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Switched from APAP to BIPAP
RE: Switched from APAP to BIPAP
I missed that you used 9/6 the first night, stay there until there seems to be an average/trend we can use.

After 3 nights at these settings any opinion on how you feel? Any obvious tiredness? Less aerophagia? More/less energy? If not really sure there has been obvious improvement or worsening that is a sign this isn't hurting and to stick with it longer to gain a better average before the next change.
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RE: Switched from APAP to BIPAP
Dang, I switched it to 8/5 last night. In terms of physical and mental energy, I haven't noticed any significant improvements. 

Here are my results:

   
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RE: Switched from APAP to BIPAP
Switched it back to 9/6 last night. Here are the results from last night:

   

Overall I still feel very fatigued and tired.
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RE: Switched from APAP to BIPAP
Your flow limits are out of site, increase your PS
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RE: Switched from APAP to BIPAP
Not yet, I want to see if pressure alone has an effect then we know if he needs to use higher pressure or if should just add ps at these lower pressures.

Data is kind of all over the place as usual but might have enough data now. Let's try 11/14 for a few nights.

Edit: Amirkas there are two types of flow restriction. One is caused by a partial collapse of airway and sometimes pressure can hold the airway open and avoid the collapse. The other is restriction due to narrow airways and no matter how much pressure you apply they don't get larger and the increasing pressure doesn't help in this situation so you need to use PS to try and force more air through the restriction.

After we find the min pressure that appears to prevent collapse then we can fine tune PS, if we try to fine tune PS while collapse is still happening then we will need excessive PS which may be too high and cause central effects when airways are not collapsed.
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RE: Switched from APAP to BIPAP
Based on a review of Jul 23, Sep 29, Oct 04 05 06, and Oct 17, I'll cut to the chase.  Totally my opinion which can be gone thru in PMs in more detail.

1. EPAPmin of 4.0, 5.0, 6.0, 7.0, and 8.0 are not working.  The reviewed nights show that an EPAPmin of 8.6 would be ok, if the settings were allowed to climb beyond that to between 9.4 and 10.6 which were the most often needed to respond to flow limitations.  The Jul 23 night showed the EPAP cycling between 7.0 and 11.0, showing effective treatment above 9.0.


2. doubt that the sleep time is anywhere near the machine-on time, most of the closeup shots look like awake breathing or in transition.

3. unable to tell for sure if lacking REM sleep or deep NREM sleep necessary for much of the restorative powers of sleep.

4. lower EPR seems like it is more effective, if the EPAP is set high enough. 

I would set EPAPmin to 8.6, set the EPR to 1.0, and the IPAPmax to (10.6)+(1) = 11.6 to make sure EPAP can reach 10.6 if needed.  And give it 3 or 4 nights at that level.

For wake/sleep determination, I hear there are devices that help.  If you have one or get one, let us know how it correlates to junk on your recordings.

I wish you the best of luck as the journey continues.

QAL

update:  the listed settings are equal to 9.6/11.6 PS 1.  
roughly equivalent to those (but I would not prefer) are 10.6/12.6 PS 2 and 11.6/13.6 PS 3. 
[previous respondent's suggestion of 11/14 I think implies PS 3 which is very similar (to 11.6/13.6 PS 3) even if arrived at differently]
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RE: Switched from APAP to BIPAP
4 nights at EPAP 5/6 and PS of 3 gave two good nights and two poor nights. Average AHI was 3.46, average minute vent was 5.81, average 95% flow limitation from the 3 nights it was recorded was 0.34.

In the 7 nights prior settings were EPAP of 7.6+, PS of 4-5 and a lot of the data doesn't look much different with good and bad nights and similar flow rate charts. Average AHI was 3.78, average minute vent was 5.79, average 95% flow limitation was the only thing better at 0.035.

I want to know if the higher EPAP had anything to do with the improved flow limitation or if it was mostly because of the higher PS. We only learn that by only changing EPAP. Recommendation for 11 EPAP trial is just because it is a significant increase that should show obvious effects if it helps and because it is within previous used ranges. I believe the higher EPAP will help with the flow limitations but need to see it tested to confirm.
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RE: Switched from APAP to BIPAP
given that re-statement, I now read Geer1 as saying IPAP constant at 14, and EPAP constant at 11 (PS 3).  - QAL
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RE: Switched from APAP to BIPAP
These are my results from last night at 14/11. While flow limits weren't flagged as much, there were still periods of obvious flow limitation, although noticeably better than what occurred at lower pressures. Let me know if I should screenshot those periods as well. Aerophagia wasn't too significant like it was before but was still a little worse than it was at lower pressures (as to be expected).

Also, the central apnea was preceded by an erratic spike in flow rate, likely indicating a falsely reported CA. 

Last night:

   
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RE: Switched from APAP to BIPAP
Many of the obstructive events appear to be following arousal as well, probably just sleep wake junk post arousal.

This is about as good as your data has ever looked although only one night of data. Lets collect a few days at these settings.
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