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Starting to see results below the magic 5 with my Bilevel
#1
Starting to see results below the magic 5 with my Bilevel
Dec. 7, 2017 I began using a newly prescribed Aircurve 10 Vauto after being on an APAP which no longer treated my apnea.  Several here helped me with understanding bipap settings and gave suggestions on where to begin.  While there were some successful nights, I could never get my average AHI below the magic 5 number with any consistency. 

It seemed no matter what combination of IPAP, EPAP and PS, I used the AHI would not average under 5 and the pesky little CA's and Hyponeas just kept showing up.  A couple of weeks ago there was a thread about the Aircurve Vauto and it's setting of Trigger and Cycle functions.  Someone in the thread also included a Titration manual which addressed the subject.

Anyway I figured what haven't I tried so I changed these settings from the factory default of medium for both.  With a little experimentation, in mid April I put the Trigger setting at "very high" and the cycle at "very low".

The last two weeks my AHI has broken the magic 5!  Over the last 14 night no AHI above 5.  The average of my last 14 nights is AHI 1.9  Virtually no CA's and minimal Hyponeas.  Below is my chart from last night.

I am not sure why the settings helped but I'll take the results.  Just out of curiosity any thoughts from the more knowledgeable here of why Trigger/Cycle settings might have helped?

[attachment=5686]
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#2
RE: Starting to see results below the magic 5 with my Bilevel
Congratulations alps

I know it makes you feel better.

Gerry
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#3
RE: Starting to see results below the magic 5 with my Bilevel
I think another user here, mhehe could give you a very good idea what works. My guess is that you had a significant number of CA events and reducing them has probably brought your AHI down. mhehe could probably explain it better, but I suspect what you are doing is tricking the BiPAP to cause some forced breathing like an ASV machine does, by making a rapid well timed transfer from EPAP to IPAP and back. See this thread and the posts by mhehe...

VAuto vs ASV
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#4
RE: Starting to see results below the magic 5 with my Bilevel
Yes Ron AKA that is the thread that first made me aware of the possibility of trying some changes in the trigger/cycle settings.  And you are right about the CA problem.  My OA has been no problem and the main struggle has been to consistently keep down the CA's and Hyponeas numbers.
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#5
RE: Starting to see results below the magic 5 with my Bilevel
(05-04-2018, 08:24 PM)alps Wrote: Yes Ron AKA that is the thread that first made me aware of the possibility of trying some changes in the trigger/cycle settings.  And you are right about the CA problem.  My OA has been no problem and the main struggle has been to consistently keep down the CA's and Hyponeas numbers.

What you might want to try as I recall Sleeprider suggested in that other thread is slowly increasing the pressure support to see if that brings down the hypopnea. It will increase your maximum pressure, and you will probably have to increase your maximum IPAP by the corresponding amount, but it may be a worthwhile tradeoff.
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#6
RE: Starting to see results below the magic 5 with my Bilevel
Don't increase the Pressure Support! Your numbers are good right now.
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#7
RE: Starting to see results below the magic 5 with my Bilevel
I agree with Walla Walla. If this is a typical night then you don't want to change anything. A few hypopnea immediately before you wake can be ignored.
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#8
RE: Starting to see results below the magic 5 with my Bilevel
Agreed with DeepBreathing and Walla Walla.

That bit of activity at the end of the session may be sleep/wake junk. If so, and if it were me, I'd ignore that bit that happened in about the last half hour.

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#9
RE: Starting to see results below the magic 5 with my Bilevel
Alps, I am glad you found a way to reduce your centrals. As Ron mentioned setting the trigger sensitivity to very high forces an inhale cycle.
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#10
RE: Starting to see results below the magic 5 with my Bilevel
Well the trend seems to be continuing.  Last night the AHI was 0.42 with only 3 Hypopneas during the entire night.  And those 3 events were during a brief time early morning when my dog decided to jump up on the bed waking me up.

Right now I will continue to keep the present settings that are working.  Numbers are great and I am feeling good so as they say "if it ain't broken don't fix it"

Thanks all for the replies and mhehe/Ron AKA for the info on the trigger function.
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