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[Treatment] New to BiPAP
#1
I was just recently diagnosed with severe OSA. my AHI from the sleep study was 60.9. The doctor has started me on a PR system one Auto BiPAP. I have only been on therapy for a little over 2 weeks. At first the therapy was great I felt great, it didn't bother me at all to use the machine, and I finally felt like I got a good nights sleep. Looking at my stats my AHI was around 4.5 the first couple of days. But in the past few days my AHI is going up every night and I am having more and more events and having many CSA events. Which during my sleep study there were no CSA's recorded. I don't feel like I am getting a good nights sleep the same way I did the first few days. I would have expected it to get better but it seems like it is going the other way. Is this normal when starting therapy? I am thinking it may be just part of the process of getting my settings dialed in. I meet with the sleep specialist again in a couple days to discuss the results and make adjustments. I currently look at my stats every morning using SleepyHead. My settings are Auto BiPAP IPAP=13, EPAP=5 min PS=2, Since the PR S1 can change IPAP and EPAP separately. One more question, since the PR S1 Auto BiPAP is rented I will buy my own machine. Thinking of ResMed S9 instead of the PR, and since I travel I have also thought of the intellipap due to it's size. Any thoughts on machines would be great as well.
Thank you for letting me share.
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#2
My two cents:

I'd put off buying a machine for a while and just continue with the rental machine. The reason why is this: With the growing number of central apneas, there's a chance that you might have complex sleep apnea, which is diangonsed when a person who has OSA develops persistent problems with central apneas only after starting PAP therapy. Approximately 10% of new PAPers have problems with pressure induced centrals. Sometimes the problem will resolve itself in the first couple of months and no change in machine is needed. But sometimes the problem does NOT resolve, and the person is eventually moved to a more expensive machine---typically an ASV machine or a BiPAP ST machine that can trigger inhalations. A standard PR System One Auto BiPAP is not the same thing and is not designed to trigger inhalations. Since you report a growing AHI made up of a lot of centrals, there's a chance that you will eventually be switched to an ASV or a BiPAP ST, and that's why I recommend continuing to rent instead of purchasing a BiPAP or a Resmed S9 VPAP Auto right away.

The usual criteria for moving a person from BiPAP to an ASV or a BiPAP ST machine are:
  • A treated AHI that remains above 5.0
    A treated CAI that remains above (or at least close to) 5.0
    CAs make up at least 50% of the events that continue to occur while on PAP therapy
There is some flexibility in interpreting these criteria when a patient is also reporting that they continue to feel bad while on PAP therapy---particularly if the patient initially felt better---i.e. that the patient felt better before the CAs started to emerge.

I'd suggest that you take a list of written questions with you to the follow-up appointment with the sleep doc, along with your data.

Finally, a comment on an important pair of differences between the System One Auto BiPAP and the Resmed S9 VPAP:

1) On the System One, the IPAP and EPAP vary independently of each other unless one of the following happens:
  • IPAP = EPAP + min PS and EPAP needs to be increased. In this case, both IPAP and EPAP will be increased.
    IPAP = EPAP + max PS and IPAP needs to be increased. In this case, both IPAP and EPAP will be increased.
    IPAP = EPAP + min PS and IPAP can be decreased. In this case both IPAP and EPAP will be decreased.
    IPAP = EPAP + max PS and EPAP can be decreased. In this case both IPAP and EPAP will be decreased.
But on the Resmed S9 VPAP Auto, the IPAP and EPAP are not allowed to vary independently of each other. In other words, IPAP and EPAP are always increased and decreased together and by the exact same amount. The difference between IPAP and EPAP remains constant on the S9 VPAP, whereas it can vary on the System One BiPAP Auto.

2) The System One BiPAP Auto has Bi-Flex, which offers a small (variable) decrease in EPAP pressure at the beginning of every exhalation. In other words, when Bi-Flex is turned on, at the beginning of each exhalation, the pressure can drop a bit below the EPAP setting as a form of additional exhalation relief beyond that provided by dropping the pressure from IPAP to EPAP. The S9 VPAP Auto does not have any additional exhalation relief beyond the drop from IPAP to EPAP. If you are currently using Bi-Flex and you like the way Bi-Flex feels, this could be a potential issue when switching to a Resmed S9 VPAP.
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#3
Robysue,
Thank you for your response. I will discuss my concerns and issues with the sleep Doc as you recommend and hang tight on buying a machine for now.
Question is it possible that I am breathing through my mouth and this appears to the machine as a CA? I have always been a a bit of a mouth breather, but I started using the nasal mask in th beginning and it worked so well the first days I thought maybe my mouth breathing was not an issue. Maybe I should try a full face mask and see if that makes any difference.
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#4
(12-27-2013, 10:09 AM)LaserBoi Wrote: Robysue,
Thank you for your response. I will discuss my concerns and issues with the sleep Doc as you recommend and hang tight on buying a machine for now.
Question is it possible that I am breathing through my mouth and this appears to the machine as a CA? I have always been a a bit of a mouth breather, but I started using the nasal mask in th beginning and it worked so well the first days I thought maybe my mouth breathing was not an issue. Maybe I should try a full face mask and see if that makes any difference.

Try a chin strap before you go to a FFM and see if the chin strap helps.
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#5
(12-27-2013, 10:09 AM)LaserBoi Wrote: Question is it possible that I am breathing through my mouth and this appears to the machine as a CA? I have always been a a bit of a mouth breather, but I started using the nasal mask in th beginning and it worked so well the first days I thought maybe my mouth breathing was not an issue. Maybe I should try a full face mask and see if that makes any difference.
Mouth breathing is typically going to show up as a long, possibly largish leak in the data rather than as a CA.

You say you've been monitoring the data with SleepyHead. What does the leak graph look like?

On the System One BiPAP, the leaks that are reported are total leaks, which include the built-in intentional leak rate for the mask you are using at the pressures you are using. Sleepy Head cannot flag official "Large Leaks" on the PR machines because PR doesn't publish the criteria that Encore uses to flag a Large Leak. Looking at lots of folks' data both here and elsewhere, it seems as though the Large Leak line on a PR machine is typically somewhere around 70-80 L/min.

If your leaks are staying pretty much below intentional leak rate + 25 L/min, then chances are you're staying well below the Large Leak level. And then the question becomes, how much are the leaks bothering you.

If you could post the leak graph and the flow rate graph for some typical nights together, I'd be happy to let you know what I think about your leaks.
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#6
Here i have posted the 22nd which had low CSA's and the 26th which had high CSA's. Taker a look, I welcome your thoughts. This will also help me with questions and items to discuss with my sleep Doc.
   
   
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#7
Hi LaserBoi,
WELCOME! to the forum.!
You might try a chinstrap before you try a full-face mask and see if that helps you.
Good luck to you with your decision on your new machine.
trish6hundred
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#8
I was on ipap of 18 and epap of 13 and then after 2 months settings changed to 23 and 18. No problems. Be patient to adjust to it all. Uncomfortable at times.
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#9
Thank you all for your responses and help.
There is no question I will continue with therapy. Using the BiPAP doesn't bother me at all, hopefully working with my sleep doc I will get the settings dialed in and not have Complex Sleep Apnea or need an ST or SV machine.
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#10
I think what is the adjustment for me is the full feeling in my sinuses and extreme dryness dispite humidity. At first it's hard to relax with the bursts of air.
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