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Switch from CPAP to Bilevel
#1
Switch from CPAP to Bilevel
Hey all
I switched from a Respironics Auto Bipap System One to an Aircurve 10 Vauto at the behest of my physician due to FOAMGATE. I noticed after my first week of use that most of my apneas are clear airway but they almost never used to be on the Respironics machine. The settings are exactly the same other than there being a TiMax and min setting that i didn't move from the default setting.
Another thing, this machine is registering quite a bit of leakage with the same two masks I usually use (Dreamwear full face and P30i nasal pillows). I would love some guidance as to whats going on. OSCAR full night and snippet is attached


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#2
RE: Switch from CPAP to Bilevel
Please remove the calendar. F12 to take screenshot will do it.
ResMed's algorithm is more agressive than PR machines. This results in lower pressure needs on the ResMed as demonstrated with very minimal pressure increases.
Please drop your min EPAP by 1cmw per night until we see clear signs of event driven pressure increases. Or your comfort decreases.
Post nightly
After that, on a different night, in the presence of a few centrals, set trigger sensitivity to high
Post results
Possibly increase trigger setting to very high.

Do it insteps so you know what did what
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#3
RE: Switch from CPAP to Bilevel
Ok thank you for the steps. So tonight I will change nothing other than lowering EPAP by 1. 
A follow up question if I may; does changing between a full face and a nasal/pillow mask require pressure alterations? Should I keep the mask constant while I make these nightly adjustments?
Thanks for your guidance
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#4
RE: Switch from CPAP to Bilevel
Mask is a comfort issue, that trumps all.

We can optimize with any mask and after a mask change some setting adjustments other than mask type may be required.
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#5
RE: Switch from CPAP to Bilevel
Ok I will keep using the Dreamwear Full face as this once seems to never leak. When using the nasal pillows even with a chin strap and mouth tape there are usually leaks. I may have oddly shaped nostrils I'm guessing.
Will post as the data comes in.
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#6
RE: Switch from CPAP to Bilevel
So last night was kind of weird, one of my kids woke up me and my wife twice due to a nightmare and that is where the awakenings came from. It seems its still most clear airways but with some more OA. Should I decrease the EPR or up the PS?


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#7
RE: Switch from CPAP to Bilevel
Here are last nights screen shots. It seems the clear airways go away when I keep pressure support at 3.6. If I bring EPAP lower than 9 I got more OA/Hypos. Any guidance on where to go from here. I still wake up like 3-4 times a night for some reason.


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#8
RE: Switch from CPAP to Bilevel
What is the trigger setting on the most recent screen shots. It does not show up in data, but if you changed to high sensitivity, that is likely why CA is gone.
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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#9
RE: Switch from CPAP to Bilevel
I did set the trigger to high and almost all clear airways are gone since then. Can you explain how you knew that and why it happened? I attached the chart from last night and have a new question. A lot of my flow chart looks like flow limitations but these aren't always coming up as that. Is there a way to improve the flow?
Thanks for all your guys help, you're all a God send.


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#10
RE: Switch from CPAP to Bilevel
This is something we have learned from both personal experience and hundreds of outcomes since we started recommending this solution. Some of us are sensitive to pressure support which reduces CO2 and decreases respiratory drive to a minor degree. The use of a high trigger sensitivity allows the machine to detect low spontaneous inspiratory effort and switch to IPAP. This seems to serve as a stimulus for the user to breathe. I have no medical studies to back this up, and it doesn't come from any recommendation by the manufacturer or standard practice by the sleep apnea medical publications. You may call this an Apnea Board specialty.
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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