Spetzal's therapy thread (Help needed with DreamStation BiPap)

[Sleeprider]

Spetzal, let's take a closer look at the respiration rate so we can see how the inspiratory wave is looking. A sampling of 3-4 minute zooms that show the wave form clearly can help us see how your are breathing during quieter times as well as how events are initiating. If we see a lot of flatness than we might want to look at using more PS. What is your current BiFlex setting?

[Sleeprider]

I was aware of the model. Your zoomed captures are nearly a full hour.  I'm looking for about 3-4 minute captures.  It's going to look more like this image showing a RERA:

[spetzal]

: IPAP 12/EPAP 10

[spetzal]

IPAP 12/ EPAP 10.5

[spetzal]

Sleeprider, i had to look for the Biflex setting.  Ive never used it.  It is set to “off”

[Sleeprider]

Many of the events I am seeing flagged as CA are obstructive and include severe flow limitation before and during the apnea. The event at 12/3 22:05:40 and 22:06:40 are positional (chin-tuck?). There event on 12/3 at 20:53:40 is similarly obstructive and we see every other breath before the apnea being severely flow-limited. This is likely a series of slight arousals between airway obstructions caused by position. The downward sloping, low-volume breath during the apnea shows occlusion of the airway and the CA event is obstructive. At 20:55:50 on the same graph are two flow limited breaths with obstructions midway through inspiration followed by a severe flow limitation and another obstructive apnea flagged as CA. All of the events flagged at 12/6 from 03:18:30 to 03:20 are obstructive with flow limitation evolving into additional obstructed inspirations and arousal. 12/6 at 23:17 is preceeded by numerous flow limits, and again, I don't think the CA flag is correct.

With these facts, it is possilbe we need to make some setting changes, but it is undeniable that there is a positional event issue that needs to be addressed. http://www.apneaboard.com/wiki/index.php...a_.28OA.29 Maybe it is too many pillows, or sleep position, or you can consider whtat might cause chin-tucking or other airway curvature, but the obstruction is present around all events. A soft cervical collar is one option, but you are welcome to try anything to help keep your chin-up. I often tuck a pillow between by shoulder and jaw when sleeping on my side. It's kind of up to you to do the detective work on this aspect of things. For settings, I think your EPAP at 10.5 looks pretty good if not for the sporadic chin-tucks. I think you need at least PS 2.0 and if that takes a lower EPAP to tolerate, then that is what you should do. Pressure support comes in behind inspiration to help mitigate mild airway resistance. This is normally a comfortable thing, but I saw your concern with higher IPAP. If you can resolve the positional aspect, then a lower EPAP will actually work very well.

[spetzal]

Not sure i followed all that…

“For settings, I think your EPAP at 10.5 looks pretty good if not for the sporadic chin-tucks. I think you need at least PS 2.0 and if that takes a lower EPAP to tolerate, then that is what you should do.”

Do you mean that if my EPAP is set to ypur recommended 10.5, then my IPAP should be 12.5 ?  

Been using “The Eliminator” snore collar off Amazon this week, but my neck is a bit taller than the cushion, so my airway still collapses a bit.  I just ordered a soft cervical collar for tomorrow.

[spetzal]

I THINK that it is understand that mixture of apneas and hypopneas cause slow heart rate/bradycardia during sleep apnea that normally isnt there. I think this is why ive been noticing a normal (for me) sleeping heart rate as low as 44 on he higher pressures i cant tolerate, and occasional drops to the high 30’s on the IPAP 12/EPAP 10 with unresolved positional issues as sleeprider described.

Therefore….if i can resolve the positional issue, my heart rate should stop dropping so low, thereby aboiding that pesky heart attack risk (wry humor)

Plz check me on my reasoning!

[Sleeprider]

Basically, I'd like to see your BiPAP used with some pressure support at 2 to 3 cm. Your latest EPAP is 10.5, but if you can resolve the positional obstruction you can probably go lower. If this is the collar you are using, I have not seen much success with that design https://www.amazon.com/Eliminator-Sleep-...B076B3YQL9 We are looking for more jaw support, and the chin is secondary. This design encourages the user to cinch against the throat too tightly.

[spetzal]

IPAP over 12 causes pain issues, im not sure how the heated tubing will affect this.  Please briefly explain (or point me towards a posting) why my EPAP cant be just 1.5cm lower, such as IPAP 12/EPAP 10.5

(12/10.5 also causes pain, its just more/less bearable in the morning…..only 12/10 causes no pain)