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New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
#11
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
(02-11-2021, 05:40 PM)Sleeprider Wrote: 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.
Thanks for your response. I get what you mean on PS, I guess what I'm asking is whether its higher PS or simply higher IPAP which is better for treating FLs? If I increased IPAP to 11 and EPAP to 8 (fixed) then I'd still get the benefit of higher pressure without risking treatment emergment centrals at PS 4.

So what I'm basically asking is would Epap 8 and Ipap 11 be that much worse than epap 7 and ipap 11? Given that epap 8 isn't that high anyway.

Interesting stuff on the rise min. I'll test it out!
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#12
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
So another day with BiPAP, and it felt like more of the same. I had raised my EPAP to 8 and my IPAP up to 11, and also set Rise Time to 300 (600 felt too much and weird when trying it out). The rise time definitely made it more comfortable, but I still ended up waking up after 3 hours of falling asleep. I then proceeded to wake up to switch sides throughout the night.

I noticed that my nose felt blocked during the night, which it isn't during the day. Once I woke up and had the mask on, my right nostril felt blocked, but as soon as I took the mask off, the nostril cleared up within a matter of minutes. Is it possible the humidifier was causing the nasal congestion? I have it set to 5 out of 6. 

I've ordered P30i Nasal Pillows and a heated hose (compatible with the s9), so I hope that will help. My nose does respond well to warmth (e.g. in warm shower or warm bath).

Anyway, here's two screen caps with my summary (both screen caps = 1 night, totalling 9 ish hours of sleep). I'll post a follow up reply to show my breathing. Most of my breathing was flow limited, especially some points I had a blocked nose and the breathing went crazy. There was one point where my breathing sort of looked okay-ish too.


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#13
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
Now I scanned through my breathing for the entire night, and a lot of FLs. There was ONE point it looked okay-ish, but mostly all Flow Limited breathing. Still woke up loads to change sides etc.


Screen-cap 1 is where it gets a bit crazy, it occasionally went like that too.

Screen-cap 2 is what my breathing mostly looked like throughout the whole night (and how it looked like when I woke up to see 3 hours after falling sleep around 8amish)


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#14
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
First screen-cap looks bad, basically in my last 2 hours of sleep, my breathing looked like that. Very long FLs?

Second screen-cap is where my breathing began to look semi-normal for a little...


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#15
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
The UA is gone, and you have some hypopnea remaining. I don't know if the flow limit is worthy of concern, but if you want to get after it, then EPAP 8.0, IPAP 12.0 (PS 4). Keep the 300 rise time.
Sleeprider
Apnea Board Moderator
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#16
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
(02-12-2021, 12:51 PM)Sleeprider Wrote: The UA is gone, and you have some hypopnea remaining. I don't know if the flow limit is worthy of concern, but if you want to get after it, then EPAP 8.0, IPAP 12.0 (PS 4). Keep the 300 rise time.

I think the Flow Limits are the main issue here. Nearly all of my breathing is Flow Limited, and I'm convinced that's what is causing me to wake up all the time (is the main issue of my UARS too). 

I think I have to keep raising the IPAP until it goes. Would jumping from PS 3 up to 4 cause centrals? I think I may end up at IPAP 15 or 16 or even beyond at this rate to squash the FLs.
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#17
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
I don't see any indication of centrals. We will take it up in 1-cm increments and back-off in 0.4 cm increments if needed. Don't be in a too much of a rush, and keep track of how you feel, preferably in a journal.
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.
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#18
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
(02-12-2021, 01:12 PM)Sleeprider Wrote: I don't see any indication of centrals. We will take it up in 1-cm increments and back-off in 0.4 cm increments if needed.  Don't be in a too much of a rush, and keep track of how you feel, preferably in a journal.

Alright, so next time I sleep, I'll put it up by 1cm. I think tonight I might not sleep with PAP, I find that sometimes having a break helps with compliance.

Also, do you think nasal pillows are likely to help? And a heated hose? Thanks.
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#19
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
I myself would disagree with on/off PAP therapy plan you are considering. You really only benefit if you use the PAP every night. I also cannot see how taking nights off therapy helps compliance.
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.
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#20
RE: New BiPAP user! (UARS). Need serious help please! Data included, much appreciated
(02-12-2021, 01:43 PM)SarcasticDave94 Wrote: I myself would disagree with on/off PAP therapy plan you are considering. You really only benefit if you use the PAP every night. I also cannot see how taking nights off therapy helps compliance.

Currently I get about 9-9.5 hours with PAP, but to feel somewhat okay and have less tired eyes, I need 10.5, and haven't been able to get this yet on PAP. Usually I side sleep and I've found that side sleeping with the full face mask is uncomfortable. I'm waiting for the nasal pillows and heated hose to arrive, hopefully that would help a lot with side sleeping and nasal congestion.
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