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Switched from APAP to BIPAP
RE: Switched from APAP to BIPAP
I still feel overly tired from what was definitely unrestful sleep. Looking through the data there were still significantly frequent periods of flow limitation, that weren't flagged.

Here's my data from last night:

   
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RE: Switched from APAP to BIPAP
Understood. The problem is that it isn't clear that the flow limitations are the issue regarding your sleep quality and the moments of lower flow rate thus far have not really been treated by anything tried so far. I know you are referencing periods like 4:45 to 5:05 but to me that is some of your better data as you slept ~ 20 minutes uninterrupted even though even though flow limitation was present. I believe the bigger issues are periods like 6:15-7:00, those periods of ragged flow are kind of specific to your individual case and they seem to always be present no matter what PAP settings you use. It could be a number of things and it isn't clear if it is caused by breathing or just poor sleep quality showing up in your breathing.

With an average of 2.08 AHI, 6.00 minute vent, 0.04 95% flow limitation these are your best results to date. I want you to stick with these settings for 1-2 more nights (1 if it degrades tonight, 2 more if tonight is another decent night) to see if they are consistently this good or were just 2 good nights. If consistently good then this will be a baseline setting we use to compare other changes to.

Did you say you picked up a P10? If so have you tried it yet? Stay with FFM for now (P10 might disrupt your sleep with mouth leaks etc and I want this data as a baseline) but I am curious to know if you have tried a nasal mask and have any data or thoughts about it.
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RE: Switched from APAP to BIPAP
I haven't tried the nasal mask yet, and won't do so until you've decided it's necessary. 

I feel like I'm getting worse sleep on these settings compared to the previous settings of 9/6. Aerophagia is definitely an issue and I've been waking more times than usual. Here are my results from last night:

   
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RE: Switched from APAP to BIPAP
Now that is interesting! AHI and flow limitations are guidelines but they don't necessarily correlate with the best quality of sleep as you have determined. Everything about your data shows improvement at these higher pressures (although this last night doesn't look great) but you noticed that you felt better before and that is a sign that the negative effects of aerophagia offset the extra flow limitation you were previously seeing.

I would say try 8/11 now to see if it hits a good balance between the two but lets skip that assuming it isn't going to provide the results you are looking for (you have used similar settings numerous times). Lets try 6/9 again but this time with the nasal mask. The nasal mask may be tough to get used to and I fully anticipate it will take at least a week to transition to it (potentially longer if having any mouth leaks, nasal congestion issues etc). Starting at that lower pressure and PS will make it a bit easier to transition to and potentially the FFM is the reason behind some of these apnea and flow limitations so it will be interesting to compare 6/9 nasal mask data to the previous 6/9 FFM data.
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RE: Switched from APAP to BIPAP
Sounds good. I'm curious to ask why we aren't going to try an EPAP of 6 with a Higher PS with the FFM before transitioning to the nasal mask. Centrals don't seem to be an issue at most pressures / PS's.
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RE: Switched from APAP to BIPAP
i made my suggestions on 10-22 that your max pressure be cut but not your exhale pressure, partly because of aerophagia. back to that is where you may eventually land.

9.6/11.6 PS 1.

QAL
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RE: Switched from APAP to BIPAP
(Yesterday, 07:38 PM)AmirKas Wrote: Sounds good. I'm curious to ask why we aren't going to try an EPAP of 6 with a Higher PS with the FFM before transitioning to the nasal mask. Centrals don't seem to be an issue at most pressures / PS's.

Frankly I don't think you are going to find the results you are looking for no matter what pressure or PS is used. I think there is something else at play whether it is related to issues with FFM or something else.

The other reason is that if FFM is an issue as it might be then you won't need as much PS with a nasal mask as you would with a FFM. Too high of PS can cause issues so first I want to see if there is improvement nasal vs FFM and then will decide which mask to use and then will fine tune PS.
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