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Switched from APAP to BIPAP
RE: Switched from APAP to BIPAP
Main thing is that higher EPAP / IPAP had no significant impact on obstructive apneas. Respiratory Rate was also more stable. Coupled with a lack of Aerophagia and it seems that lower pressures are more conducive to better sleep. 

I would like to note that based on my personal findings, flow limitations were more noticeable and frequent last night than they have been for the past week, hence why I probed to increase PS to 4 as central apneas did not occur and aren't an issue when using Very High trigger settings.
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RE: Switched from APAP to BIPAP
too bad the BiPAP or CPAP machines do not differentiate awakeness from asleepness, so we (you) really don't know if sleep quantity and quality are better now. It will be interesting to see the results of the new setting max 9 EPR 3 with flow limitations recorded. What to you think is an effective means to reduce flow limitations?

Good luck.

QAL
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RE: Switched from APAP to BIPAP
Yes the main thing we appeared to learn is that obstructive apnea is not an issue and the obstructive apnea seen at higher pressures/PS are either not real (post arousal etc) or are induced by the higher pressures/PS (potentially due to FFM). This isn't that surprising to me as your sleep studies do not indicate apnea as being an issue.

AHI of 2.02 is about as low as it has been recently and is lower than the average of recent days when you used PS of 4-5 at 8+ EPAP. This was only one night of data though so in order to compare we should collect multiple nights of data.

Also worth noting is that your minute vent of 6 appears to be no lower than the average value at higher PS. If your body wanted more air then minute vent should be higher at higher PS. PS of 3 appears to be adequate and right now determining the effects of pressure and ideal pressure settings/ranges is more important than adjusing PS.

So now we need to take the next step and that is to check if this was an average night or a one night phenomenon. We run these same settings for at least 3 nights so that we have enough data to get an average from. This also gives your body some time to adapt to the new settings and for you to be able to draw a better conclusion about how you feel after these changes. We also change to vauto mode so we can see/track flow limitation stats which will be used in next test.

The next test after 3+ nights at your current settings is to increase pressures from 5/8 to 10/13 and run that for 3+ nights. We compare AHI and flow limitation values as well a how you feel and hopefully it will be clear as to whether increasing pressure helps, hurts or makes no difference.

Edit: For clarity stick with Min 5, Max 8, PS 3.
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RE: Switched from APAP to BIPAP
My current settings and the one used for last night were 9/6. (Median IPAP has never been below 9 since the beginning of APAP therapy in June).
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RE: Switched from APAP to BIPAP
For the sake of uploading my data, here are last night's results:

   
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RE: Switched from APAP to BIPAP
AK -- have you been following my latest thread: http://www.apneaboard.com/forums/Thread-...-your-data ?

Last night I set trigger to VeryHigh and PS of four. The two previous nights I turned off PS entirely. The VeryHigh trigger was even more of a disaster for me than no PS at all. It looks like when the trigger is too sensitive and I am in the wrong position, it sets up a resonance frequency between my airway and the cpap. It feels pretty nasty, too!
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RE: Switched from APAP to BIPAP
How would I tell if Very High is too sensitive for me? The difference between Very High and High is very significant in regards to centrals.
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RE: Switched from APAP to BIPAP
Wish you would have used the same settings. We are trying to learn what ideal settings are and we can't do that when changing settings every night. We just lost a night of data and are now a day behind schedule on trying to figure this out.

We need  multi day averages. Case in point 5/8 to 6/9 did not cause the difference in your data, that was just a nightly variation. Until we get multiple days at a single setting we cannot draw any conclusions. The main conclusion I am currently  trying to draw is if increasing pressure helps treat your flow limitations and to do so I wanted you to start at min pressure (I started at 5 because it seems to work better than the machine min of 4) and then will compare it to a higher pressure. 

APAP is not reliable in testing breathing issues because it is simply programmed to increase pressure to attempt to treat flow limitations, it does not attempt to understand if doing so is helping. This works for some people but not all and is the basis for what I have told you multiple times, pressure only helps if it helps.

Many people do poorly with APAP due to flow limitations that do not improve with increase pressure. Many of these people get better sleep by handcuffing the machines max pressure as I am currently getting you to do. You need to choose if you would rather believe me and follow my recommendations or if you prefer to believe your APAP machines simple programming. I already said I was giving up once, but from your response I thought you might finally be committed to trying to figure this out so tried again. I believe a part of you is finally ready to work on this but for some reason you just can't stop yourself from turning the damn knobs....

To be very clear, I am not looking for an ideal setting tomorrow. I am looking to find you improved settings in the next 2-3 weeks and an ideal setting sometime in the next 2-3 months. That is how long this will tank and in order to find ideal settings you will have to try inadequate settings to prove they are inadequate. If you want to proceed go back to 5/8 again and stay there for another 2-3 nights (or as necessary to get an idea of average results at those settings), if not go back to doing your own thing.  

Regarding trigger sensitivity leave it at very high at least for now. Cathy has other issues that make very high an issue for her (funky flow rates that prematurely trigger IPAP). Your central issue is something that has been improved in others by using very high and it appears to work better for you. Gotta figure things out in stages, first step pressure, second step ps, third step timing controls.
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RE: Switched from APAP to BIPAP
Hi Geer1, I used the same settings of 9/6 for the past 2 nights. I never used 8/5 since my Medium IPAP  never went below 9 during the entirety of my therapy. If I need to use 8/5 I will gladly do so.
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RE: Switched from APAP to BIPAP
Yeah, I thought you were at 9/6, and that the example someone gave mentioned 8/5 for instance, but your chart they were commenting on showed 9/6.

I think you can make progress, just hold on to that.

QAL
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