Shnorky's therapy thread / BiPAP Settings

[Sleeprider]

This looks so much better than what we saw without the collar, and the higher pressure support is helping too. On future graphs, I'd like to replace pressure with Mask Pressure to be sure you are getting the full benefit of pressure support. If this higher pressure support is comfortable to you, it might be something to consider increasing later to see if it gives further relief to the remaining flow limits.

[Shnorky]

Sure - for some reason the pressure feels much more comfortable on this machine than on the dreamstation (like 13cm on the dreamstation will slightly puff my cheeks out). Not sure what is most helpful to check regarding the mask pressure, added a few graphs.

[Sleeprider]

As you can see from the mask pressure, the pressure support follows your respiration, and does not supplement shallow breaths. I would rather that the pressure support would be delivered consistently because it seems to come up short exactly when you need it most. I'm going to go out on a limb and make a suggestion that might help some of those shortened or incomplete breaths. Try taking your Ti-Min to 0.5. This will help sustain PS just long enough to prevent those incomplete breaths. In the near future, I'd like to try a lower EPAP min (13.0) and higher PS (4.4).

[Shnorky]

Thank you!
Last night I tried first a higher min epap (15 cm H2O), could not breathe out against it very well while awake... Then after that I tried the settings you suggested, seems like I got 12cm H2O with PS 5 (wasn't really sure about the numbers in the dark without my glasses). That seems not to have worked too well, but at least the event clusters got the machine to react :-) woke up with a headache, tried to up the pressure again a bit while keeping the PS. OSCAR is showing an AHI of 2.22 for that part of the night. (All of this with Ti-Min 0.5).
In general the flow rate seems to be a bit more regular than the previous nights, and less "square-y" than with the philips dreamstation.
Out of curiosity, is there a reason why a PS of exactly 4.4? (Trying to understand if my stupid brain who likes round numbered settings did something very wrong...)

[Sleeprider]

I would have preferred to stay with the previous night settings, changing only the Ti-min. I tried to be clear there are some things I want to try, but I would introduce those one at a time. I'm sure that was confusing, but I often include this kind of roadmap as a note to myself. This chart makes the clusters of obstruction much more clear. This shows positional apnea or chin-tucking as we have discussed. The use of smaller increments of PS is to attempt to find a more optimal level of pressure support. As we get above 4 cm PS, it is helpful to make adjustment in smaller increments. I think the settings I was after are as follows:
Mode Autoset Standard
EPAP min 13.0
PS 4.4
Max IPAP 20,0
Ti Min 0.5
Ti Max 2.5
Trigger and Cycle medium

[Shnorky]

Thank you for your patience, and again for your explanation, and taking the time and sharing your experience with me.
And sorry to have rushed changing the settings. From having experienced it a few times I knew that I have only a few days using the Resmed Aircurve 10 VAuto to try and make it work before I am too broken to function. Still not sure why. One weird hypothesis my foggy brain could come up with is that with the Dreamstation auto I get events, which wake me up, so I wake up tired, but the oxygen levels look to be higher, with smaller dips, whereas on the resmed the oxygen levels look (to me, as an inexperienced newbie) to be lower, with dips going lower and lasting longer, but fewer events, so I sleep "better" but my brain kind of shuts down.
Will try your recommended settings as soon as possible.

[quiescence at last]

for your information, on Dec 8 at 02:51:00 to 02:56:00, you appear to have much quicker and smaller breaths. And, from my extensive interest, time spent on the subject, but still humbly submitted, you are in REM sleep at that point, quite probably dreaming.

QAL

[Shnorky]

Hi everyone!
Learning and trying new options, it seems like pressure support/flex is killing my sleep. Trying without any support and of course the centrals are coming back. And looking back it seems like the dreamstation was misinterpreting the centrals as obstructive, is that common?
If I were to set it on straight CPAP (doctor mentioned I might be very sensitive to pressure changes), what pressure do you then set it to? Median? 95%? 99.5%?

[Sleeprider]

CPAP therapy is generally set at the 90th percentile pressure for obstructive events. It can be fine-tuned from there. As you know, the Philips can be a bit slow to respond to events, so there is a bit of uncertainty where you will do best. It is not unusual for CA events to be significantly improved with fixed pressure.

[Shnorky]

Thank you! Will try and report