In anticipation of my BIPAP Re: New Thread

[slowriter]

I think it would be based on sleeprider taking a look at your closeups to see if he sees promise in the experiment.

If there's no value in turning off the easybreathe algorithm, then could switch back to vauto mode and use this info to adjust the settings further.

Otherwise, if it seems wise to stay on S mode, any changes would likely be based on the FL graph details, and also how you're feeling.

But let's hear his thoughts; I'm curious myself!

[Plmnb]

Slowriter,

I don't know what to think about how I feel.

Even when I have had better "numbers", I feel exhausted.  I see people who have posted low AHI, as low as 1, and they say how much better they feel.  I have also seen people post 1 AHI and they still don't feel better.  I wonder if I will ultimately be one of these later people?

Are there people who just are extra sensitive and no matter how good their numbers, will feel tired?  I guess until I get a night where I have "good" Flow Rate waves, I won't know?

sigh.

[slowriter]

Right. You're going to have to be patient.

For how you feel, I would include reducing your time awake. It took me months to (mostly) eliminate those. I consider that a key variable on how well things are doing.

Think of it this way: you're trying to find the machine settings that address your SBD, and then to give your body and brain time to adapt to that new world.

[Plmnb]

Slowriter,

HOW did you reduce your time awake???

Plmnb

[slowriter]

I'm not really sure exactly.

But in general, dialing in the settings, and giving it time.

[Sleeprider]

The fact the machine does not log Flow Limitation in S mode is why you have to look through the closeups to see if their severity and the machine response is improved. In addition the OA is now reported as UA and there is no FOT during apnea. One of your closeups showed that there was no flow limitation at 00:40:00. The chart closeup at 04:41:30 was not so good. The big difference is you now have a more durable pressure support that is the same size on every breath and pressure never changes. Whether this is a more comfortable mode for you or not is up to you. The results may be a bit better but not that significant, so the advise is do what feels best. When I look at hypopnea events in the close-up they seem less severe in S mode.

The bad news is I am running out of ideas for a conventional bilevel approach to your problems. It will be interesting to hear ideas from others on where this should go.

[Plmnb]

Morning Sleeprider.

I am digesting your reply.

Here is what I am thinking and wondering:

1) If some measurements appear better, why can’t I find even one area of good or at least decent wave forms for my Flow?  Is there a good probability that no matter what I do with this machine I will not have any decent period of time with decent or good breath waves?

2) What is FOT?

3)  I don’t have machine available at the moment, so I can’t double check for this adjustment, but should I increase the PS tonight and see what happens? 

4) Should I leave everything set as it is and try the cervical collar once more?

If you are running out of ideas, that’s understandable, we have tried a lot.  Look forward to your thoughts and thoughts from anyone else that would like to chime in.

Plmnb

[ApneaQuestions]

Well, because the machine no longer tells you where to look for flow limitations, you need to do what you did and zoom in to a 2 minute window then scroll through time looking for a "good" area where there are no events and things look as rounded as possible.... and then to another "bad" area where things look totally unrounded.

So great job on the zoooming!  

I've spent my whole career looking at wiggle plots in a totally different discipline (seismic data analysis).  Without any consideration of how you feel, it's still shockingly clear that your waveforms are nothing like a "perfect rounded inhalation" and (intuitively) I would want mine to be much better.

If I was in your shoes I'd be following two paths..

1) Why is it that sometimes my waveforms seem reasonably good and other times they are very poor?  That can only be answered by grabbing that old camcorder from the basement or borrowing one from a friend and recording yourself during the night to try to see if there is anything obvious showing up during the "good" times and the "bad" times.

2) I would also be asking my sleep doctor if they have any loaner ASV machines that they can lend me for a week to experiment to see if the bad waveforms can be improved using the ASV technology.  In my case, they were happy to lend me one and that rapidly turned into a prescription for one.  You might be able to get a loaner machine within a day or two if you are lucky.

EDIT: FOT Forced Oscillation Technique. Where they send a ripple of pressures during an apnea to try to see if it is OA or CA. (See Autoset Clinical Manual for details).

[slowriter]

The bad news is I am running out of ideas for a conventional bilevel approach to your problems.  It will be interesting to hear ideas from others on where this should go.

Do you see any evidence that easybreathe turned off helped or hurt?

If it hurt or did not help, my impulse would be to go back to vauto mode (which has easybreathe on by default), and use the cervical collar, with settings that mimic last night, but maybe even higher PS; like min EPAP of 12, PS 6.4, max IPAP of 19 or 20.

That should tell us whether there's promise in bilevel, or whether she needs to explore ASV?

[Plmnb]

You guys are so great!

I’m taking in all your advice.

As it happens I have been given a 2pm appointment today at the DME for my mask problems.

Is it ok to show them the information contained herein to assess the lending of the ASV, or would that be a no no because none of what we are doing is from the dr?

BTW, I just spoke to ENT office to find out what her official classification for my tongue is and it’s definitely Class 3.  I also have “naturally narrow nasal passages”.