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On Bipap trial, unsure where to go from here
#1
On Bipap trial, unsure where to go from here
Hi all,

I was diagnosed with mild OSA after a sleep study last spring (AHI 6.6, RDI 19) and used a Airsense 10 Autoset machine for two months. I then tried an oral appliance for few months, but unfortunately had a problem, and went back to CPAP in October. This time, things went better, though I was still waking up at night and having a hard time staying asleep in the early morning.

I had a follow up sleep study in the fall, which indicated UARS. My doctor suggested I try a Bipap or ASV. I've been on a home trial, which hasn't gone particularly well. I don't think the techs I'm working with understand the more advanced machines, and they see my AHI and assume everything is going great. I am still waking up at night and am having difficulty consistently feeling good after a night of therapy. When I was using the APAP, I could consistently get my AHI below 1, and felt best when it was around .5 or lower, though my results were variable. 

My leaks have gone way up recently, and I'm not sure why. I think I may have either a mask fit issue or some mouth breathing or both. I've recently tried mouth tape, which seems to help some.

 I'm 39 years old, physically active, normal BMI, don't smoke or drink. I do have some problems with congestion and allergies and am working with an ENT. I had a turbinate reduction in one nostril in December, and am getting some allergy tests done and considering a septoplasty. 

In the near-term, I need to decide whether to continue with the Bipap or go back to the Airsense 10 Autoset.


Thanks for you help. This is my first time posting, though I've gotten a lot out of using the software and reading the info here. 

-Alex


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#2
RE: On Bipap trial, unsure where to go from here
Hi AlexB!  -  Welcome

First, Please use the F12 key to take your screenshots.  This will collapse the calendar and better provide a display of your statistical data.

Now, your treatment...  You have your VAuto set up like a CPAP.  That's akin to having a Ferrari and just using it to go get groceries.   In order to address an UARS condition, you will need to have your IPAP higher than your EPAP.  This provides added pressure to overcome your flow limitations during an inhale phase.  Setting your EPAP to 5.0, your maximum IPAP to 14, and a PS to 4, should help with your results.  This will give you a pressure range of EPAP: 5 to 10 and an IPAP range of 9 to 14.   See if this reduces your Flow Limitations.  When you post these results, please provide the normal Daily screenshot and a 2 to 4 minute zoomed image, so we can see your flow rate close up.  While you are adjusting your settings, make sure to have "Easy-Breathe" turned on and, due to problems with this feature, have "Smart-Start" turned off.

(Side note: The large leaks don't help. See if you can work on them.)

- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
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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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#3
RE: On Bipap trial, unsure where to go from here
Welcome to the board. With the settings your are using you are not using the bipap. You have ps 0??

The reason you use a bipap is to use the ps.

I would suggest these settings

Min 4
Ps 4
Max 15

Try this for 1 night and post tomorrow. Get rid of the circle graph and calendar in the left column. You only need to put the graphs I have linked in my signature.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: On Bipap trial, unsure where to go from here
Thank you! I've updated my settings and will try tonight. I turned off Smart-Start though don't see the setting to make sure Easy-Breathe is on.

I thought it was weird that PS was set to zero. I initially tried an ASV, which I had difficulty tolerating, as I felt like it was trying to speed up my breathing. Not sure if that has anything to do with having PS at zero...
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#5
RE: On Bipap trial, unsure where to go from here
ASV is a special pap machine to treat centrals. You don’t have hardly any centrals - it is the wrong machine for you.  The VAUTO is the normal bipap machine that I also use. It is a great machine.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#6
RE: On Bipap trial, unsure where to go from here
Thanks Red and staceyburke for your suggestions!

I tried the new settings last night. I had a hard time sleeping, and after a couple of hours woke up. I felt like the pressure was high at the end of my inhale and I was swallowing air. I also think I may have had C02 build up--in the morning I had shortness of breath, mild sense of panic, etc

On the bright side, I think I figured out my mask leaks (in the middle of the night when my usage is especially fragmented). 

Any thoughts on where to go from here?

Thanks in advance for your help!


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#7
RE: On Bipap trial, unsure where to go from here
I don’t know why this setting did not feel better. Take a look at your flow limit charts from the 2 days. The first night (ps0) had a large amount of flow limits. Last night you had NO flow limits.

Flow limits ARE apnea but are not scored in AHI. Flow limits disrupt sleep and stop you from getting into deep sleep. So from what I see your night SHOULD have been better
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#8
RE: On Bipap trial, unsure where to go from here
Thanks for the quick reply. I definitely noticed a difference with not fighting against congestion as much. I wonder if the issue I'm having is related to the TiControl settings. With the ASV, the tech doubted that and said that's usually an issue for people with COPD, etc...

I'm having difficulty accessing my data at the moment, but one thought I had was to compare my nighttime respiratory rate against the table in the Resmed clinical manual
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#9
RE: On Bipap trial, unsure where to go from here
FWIW, my Fitbit has by nightly breathes per minute at 16 or 17. The settings on loaner machine are Ti Max 2.6; TiMin .6

That seems at odds with the parameters in the attached table...


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#10
RE: On Bipap trial, unsure where to go from here
The table is applicable for treatment of COPD patients that require more expiration time preserved by settings. The shorter Ti Max ensures the machine will encourage cycling to expiration to allow sufficient time for complete expiration. In healthy individuals, this cycling can be disruptive to sleep when the machine pressure cycles to EPAP while they are still inhaling. There is a natural variation of inspiration and expiration time, and your median I:E times are 1.6:2.6, but your 95% inspiration time is over 2.48 seconds. Your current settings allow for that natural variation without hitting the machine cycle. If you were unable to expire the air in your lungs due to emphysema or asthema, you might experience "air stacking". This is a condition where the lungs remain full of air and effective inspiration is not possible. You do not have this problem, so we set TiMax to accommodate at least your 95% expiration time.
Sleeprider
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