Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
#1
New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
Okay - so I'm diagnosed with UARS and bordering on mild sleep apnea. I tried APAP for 1 week (Phillips Dreamstation) and saw SOME benefit, e.g. deeper dreams. But my main symptom (waking up to pee several times, waking up to change position; when i change from side to side, I wake up and have to adjust my position) still persisted. I was mentally sharper but still the wake ups were too much, and my flow limitations kept persisting no matter what pressure (couldn't breathe against higher pressures either)

So I just ordered myself a Resmed s9 BiPAP ST w/ humifidier. Set it to S mode, and set the IPAP at 10 and EPAP at 7 (pressure support at 3). Slept roughly around 9.5 hours with it (usually sleep 9-10.5 hours). Went/fell asleep around 5.30am and woke up around 2.45pm. Felt more energetic in that I could spring out of bed and feel mentally sharper, but my eyes still feel tired/heavy (I know its 100% due to sleep, because when I previously used to wake up and get tired eyes, I'd go back to bed and they would feel fine. But since my UARS got worse, I haven't felt non-tired eyes for a while).

Now for the first FOUR hours, I did not wake up once. This is VERY unususal for me, as I usually wake up every hour. However for the 5.5 hours which followed, I woke up a lot more to change position. Throughout the whole 9.5 hours, I probably woke up twice to actually pee (bedside bottle) and then several times to change side to side. Maybe I was hitting more REM in the second stage, idk. My nose was a bit blocked too. Currently wearing a full face mask and waiting for my p30i mask and heated hose to arrive (heated hose should clear my nose more as warm baths usually do)

I've attached my data below. For some reason OSCAR split my sleep into 2 days (10th and 11th of feb) but its NOT, its one sleep session from 5:30am throughout 2:30ish pm. 

I scanned throughout the entire nights worth of data in zoom mode and found that I had FLs ALL night. Ofc the machine didn't log them, but these two screenshots show how I was breathing. The first FL screencap around 6:20am is how I breathed from 5:30am to 12:00pm, then the second screencap of the longer FLs around 12pm is how I breathed from 12pm to end of sleep (lots of tossing and turning during this period)

So I know the BiPAP is providing benefits, but I think I really need advice. Clearly the FLs are still there. How do I get rid of them? Is my IPAP too low? EPAP needs to be higher? I guess I could breathe against EPAP 8 or 9. Much appreciated!

And as for the Flow Limited breathing screen caps, I'll include them in my second reply on this thread.


Attached Files Thumbnail(s)
       
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
Okay, so here's some examples of what my breathing looked like the whole night.

First screencap from 6am, breathing looked like this until 12pm:

Second screencap from 12pm, looked like this until 2:30pm when I woke up. Around this time I was changing sides a lot and drifting in and out of dreams.

As for the leaks in the OP, its because when I woke to pee I also took my mask off to drink some water (have water bottle next to bedside).


Attached Files Thumbnail(s)
       
Post Reply Post Reply
#3
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
On the full night charts please minimize the monthly calendar. All of the statistics and settings are missing and we get to see the calendar instead. My impression is there is considerable flow limitation. You could reduce EPAP to 6 and leave IPAP at 10 for PS 4 or just raise IPAP by 1.
Sleeprider
Apnea Board Moderator
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.
Post Reply Post Reply
#4
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
(02-11-2021, 01:13 PM)Sleeprider Wrote: On the full night charts please minimize the monthly calendar.  All of the statistics and settings are missing and we get to see the calendar instead.  My impression is there is considerable flow limitation. You could reduce EPAP to 6  and leave IPAP at 10 for PS 4 or just raise IPAP by 1.

Ok I have attached the screen-caps below. I will also edit them to the OP without the calendar.

Yes my goal is to reduce FLs. Is raising the IPAP by 1 likely to do this?


Attached Files Thumbnail(s)
       
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
(02-11-2021, 01:13 PM)Sleeprider Wrote: On the full night charts please minimize the monthly calendar.  All of the statistics and settings are missing and we get to see the calendar instead.  My impression is there is considerable flow limitation. You could reduce EPAP to 6  and leave IPAP at 10 for PS 4 or just raise IPAP by 1.

Also I changed the Y axis to -50 and 50. This is how the wave form changes from the 2 FL pics I showed you. First screencap at 6.30am and second at 12pm ish.


Attached Files Thumbnail(s)
       
Post Reply Post Reply
#6
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
My take is we'd have to try the setting edit to see how events and such respond. PAP adjustments are very much trial and error.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#7
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
(02-11-2021, 01:37 PM)SarcasticDave94 Wrote: My take is we'd have to try the setting edit to see how events and such respond. PAP adjustments are very much trial and error.

Mmmmh, I actually found the settings very comfortable. I had used the bipap the night before (w/o sd card) only slept 5 hours and it felt like the pap was cutting off my inhalation. So i changed the settings and felt very comfy with it, but if changing could help then I'm open to that. 

My settings are:

IPAP - 10
EPAP - 7
Trigger - very high
Cycle - very low
Ti min - 0.3
Ti max - 3.8
Rise - min
Ramp - off

As for why Ti Max is so high, its because when I fall asleep i do very slow meditating deep breaths to help relax me and fall asleep.
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
Nice improvement on the posted charts, we can now see the time of inspiration is between 1.4 and 2.5, tidal volume 400 mL and minute vent 6.38 at 15.8 BPM. On zoomed charts, there is no need to be closer than a 2-3 minute segment. This is actually just a bit tight and exaggerates the flow limit.

I keep my TiMax at 3.0 and that would probably meet your needs as well. We are not using that inspiratory time control for any purpose other than to stay out of the way. We sometimes shorten TiMax for people with COPD to cause them to cycle to exhale and give more time for expiration to complete. This is mainly for people with a lot of dead space in the lung and hyperinflation. None of that is a concern here, so that is probably TMI.

For Flow limitation we increase pressure support, and on a fixed VPAP that means increasing the IPAP pressure. You are at 10/7.0 pressure, PS 3, and we are suggesting 11.0/7.0. I believe the minimum rise time is 0.3 seconds, and the usual reason to increase that is if you feel the transition from EPAP to IPAP is too abrupt or disruptive. Getting far into the weeds on rise time, a longer rise time has been shown to result in higher peak inspiratory flow, and shorter inspiration time. (see Tables 2 and 4 and Figures 1 and 2 http://rc.rcjournal.com/content/58/3/465 ) and these are objectives in treating inspiratory flow limitation. So a longer rise time may be worth trying in the range of 0.5 and 0.8 seconds. Although that study is with a servo-ventilator, the principles apply here as well.
Sleeprider
Apnea Board Moderator
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.
Post Reply Post Reply
#9
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
(02-11-2021, 04:37 PM)Sleeprider Wrote: Nice improvement on the posted charts, we can now see the time of inspiration is between 1.4 and 2.5, tidal volume 400 mL and minute vent 6.38 at 15.8 BPM.  On zoomed charts, there is no need to be closer than a 2-3 minute segment.  This is actually just a bit tight and exaggerates the flow limit.  

I keep my TiMax at 3.0 and that would probably meet your needs as well. We are not using that inspiratory time control for any purpose other than to stay out of the way.  We sometimes shorten TiMax for people with COPD to cause them to cycle to exhale and give more time for expiration to complete. This is mainly for people with a lot of dead space in the lung and hyperinflation.  None of that is a concern here, so that is probably TMI.

For Flow limitation we increase pressure support, and on a fixed VPAP that means increasing the IPAP pressure. You are at 10/7.0 pressure, PS 3, and we are suggesting 11.0/7.0.  I believe the minimum rise time is 0.3 seconds, and the usual reason to increase that is if you feel the transition from EPAP to IPAP is too abrupt or disruptive.  Getting far into the weeds on rise time, a longer rise time has been shown to result in higher peak inspiratory flow, and shorter inspiration time. (see Tables 2 and 4 and Figures 1 and 2 http://rc.rcjournal.com/content/58/3/465 ) and these are objectives in treating inspiratory flow limitation.  So a longer rise time may be worth trying in the range of 0.5 and 0.8 seconds.  Although that study is with a servo-ventilator, the principles apply here as well.

Thank you for your response. So you think I should decrease my TI Max to 3? I had found 3.8 comfy, but if you think if will help then I will happily do this. Yeah I'm 23 and have no known lung issues so COPD not a factor as you said.

So with the Flow Limitations ~ is it the actual Pressure Support or increased IPAP that will help? My understanding had been that it was the increased IPAP. If that's the case, can't I just increase the EPAP from 7 up to 8 and also the IPAP from 10 to 11? This way the PS would remain at 3. This is assuming I can tolerate EPAP 8 (which I think I can).

Thanks for rise time. Didn't know that. So if between 0.5 and 0.8, then 0.6 could be good?
Post Reply Post Reply
#10
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
I don't think you need more than 3.0 for TiMax. It doesn't make much therapeutic difference JMHO.

Pressure support is the same as increased IPAP. Assuming EPAP is constant at 8.0 with this fixed bilevel pressure device, more pressure support is achieved by increasing IPAP. PS is the difference of IPAP minus EPAP. So at IPAP 10, EPAP 7, PS =3. With IPAP 11, EPAP 7, PS is 4.

In all honesty, I have not used rise time in a therapeutic application for flow limitation. I am very interested to see if a rise time of 0.6 works better for you. If you find it is not as comfortable after a trial, then reduce it to a better timing. In this case, I'm relying on some promising research as the basis for my suggestion. I have no experience with actually putting this into practice, however I have had a number of individuals using rise-time that preferred a longer rise time for comfort. I was previously unaware of the potential for better peak flow and shorter inspiration time, but it makes a lot of sense.
Sleeprider
Apnea Board Moderator
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.
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Symptoms returning after 21 months of APAP use - OSCAR data included victoriabk 16 295 Yesterday, 01:08 PM
Last Post: Crimson Nape
  First Post - 60 days using CPAP - AHI still 10+ Oscar Data included fikus56 18 290 04-08-2021, 09:42 AM
Last Post: fikus56
Arrow AHI < 1.0 now, but still tired? Is it UARS, RERA, arousals or FL in your FR peaks? 2SleepBetta 24 1,506 04-08-2021, 03:11 AM
Last Post: 2SleepBetta
  New User joej85 5 152 04-06-2021, 01:28 PM
Last Post: joej85
  New to CPAP lost with the data. Any help appreciated LBTRS 20 563 04-05-2021, 08:13 PM
Last Post: SarcasticDave94
  Bipap Titration for Preliminary UARS Diagnosis marasmus 5 278 04-05-2021, 07:43 AM
Last Post: marasmus
  Advice appreciated martyedb 55 1,933 04-01-2021, 07:11 PM
Last Post: martyedb


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.