Switched from APAP to BIPAP

[AmirKas]

I was going to select 6 instead of 8. My concern is that when my pressure was flatlined at 14cmH20, my flow limits were around 0.5 for at least 30 minutes. Not sure if this means that PS was too small or IPAP was too small. As well as that, my tidal volume, which should be at least 400ml, was 240 on average --> something's up with my breathing pattern. 

I attached two close-ups of data, one from the Autoset at 14cmH2O EPR 3, and one from the Aircurve at 14cmH2O at PS 4.

Autoset:

[attachment=33834]

Aircurve:

[attachment=33835]



I believe changing TI min/max and cycle settings can surely resolve a lot of issues since my breathing pattern has definitely changed from using the Autoset. 

For reference, here is what my flow rate looks like next to my mask pressure:

[attachment=33836]

[SarcasticDave94]

OK, just watch the CA rates if you go for a larger pressure range than what you tried that's different than 8-14. Also lowering EPAP may increase flow limits too.

I think increasing IPAP would be safer than increasing PS due to the CA. Higher PS may induce more CA for you.

On the zoomed flow rate, I'm certainly not near expert but the inhale tops look like they're flattened somewhat. Not exactly sure but they look "off" as in not the right shape.

[Geer1]

Data looks weird, not sure I trust it. I think you need to try and clean blower and get it working better.

You don't need to change Timin or Timax, those are settings for people that lack spontaneous breathing capability. Cycle and trigger sensitivity eventually can consider changing but best to first know machine is working properly and to try to dial in PS/pressures.

Like before it isn't clear if pressure actually helps that much. Might be better off lowering EPAP all the way down to 4 cm, I still can't help but wonder if part of the issue is FFM/mouth breathing.

[AmirKas]

I'll probably continue to use the Autoset till I can get a new machine that is almost guaranteed to be functioning properly.

[AmirKas]

Hi everyone, after a long hiatus from the board, I'm back to trying to optimize my Autoset therapy. 

First, let me explain the situation regarding the Aircurve 10 VAuto. While my nurse did prescribe the machine after viewing my OSCAR data with me, my supplier quite literally told me "Since we are money hungry, we want solid proof that you need a machine upgrade, since we're not sure whether insurance will pay us." I did look at the insurance policy beforehand as I discussed in a previous post and should've had all the proof necessary, but my supplier doesn't believe so and won't connect me to the justification team no matter how many times I ask. I'm hoping that I'll be able to get the Aircurve 10 VAuto from a donation service, but won't be able to use it till another week. 

In the meantime, I'm still struggling with debilitating brain fog and fatigue, which has significantly affected both the academic and social aspects of my life. I've been using the Autoset at settings between 8-14cmH2O and 10cm-14cmH2O, with little alleviation of my symptoms.

One thing to note is that even at higher pressures at EPR 3, my central apneas (which are real) have reduced almost to the point of extinction. What exists now, are OA's. H's and a considerable amount of unreported RERA's / Arousals. Here are my results for last night (Which despite the systems is one of the best sleeps I've had in a while):

Part 1:

[attachment=34076]

Part 2:

[attachment=34075]

Unreported RERA:

   

[SarcasticDave94]

OK change your DME supplier. This supplier is lazy and doesn't want your business. Just fire the supplier and get another one that's in-network with your insurance.

They won't know if insurance will pay if they won't submit the script for fulfillment! And never give your DME supplier your credit or debit card info, as maybe they'll double dip the billing, getting you and insurance to both pay.

PS: your OSCAR data doesn't look bad, except flow limits and therapy sleep time could be longer than 5 hours.

[AmirKas]

Turns out that wasn't all the data from last night. REM during the last part of sleep consistently seems to make my AHI / RDI worse. My sleep study also shows a significant difference in apneas/arousals between NREM and REM, with a ratio of REM/NREM > 2. My hypothesis is that my symptoms are a result of consistently, very, poor REM sleep. All CA's were preceeded by either a spike in flow or a period of flow limitation. Let me know if you need me to zoom in to any periods. 

[attachment=34078]

[Geer1]

Keep giving it time and even with this current machine and EPR of 3 I think you will continue to see improvement.

Did you try cleaning your vauto/blower to see if that helps?

[AmirKas]

I don't have a condensed air canister to clean it, nor a car to affordably get one yet. I will figure it out soon though.

[Geer1]

Cleaning it might work but I imagine might need more then that. I saw one website where pricing appeared to be $250 to get a new blower/motor installed. Could look into repair options since you already have the machine.