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[Treatment] Need help titrating BiPAP
#21
RE: Need help titrating BiPAP
(05-03-2021, 03:52 PM)Dormeo Wrote: Some improvement is better than none, but this is still not where we hope it will be.

Please leave the trigger where it is and try reducing the PS tonight to 4, with a minimum EPAP of 6.  The lower PS may reduce CAs, and the higher minimum EPAP may reduce obstructive events.

I'll reduce the PS to 4 tonight. I already have minimum EPAP at 6, should I leave it at 6 or bump it up to 7?
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#22
RE: Need help titrating BiPAP
Working with a BiLevel is a bit different than a CPAP, The "min" Pressure can be quite a bit lower than a CPAP. We pick 7 on a CPAP because that gives EPR room to work and lower pressures (lower than 7) are frequently too low for comfort for most adults. The CPAP math is 7-EPR (3) =4 the machine min.

The pressure that is equivalent on a BiLevel is EPAP Min + PS => 7. So 6 should be fine.
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#23
RE: Need help titrating BiPAP
Typo -- sorry! I was recommending going up to 7.

Gideon, I recommended the increase because there are OAs that are not being addressed. Does that seem like a good idea to you?
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#24
RE: Need help titrating BiPAP
Looks like our OP is a bit susceptible to PS differences that are maybe the trigger for the CA. OK found the answer to my own question on PAP therapy time...

P.S. my post is partly a placeholder so I can find the thread later.
Dave

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#25
RE: Need help titrating BiPAP
Looking at the chart, which I didn't do, yes increase the min, but also the max, say to 18 for now to buy room.
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#26
RE: Need help titrating BiPAP
(05-03-2021, 07:27 PM)Gideon Wrote: Looking at the chart, which I didn't do, yes increase the min, but also the max, say to 18 for now to buy room.

Ok right now I have it set to Min EPAP 7, Max IPAP 18, PS 4, Trigger High. We'll see what the chart shows tomorrow.
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#27
RE: Need help titrating BiPAP
Hello, I made the changes to my BiPAP last night and these were the results. It did seem like I had less centrals and obstructive events but I still woke up feeling tired with brain fog. I also woke up a couple times then fell back asleep.

I am curious if part of my problem is positional (i.e. chin tucking) and this is causing the hypopnea cycles (at least I think that is what that is). I have a soft cervical collar I bought but I find it extremely uncomfortable and only managed to sleep through the night once with it on. I'm willing to give it another shot if this will help, but I think I'd rather get the settings as best as possible first. I'm curious what others think and if this will be beneficial.


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#28
RE: Need help titrating BiPAP
some of your zoomed screenshots suggest the possibility of periodic limb movement. for example:

[Image: attachment.php?aid=31907]

[Image: attachment.php?aid=31951]

the fact that your pressure went up to max 12, then 17 of max 18 is also a (weak) potential indicator. 

I've attached shots of my respiratory response to plm with and without events so you have an idea what to look for. I can't say with certainty yours is plm and wonder if you experience restless legs, have plm indicated in your sleep test report (check the full report if you don't see it listed in the summary) or had someone witness movements in your sleep.


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#29
RE: Need help titrating BiPAP
It's good to see progress in your most recent chart. It may take some time for you to start feeling more rested.

You might be having some positional issues -- your flow limitations are clustered, and you had that little cluster of OAs. How do you usually sleep (side, back), and what is your pillow like?
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#30
RE: Need help titrating BiPAP
This is interesting that you mention that. I did a total of 3 sleep studies, but the first 2 were considered "inconclusive". The O2 ring fell of my finger for my first HSAT. I think my AHI was lower but they weren't scoring RERA/RDI. Then I did the in-lab PSG, but I could only sleep a total of 1 hour in the study. I don't think I had any apneas but I had a total of 11 "spontaneous" arousals. I figured this didn't make much sense so it's more likely the sleep study wasn't accurately scoring RERA/RDI. So I ended up doing the WatchPat for my last sleep study because I knew it was UARS-friendly and scored RERA/RDI. I included the results of the WatchPat study. 

I have noticed in the past year or so when my symptoms became more severe I sometimes get restless legs, or when I'm trying to sleep my body feels "stressed" and I start moving my legs. But this usually isn't a regular occurrence and I haven't been told by anyone that I move or jerk my legs in my sleep, but something perhaps worth exploring.

(05-04-2021, 06:25 PM)Dormeo Wrote: It's good to see progress in your most recent chart.  It may take some time for you to start feeling more rested.

You might be having some positional issues -- your flow limitations are clustered, and you had that little cluster of OAs.  How do you usually sleep (side, back), and what is your pillow like?

I usually work on sleeping on my side, and keep a pillow between my knees to try and deter tossing and turning in my sleep. I found it very hard to fall asleep on my back because sometimes I can actually feel the obstruction happening in my airway. But despite this I suspect I still toss and turn a lot in my sleep. I think it's possible that, while my airway might be open in one position, if I move positions in my sleep this could be causing flow limitations.


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