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In anticipation of my BIPAP Re: New Thread
RE: In anticipation of my BIPAP Re: New Thread
My observations would simply be re-stating those that you are probably already thinking..

1) You have large areas of flow limitations
2) The machine continues to bang up against the ceiling
3) When the machine hits the ceiling you are breathing out against pressure 15 (MaxIPAP minus PS)

The ways to address these are probably either or both of the following..

a) Increase PS to assist flow limitations
b) Increase ceiling to give the machine room to maneuver (MaxIPAP)

Don't change anything unless sleeprider replies though.
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RE: In anticipation of my BIPAP Re: New Thread
I am more inclined to drop pressure and increase PS. I'm coming around to the conclusion that ASV may ultimately be the best choice. With what I'm seeing in the latest chart, I think we can drop the maximum pressure to 18. Higher pressure is not going to accomplish anything but discomfort. Pressure support is still the avenue to success. The problem is Vauto is not delivering the full pressure support when flow limitation is at its worst. I'm in new territory with this because PS 6.0 is not making a dent in the flow limitations in Vauto mode. I'd like to try something a bit off that wall, and that is switching to VPAP S mode with an EPAP of 12 and IPAP 18 and Easybreathe OFF. If we can set trigger to high and cycle to low, let's keep that, but I don't know if those options are available in VPAP S mode. This is a fixed pressure mode and is not very far off from what your titration suggested. If it is not tolerable, and you must switch back, then your current settings in Vauto mode won't be changed. Your machine saves the settings in alternative modes, so you can quickly switch back to Vauto and have a more familiar therapy algorithm. Be sure to set your ramp for VPAP S as this is going to be at 18/12 and not change.
Sleeprider
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RE: In anticipation of my BIPAP Re: New Thread
Thanks guys.

I just woke up and read your replies.  I’ll try Sleepriders suggestions at next bedtime.  Sounds pretty complicated to me but I’ll get it done.

At the moment the mask situation is better, although I have a headache again.  I might have to buy one of those oxygen things to check if my o2 levels are still dropping or if my straps are just too tight.

I think there is also an issue with the heated tube and the humidity level.

Well, back to sleep.

Until next charts,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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Ohmy 
RE: In anticipation of my BIPAP Re: New Thread
Morning all.

Very rough night.  I'll spare you the details this time.

I have just printed out Sleeprider's latest suggestions for the settings.

Here are the charts for last night.  Sad

[attachment=18812][attachment=18813][attachment=18814]

Sleeprider, based on what little data there is here, do you still want me to make the setting changes?

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
Trying S mode without Easybreathe is the only way I know that may provide full time and consistent pressure support for every breath. As I said, it's uncharted territory. I want to compare the shape and size of the mask pressure and hopefully see some change in results. I guess we'll see. If we pick back up with Vauto mode, the next move there is logically more pressure support, but I'm not seeing so much benefit to higher maximum pressure.
Sleeprider
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____________________________________________
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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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RE: In anticipation of my BIPAP Re: New Thread
I’ve noticed that the flow limitations are drastically reduced the second half of the night in the past few charts. Could this all be from chin tucking and the tongue dropping back? If that’s the case the Inspire implant is the only thing that’ll stop the tongue from dropping back and staying there. This is why the guy at work is getting it. He’s had all the other surgeries and nothing has stopped his tongue from falling back. Except he hopes the Inspire. But in this case it looks like something is stopping it because the flow limitations are drastically reducing. Just a thought SR and AQ
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RE: In anticipation of my BIPAP Re: New Thread
There is no doubt the severe flow limitations, hypopnea and OA are all front-loaded in this example. After 23:20 everything looks very good. If we could know what causes the problems we see in the first 2-hours, then we could stop guessing.
Sleeprider
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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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RE: In anticipation of my BIPAP Re: New Thread
(01-08-2020, 09:58 AM)Sleeprider Wrote: If we could know what causes the problems we see in the first 2-hours, then we could stop guessing.

So what should she be looking for?

Positional issues (back vs side, chin tuck or no) first?

I don't recall if she's using a soft cervical collar, but if not, that would seem the obvious next step?
Caveats: I'm just a patient, with no medical training.
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RE: In anticipation of my BIPAP Re: New Thread
Hello again.  

I do see where the first half of the night appears worse than the second in these charts.  However, the entire night was freaking miserable.  The change of machine and the initial settings Sleeprider suggested started out promising, but now it seems like each night sleep quality is worse than the previous. I am going to hope that these latest tweaks might be of help.

Sleep lab tech said she didn't notice an issue with the tucking.  I'm going to follow up on that.  (Cervical collar experiment showed no improvement either way).

Gotta go to work.

Check-n later.

Regards,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: In anticipation of my BIPAP Re: New Thread
I think it’s positional. The collar properly worn would work better now that she’s on bilevel wouldn’t it? 
I had my girlfriend pay attention to the position I was in and what time I had my chin tucked and what time I made a grunting or choking sound then I’d take that info and compare it to the Oscar charts. I think that’s the only way we will know for sure is if she asks her husband to do the same.
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