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Started BiPaP treatment, makes things worse. Struggling with the settings.
#21
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
I think once these settings bake-in, we may try increasing PS in 0.5 cm increments. to learn your trigger point of CA. It's too early to judge your ultimate response to therapy on the basis of the first more or less optimized night. This is the beginning of what we hope will be a more successful long-term approach.

Regarding a collar, the closeups where hypopnea occurred, have an obstructive look like I would expect from a brief chin-tuck, however they are not at a level that I would recommend the inconvenience of a collar. There is no need to make that decision now.
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#22
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
I definitely misinterpreted the overall message before and jumped the gun, my bad!

I'd be so stuck without your help, I appreciate it more than you can know.

I've noticed that occasionally there's missing areas in my charts, and my flow rate becomes a little erratic. I've attached an image showing what I mean. Any cause for concern?

Attached is also an image showing a really rectangular-looking flow rate. Is this "the goal" for flow rate? To have it very consistent like that?

Last image is just general breathing around a flow limitation. I don't think there's anything to gain from it but figured it can't hurt to have some more data around.


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#23
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
Missing data periods seem to happen randomly and Oscar can only graph the data the machine provides. If the data stream is disrupted, that is what you see. It's in the machine or storage card. I'm pretty sure it's not just a time warp.

Erratic flow in that example looks like a change in body position in bed. Roll-over Beethoven. It's a light arousal, a large inhale and breath hold and a resettling before resuming sleep. We want to solve sleep problems, but I'll warn you against getting too far into the weeds on analyzing the flow rate chart. It's best to accept that it's natural to have a lot of irregularities that come with being human.

I'm either not seeing or understanding "rectangular flow rate".
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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#24
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
Yeah you're right, I agree. But I also ask for my own learning about the process in general!

By rectangular flow-rate, I just meant when zooming out, the peak/low of the flow rate is so consistent that it almost looks like a solid bar of black as opposed to something that spikes up and down randomly. 

I haven't cleaned my machine properly yet - do I just clean the mask/tubing/humidifier with mild soap and leave to air dry?
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#25
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
I think you are talking about the flow rate looking very consistent without a lot of spikes or variation. That is one of the objectives is to even-out the respiration. That indicates there are few arousals and respiration is mostly stable as it should be in sleep.

[Image: attachment.php?aid=29656]

Just follow manufacturer instruction on cleaning the mask, tube and humidifier chamber. Wash and rinse works fine. The tube can be hung to drip-dry and will quickly evaporate droplets after you turn on the machine. I empty and wipe the humidifier chamber daily, let it sit open, and use tap water. Rarely needs much more than that. I sometimes need to use some hydrogen peroxide and a Q-tip to remove a residue if that happens.
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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#26
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
Yeah, that's what I meant. Thanks a lot for that!

Update on my second night.

Subjective: Mask wasn't fitted quite right for my nose when I woke up, so I think at some point nose breathing would definitely be a bit more difficult but it didn't break the seal. It was a "good night", nothing outside of typical variation pre-treatment, but definitely preferable if it became a new average! Interestingly, I'm a little more motivated, proactive, happier, more focused, etc today, and that was without seeing the data / thinking my mask wasn't on right so I doubt it is placebo. Anyway, seems good to me.

Statistical: AHI / All negative stats are slightly worse. I was asleep a bit longer than the previous night, could just be that? 6.30-8.15 seems particularly troublesome relative to the rest. 

I've attached basic, advanced, and the worst "problem area".

I also found that after around 2:57 my flow rate changes quite a bit and there's no associated events around the change, and it barely ever returns to the same level of stability. No idea what that indicates or if it's useful.

There's also a flow limitation event with no changes to any of the graphs, what does this mean?

Images attached for both.


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#27
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
Analyzing the respiratory flow through the night and considering what is going on, and what might be done to mitigate certain patterns is an interesting exercise, but the more important data right now is how you feel. You live on the edge of complex apnea, and your current settings are effective in balancing your need for positive air pressure to prevent obstructive events, while not triggering a lot of central events. We have seen in full ASV mode, your machine makes you more tired, even though it can treat the central apnea for the most part, so I'm trying to avoid going that route. If you had a Resmed ASV, I would not hesitate to move to full ASV because it responds that much better.

What I see in your charts are a low-grade flow limitation that may respond to a a slight increase in pressure support, however you will risk tipping the apneic threshold in favor of central apnea. With this in mind, if you feel you want to try an addition 0.5 cm PS, then increase the minimum and maximum PS to 2.5. If you are feeling better at the current settings, then I suggest you err on the side of caution and keep current settings.
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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#28
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
That makes sense!

I'll raise PS minimally as you suggest after a few days (or a week or two), but I think it's wiser to see how I feel on a longer-term basis and to rule out placebo or good luck on my recent experiences.

I am curious on the difference between the two days - would you say it's just general night-to-night variability? I've no idea what effective treatment looks like over multiple days.

Also, if I keep the current settings and don't get "bad days" like I used to, but also don't particularly see energy/cognitive/whatever benefits over the long term, is that just the way it has to be? Could I benefit further from a different machine / other therapies, or is this "as treated as I can get" given the balancing act you describe?
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#29
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
Really good questions, and I agree with the decision to continue with these settings and base your choices on results. Central apnea is consistently inconsistent, and you're asking me about day to day variability? Trust me, it exists, and we have to rely on trends or you will never stop spinning the dials. On your last question, let's cross that bridge when we get there and see how high the water is.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
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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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#30
RE: Started BiPaP treatment, makes things worse. Struggling with the settings.
Just Dave's 2 cents, not disputing anything but just putting a suggestion:

Here's the place where a new PAP user has made a certain level of progress in therapy optimization, and has entered the need to stabilize and working to build a trend of multiple days of good to great therapy. If you can do that, voila success.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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