that seems meaningful, or support you in questions for your appointment.

Luckily I can make the changes myself.

My settings currently are
IPAP: 18
EPAP: 8
Ti: 1.5
BPM (Backup Rate): 16
Rise: 3 (1-6)

What do you mean by "ou have a lot of pressure support (7-cm) on your ST machine"

With central sleep apnea would a lower EPAP be better?  Maybe im having a hard time exhaling or something
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#6
RE: Help, Ive messed something up terribly
I can't judge whether your EPAP setting is appropriate with current information. EPAP is set to prevent obstructive apnea. If your current results do not show any apnea, you can try lower EPAP. Without knowing what your complaint is in terms of comfort, I can't suggest changes, however your BPM is above the normal default respiratory rate of 15, and many people prefer a lower rate than that. Your pressure support is actually 10, so that is plenty to provide the respiratory effort for inhalation.

Let's ask another question. For central apnea, an ASV might be superior to ST unless you have known congestive heart failure with left ventricular ejection less than 45%. Are you aware of any conditions like this?
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#7
RE: Help, Ive messed something up terribly
(01-07-2018, 09:27 PM)Sleeprider Wrote: I can't judge whether your EPAP setting is appropriate with current information. EPAP is set to prevent obstructive apnea.  If your current results do not show any apnea, you can try lower EPAP.  Without knowing what your complaint is in terms of comfort, I can't suggest changes, however your BPM is above the normal default respiratory rate of 15, and many people prefer a lower rate than that.  Your pressure support is actually 10, so that is plenty to provide the respiratory effort for  inhalation.

Let's ask another question. For central apnea, an ASV might be superior to ST unless you have known congestive heart failure with left ventricular ejection less than 45%. Are you aware of any conditions like this?

I have no congested heart failure as of yet, though this seems to be making my health terrible.  Further my main issue is not obstructive sleep apnea, its centrally caused which is why I thought that maybe since my breathing is so weak that a lower EPAP (like a 5) would maybe work better.  Ti
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#8
RE: Help, Ive messed something up terribly
With ASV, the machine supplies pressure support as needed, in the amount needed to stabilize breathing encouraging spontaneous respiration when possible. With ST, you get fixed pressure support all the time making you dependent on the machine. In my opinion you should be complaining to your doctor to encourage a change in prescription from the older technology to the more adaptive one. Lots of members here are using ASV (Resmed S9 Adapt, Aircurve 10 SV and Respironics BiPAP SV Advanced) with good success and comfort. ST is not designed or central apnea, it was intended for restrictive lung disease and obesity hypoventilation The simple truth is you're probably not on the right machine, and we can help you get educated on the better ASV technology.

https://www.resmed.com/us/en/consumer/pr...0-asv.html
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#9
RE: Help, Ive messed something up terribly [messed up bilevel settings]
Hi sprockets,
WELCOME! to the forum.!
Good luck with CPAP therapy and getting it fine-tuned.
Hang in there for more responses to your post.
trish6hundred
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#10
RE: Help, Ive messed something up terribly [messed up bilevel settings]
Welcome to the Apnea Board. I just wanted to chime in and wish you best success. If you join me in ASV treatment, assuming you may be headed there, it'll do wonders for you. I'm not attempting to promote any brand, but ResMed is what I chose. Again sincere best wishes in proper treatment.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

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