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New BIPAP - Higher CA's than when on APAP
#1
New BIPAP - Higher CA's than when on APAP
Hi all.

So I finally got my new AIrCurve 10 Vauto and after the first night, I see quite a few CA incidents. Always had some while on the APAP but none to this magnitude. Basically just wondering what I can do to reduce them. Including screen shots of last night on APAP, which was a typical night and also including first night on BIPAP. 
Now I did not have a problem with the pressures, they were comfortable.  
My mask did seem to leak more than it did on APAP.
I did roll around alot the last few nights as I hurt my shoulder in the gym and it is a bit tender to move or sleep on.
I also seemed to have have swallowed a bunch of air.
I do use a cervical collar, body pillow, and tape.


Thanks


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#2
RE: New BIPAP - Higher CA's than when on APAP
You changed from a Respironics machine to a Remed. They have different algorithms. The general advice id to stay with the same brand machine to avoid adjusting to the machine differences. 
Hang in there you have an excellent machine and you will adjust to it shortly, sort of like starting over.
The VAUTO is running about 0.78 cm/h2o higher than the Respironics. Your tidal volume is also greater on the VAUTO. Your insp. and exp. times are different. You will adapt. Post some more charts after a few days. The PS can also affect you.
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#3
RE: New BIPAP - Higher CA's than when on APAP
(05-19-2018, 06:25 AM)Kosoku Wrote: Hi all.

So I finally got my new AIrCurve 10 Vauto and after the first night, I see quite a few CA incidents. Always had some while on the APAP but none to this magnitude. Basically just wondering what I can do to reduce them. Including screen shots of last night on APAP, which was a typical night and also including first night on BIPAP. 
Now I did not have a problem with the pressures, they were comfortable.  
My mask did seem to leak more than it did on APAP.
I did roll around alot the last few nights as I hurt my shoulder in the gym and it is a bit tender to move or sleep on.
I also seemed to have have swallowed a bunch of air.
I do use a cervical collar, body pillow, and tape.


Thanks

You are now using a PS=3.  What were you using for FLEX?
It is very common to have CA events due to sleep disturbances (it sounds like you had plenty of disturbances).  Those CA events are false since you are not truly asleep.
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#4
RE: New BIPAP - Higher CA's than when on APAP
Congrats on the Resmed Vauto. It is one of the best and most flexible machines going. The CA may decline in time, but for the moment you may have better results with a lower PS setting. Your respiratory statistics are considerably better on the new machine, snore and flow limitation are essentially gone. Give it time to settle down.
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#5
RE: New BIPAP - Higher CA's than when on APAP
Thanks for the advice everyone.

I did have flex at 2 on the CPAP. Pressure's don't seem to bother me and I tend to tolerate them quite well. Think I should reduce PS from 3 to 1? I found this machine is way way easier to breath out with compared to the CPAP which made me feel like I had to force it and the higher intake pressure seems easier to handle than the CPAP as well. Breathing felt more natural overall. 
What about the ti min/max which are at 2/.3 respectively. 
Also trigger and cycle are both on medium. Any changes warranted there or am I reacting to soon and trying to over complicate things.
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#6
RE: New BIPAP - Higher CA's than when on APAP
For now I would leave TiMin and TiMax at default as well as trigger and cycle sensitivity. The clinical manual does a good job of describing what those functions do, and if you need more or less inspiration time you can adjust TiMax. PS to 1 or 2 cm will relieve the CA, and it's possible you can add some back later. This is not an uncommon reaction to someone starting bilevel for the first time, and I suspect the CA duration are minimal (10-15 seconds). You are more ventilated than you were previously and it just takes time to adjust.
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#7
RE: New BIPAP - Higher CA's than when on APAP
2nd night with the new bipap. I set PS to 1 from 3. Lowest OA and H scores I have ever seen. Snores, flow limitation, OA and H seem well under control now. Most graphs seem to be more consistent. Not as many CA's as the night before, but hopefully they will go away over time. I know some are false as I do tend to wake a lot still during the night and roll back and forth until I get back to sleep. Always have. Hoping the bipap will eventually give me the ability to sleep fully through the night, and not keep waking 10+ times. Plus we had one interruption where the power went out briefly.


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#8
RE: New BIPAP - Higher CA's than when on APAP
Your OSA is well controlled. The only question I have is why your minimum epap is set to 14. You may have it set higher than needed. Have you tried 12, 10, ...???
The CA could be due to discomfort caused by your injury, gas pain, .... or they could be real. I suggest getting your OSA properly treated and give it time before trying to address the CA.
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#9
RE: New BIPAP - Higher CA's than when on APAP
I agree with Ted. You should start reverse titrating to lower pressure. I would start with EPAP min at 12, and if OA does not emerge, continue lowering EPAP pressure by 1-cm until you see more obstructive events.
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#10
RE: New BIPAP - Higher CA's than when on APAP
(05-20-2018, 07:07 AM)tedvpap Wrote: Your OSA is well controlled.  The only question I have is why your minimum epap is set to 14.  You may have it set higher than needed.  Have you tried 12, 10, ...???
The CA could be due to discomfort caused by your injury, gas pain, ....  or they could be real.  I suggest getting your OSA properly treated and give it time before trying to address the CA.

Minimum epap was set to 14 by the DME. I believe she set it at this pressure to reduce snores. This is only my 2nd night on Bipap so no, I have not had a chance to lower the EPAP pressure yet. I will start the reverse titrating as per sleeprider and see how I fair.

Thanks guys.
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