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[Pressure] Changing Max Pressure and starting a BiPAP trial
#11
RE: Changing Max Pressure and starting a BiPAP trial
I have not generally seen good results from the CVS collars. They are convenient, but tend to be soft and ineffective for our purposes. I don't have a favorite to suggest as the process seems to be mostly trial and error, but the Coreflex has some good reviews and has demonstrated good results.
Sleeprider
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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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#12
RE: Changing Max Pressure and starting a BiPAP trial
Tonight I start a 2-week BiPAP trial. The script called for the following settings:
  • Auto BiPAP 
  • max IPAP 15
  • min EPAP 5
  • PS 5 cmH2O
The DME specialist looked at my last 2 weeks of AutoCPAP data and saw my 95th percentile of pressure was at 14.7 cm so thought the max IPAP of 15 cm could be okay. I'm not going to mess with the settings for 2 weeks then look at the data with the DME specialist and see what he would recommend, then possibly get another 2 week trial with revised settings.

My last night on Auto CPAP had an unusually low AHI score, charts attached. I did not wear the CVS collar last night, waiting for the good Coreflex model, but as I went to sleep, I had in mind that I should keep my chin up. Maybe that thought affected my position while I slept. I don't know. My AHI average for the last 9 days was 7.2 and the Central Apnea or Clear Airway (CA) average score was 2.2 so if I could sleep like I did last night every night, that would be great!

I was told one of the benefits of BiPAP is that it can treat CA events, while Auto CPAP can't. I will post my first night of BiPAP tomorrow, and we will see what the data show. After I can average a week or two, I will post some statistics.


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#13
RE: Changing Max Pressure and starting a BiPAP trial
This has cut your AHI in half and looks very promising. You have 5-episodes of positional apnea as we have discussed, so don't abandon the collar just yet. It would help if you changed your Y-axis on the insp. time to 0 to 5 seconds. During positional apnea events you are not cycling out of your strong inspiration efforts to get a full breath, so I also want you to change the TiMax setting to 3.0.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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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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#14
RE: Changing Max Pressure and starting a BiPAP trial
I'll be back with the collar when the good one shows up.

The charts in my last post were from the Auto CPAP, not the BiPAP. I have no idea why the AHI went down so much compared with the same machine and same settings for the last couple of weeks.

Tonight I start with the BiPAP and I see that the machine is already configured with a TiMax setting of 3.  My post tomorrow will show the charts from the BiPAP.  Thanks for your interest Sleeprider.
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#15
RE: Changing Max Pressure and starting a BiPAP trial
First Night of BiPAP

Was not happy to wake up and see AHI of 22.4

Looking at the pressure plot, it is obvious that the Max IPAP of 15 cm is too low for me.
I was quite happy on the Auto CPAP with a max pressure of 20 cm because it never needed to go that high.
Open to suggestions on settings for my second night of BiPAP.

I noticed that the mouth tape had a small leak when I woke up and that is shown in the data in the last 15 minutes.

   


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#16
RE: Changing Max Pressure and starting a BiPAP trial
That shows a very strong positional element.
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#17
RE: Changing Max Pressure and starting a BiPAP trial
Thanks for that observation Gideon. I will make a second attempt with the Soft Cervical Collar from CVS (3M Futuro) that had no significant improvement on the first attempt, but this time I will not leave it as loose as I did the first time. Still waiting for delivery of a mail-order Coreflex in my size.
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#18
RE: Changing Max Pressure and starting a BiPAP trial
Second night of BiPAP

Changes from first night: used CVS Soft Cervical Collar, increased IPAP to 18 cm (was 15), set Mask Type to Pillow (was Full Face).

BiPAP Results: AHI = 19.57 (was 22.40 first night), Central = 6.3
Not a dramatic improvement over the first night on BiPAP, but I felt better this morning than I did waking up yesterday.

AutoCPAP History:  AHI = 7.2 (Max Pressure 16 cm), Central = 2.2 (numbers are a 9 day average)
I'm testing the BiPAP looking for an improvement over my AutoCPAP device.

This was only the second time I used a CVS Soft Cervical Collar. The first collar use was on AutoCPAP but I wore the collar very loosely. Last night I snugged the collar up a bit, still leaving space for a couple of fingers to fit in. I noticed the collar is not symmetric so I put it on the right way up!  Waiting on a mail-order Coreflex in my size. I sleep on a single feather pillow that is less than 2 inches thick.

First two OA

   

First cluster of OA ended with me waking up to relieve build-up of air in stomach.

   

Second cluster of OA

   

BiPAP Therapy settings 
Mode: VAuto
Max IPAP: 18.0
Min EPAP: 5.0
PS: 5.0
Ti Max: 2.0s
Ti Min: 0.3s
Trigger: Med
Cycle: Med
Mask: Pillows

While awake, during a long slow inhale, I notice the pressure support drop after 2 seconds. Sleeprider suggested a Ti Max setting of 3.0s which I will set for the third night.  I will be grateful for any suggestions and glad to provide additional data.
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#19
RE: Changing Max Pressure and starting a BiPAP trial
Don't be frustrated and let's hope for better results from the Corflex. In bilevel positive air pressure therapy, OA events are addressed first by raising EPAP. You clearly need to move your EPAP min up higher.  Mine, as shown in the profile at left starts at 9.0. You can use less pressure support to perhaps relieve aerophagia because in your case the priority is OA.  We may not be able to pressure through the positional apnea, but your odds are a lot better with higher minimum EPAP.  Use what you can tolerate.  The image below is the titration protocol for your machine in S-mode. In vauto mode the machine makes these adjustments automatically, but you have to optimize. For obstructive apnea "increase EPAP" in Vauto means to increase the minimum. For hypopnea the protocol calls for raising IPAP, or in the case of the Vauto PS.  You only have OA, so we are not concerned with raising PS at this time.

[Image: attachment.php?aid=4118]
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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#20
RE: Changing Max Pressure and starting a BiPAP trial
Thanks for this advice Sleeprider!

After I posted my previous reply this morning, I decided to have a nap and switch out the BiPAP for the CPAP. The nap lasted 1.5 hours and there were four OA events, plotted below.

CPAP Results - ResMed AirSense 10 Results: AHI = 4.7, Central = 2.0  

   

From this pressure graph, the OA seems to be treated with a pressure of 13 cm, since there were no more OA's after that level was reached. This is consistent with a 9 day average on CPAP where the 95th percentile of pressure was 13.3 cm.  Translating that into BiPAP terminology, that would be the EPAP level on the ResMed AirCurve 10 VAUTO.

Following the protocol, if EPAP 13, and PS 4, my inhale pressure would start at 17 cm. I may be able to tolerate that because the last 4 days before the BiPAP trial started, I used the CPAP with a Max Pressure of 20. There were nights on CPAP when the pressure went above 17 for a short time, but almost never went above 18 cm.

If I leave the IPAP at 18 cm, that only leaves a 1 cm increment for the Autoset algorithm to use, but I suppose if there are no OAs then there is no need to increase.

On the other hand, I had a good sleep on March 9 on CPAP, and the Autoset algorithm did not need to go above 15 cm. See chart below. Based on that unusually good sleep, I would set EPAP 11, PS 4 and IPAP 18 so my inhale pressure would start at 15 cm but there would be 3 cm of range for the Autoset algorithm to use.  Thoughts?

CPAP Results - best night's sleep in last week

   
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