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New to Bipap, 4 years on Cpap
#21
Hardly know what to think with this chart. Pressure set at 13-8, med. Amara View with liner and chin strap. No epap pressure line at all....I did remove the mask liner during the large leak between 1 a.m. and 1:30 a.m. and the remainder of the night has lower leaks. I’m thinking to try same pressures tonight, med. Amara View mask and no chin strap.
http://imgur.com/a/6P4BV
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#22
There is no EPAP pressure line because PS was set to 0.0, so this was like auto CPAP pressure.  I would say you can add pressure support back in to what makes you comfortable.  Compare the last two images you submitted and the settings are very different.  On 2/8 you averaged 16.5/13.5 pressure, while on 2/10 you average 10.58. So the CPAP pressure was lower than your previous EPAP.  Leaks were worse, and overall AHI a bit lower and dispersed through the night. Unclassified apena appear to be obstructive events occurring during periods of leaks. 

Neither graph suggests a major problem other than controlling leaks.  I think  your pressure was set to high on 2/8, and if you add pressure support back, I would target an EPAP of about 10 cm.  That means EPAP min of 9.0, IPAP max 15.0 over whatever PS between 0.0 and 3.0 you feel best with.  Keep working the leaks.


[Image: ZUG77S0.png]

[Image: On07Ht7.png]
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#23
Sleeprider - Are the recorded events ones that the machine didn’t take care of, or are the recorded events ones the machine did take care of? 

I will adjust settings as you suggested. No liners, no chin straps for now. Followed someone's suggestion to soak parts for 10 minutes, then scrub with a toothbrush, which I also followed.
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#24
Apnea events are simply pauses in breathing for 10 seconds or more, and the machine does not change pressure during those events. For obstructive apnea, the machine will raise pressure after the event. The machine also raises pressure for flow limitations and hypopnea.

I think the minimum pressure of 9 makes sense considering the machine rapidly increases pressure from 8. You reported feeling better with the CPAP, and so minimizing PS achieves a similar feel. I think you're getting closer to comfortable and effective settings, and hopefully the leak issues can be further controlled. Best of luck!
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#25
I saw the sleep doctor yesterday, took him a nice chart of 30 days of 95 % leak rates, percent of large leaks and AHIs. He seemed unable to comprehend what he was looking at. He had the compliance data printed out from the machine and he showed me where the MEDIAN leak rate was 2.1. How much more favorable could Resmed make the data look to them than using the median leak rate?? Especially as the patient sits there saying if I can’t get a seal, I can’t get therapy, the leaks are waking me up.

He pondered things and decides to go with an auto cap setting. I told him this machine had CPAP but not auto CPAP. I showed him it didn’t have auto CPAP. He took the machine and left the room, coming back and saying he was going with a straight CPAP setting of 16, EPR 3, and ramp start at 4.

Here is that data from last night, with those settings: http://imgur.com/a/VYB4w

Before I left his office I asked him about the machine’s TI Min and TI Max settings, and trigger. He didn’t have a clue, said only that they sounded vaguely familiar. So who sets those and based on what? Is there something I could better change them to?

I can see this CPAP thing isn’t going anywhere for tonight. We try not to change too many variables at a time, but I’m reluctant to start the night with the machine on CPAP. I’m inclined to return to VPAP IPAP 20 EPAP 16, PS 3 and give the new F20 a go.

Any and all input appreciated. Thanking you.
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#26
I saw the sleep doctor yesterday, took him a nice chart of 30 days of 95 % leak rates, percent of large leaks and AHIs. He seemed unable to comprehend what he was looking at. He had the compliance data printed out from the machine and he showed me where the MEDIAN leak rate was 2.1. How much more favorable could Resmed make the data look to them than using the median leak rate?? Especially as the patient sits there saying if I can’t get a seal, I can’t get therapy, the leaks are waking me up.

He pondered things and decides to go with an auto cap setting. I told him this machine had CPAP but not auto CPAP. I showed him it didn’t have auto CPAP. He took the machine and left the room, coming back and saying he was going with a straight CPAP setting of 16, EPR 3, and ramp start at 4. 

Here is that data from last night, with those settings: http://imgur.com/a/VYB4w

Before I left his office I asked him about the machine’s TI Min and TI Max settings, and trigger. He didn’t have a clue, said only that they sounded vaguely familiar. So who sets those and based on what? Is there something I could better change them to? 

I can see this CPAP thing isn’t going anywhere for tonight. We try not to change too many variables at a time, but I’m reluctant to start the night with the machine on CPAP. I’m inclined to return to VPAP IPAP 20 EPAP 16, PS 3 and give the new F20 a go.

Any and all input appreciated. Thanking you.
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#27
Doc sounds confused! First, he could have gotten the same results on VPAP-S at EPAP 13 and PS 3.0. If you're going to change to Vauto, then I would set EPAP min at 12 and IPAP max at 20 at PS 3.0. Your settings would start at 19/16, and would only go as high as 20/17.

Quote:I’m inclined to return to VPAP IPAP 20 EPAP 16, PS 3 and give the new F20 a go.

Your leaks are fairly high, and hopefully the F20 will help with that. The clustering of OA also suggests you may be allowing your chin to tip onto your chest which shuts off the airway. If this pattern continues in spite of high pressure, a cervical collar or ergonomic pillow that keeps your chin off your chest might be more effective than more pressure. Hope this helps.
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#28
Thank you Sleeprider. I just adjusted the mask some - those large leaks around 4-4:30 am resulted in bagging the mask for the remainder of the night. 

Then I adjusted the machine settings per your suggestions.
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#29
Hey guys - got the leaks under control and want to tell you how I did it, in hopes of helping someone else. I was washing the mask in Dawn and my face in CeraVe Hydrating wash. It wasn’t helping much with the leaks however.

One night I thought about using my sonic face brush (Clarisonic, altho many others make them for a lot less). I also went with a face scrub (Clinique scrub soap.) Now my face was getting clean, by something other than rubbing the slick CeraVe around. I also added a last minute wipe down of my face and the mask, after reading another reader’s rec for Walmart unscented baby wipes (80 count, white package, blue dots and green letters).

The difference was awesome! The leaks went way down and with them, my AHI. Running around 2 somethings then, went down by half to 1 somethings, now, FINALLY, under 1. I have had some 

In the meantime, I asked the doctor to give me something to reduce 90 some limb movements a hour. He ordered a ferritin test, and I am way low, at 8, and he said the cutoff for RLS is 50. He’s also gone back to get a CBC.

So, now I have an explanation for why the daytime sleepiness has continued, in spite of AHI’s well under 5, why my 1-1.5 mile walks oftentimes leave me exhausted, shortness of breath seemed worse, all sorts of things tie back to iron deficiency. Presently I’m on 2t 220 mg Ferrous Sulfate Elixir liquid. Doc said it does take awhile for it to go up, so he wants another test in six months. Still waiting to get the CBC results. 

That’s my updated story, I’m very optimistic and hope this may help another newbie. I think the face scrubbing was key to getting the leaks under control.
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#30
Hello everyone, hope you are well. Last week we spent four nights in a Gatlinburg TN hotel and had really low AHI readings all four nights (2nd screen shot attached).

Figured it must be the bed pillow, so I swapped my 14 y/o contoured memory foam pillow but right back to AHIs under 2. I have been wearing the soft cervical collar for about 3 weeks now and I had it on in TN.

Then I thought it might be the lower altitude, about 2000 feet lower than home. Ruled that out because I have had lower AHIs at home, just not four straight nights. (1st screen shot attached)

Some leaks but nothing like I had earlier. 

Are there tweaks I could make in pressures? I’ve been on the PS 2.6 and 16.2-20 for some time and the pressures almost always run right at, or just below those settings. Amara View mask. 

I do think the ferritin levels must be climbing since I think I’m moving around less and some, if not all of the afternoon sleepiness is abating.

Would someone please provide me with the amounts of soda and water for boiling my mask? I think scrubbing it every night is resulting in premature failure. 

As always, thank you.
Fabby 


http://imgur.com/a/KnP2N
http://imgur.com/a/V4iAO
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