First Night Questions

[silversnore]

Well I had my first night on the bipap machine.  I think that things went ok.  I was able to sleep, however I did wake up a few times and my mouth was open and one time I seemed to have lip flutter or a little rumbling sound.  I uploaded data to Sleepyhead and was expecting to see some large leak data from mouth breathing, however that was not the case.  I am wondering if there is a relationship between the clear apneas and air escaping from my mouth.  I can't begin to tell you guys how much help that you have been, thanks.

there is some time on the graphs where I was just trying out the machine.


Here is the link to my data http://imgur.com/a/RP4L1

[silversnore]

maybe mouth breathing is not correct, air was coming out of my mouth because of the machine,

[Sleeprider]

Actually looks good to me. Give it another night and if you continue to see these CA events change pressure support to 3. You don't suppose I did that for no reason, do you?

Your sense of having leaks is not reflected in the data. Remember a little nudge behind the jaw can be a real help. When laying on your side, pulling a corner of the pillow towards your chest and under your neck and chin is exactly the kind of support I'm talking about, however your leaks are not a problem based on the data.

What was the reason for the breaks in therapy?

[Gideon]

Based on that chart mouth breathing is not enough to be a concern.  Did you sleep?  I ask because of the trying out statement.  Nice job and well done

Posting.
In Imgur click on the image you wish to post.
in the lower right corner of the popup, click on Large Thumbnail
above that click on the "Copy" button for "Linked BBCode"
Paste into your post.

That will put a linked thumbnail into your post.  A lot fewer steps for anyone looking at it.

My first move would be to ease up on the PS. try 3 and see if the CAs improve.  


Did your sleep study say anything about Centrals?

[Sleeprider]

I went back and looks at your previous posts and the sleep study you posted here http://www.apneaboard.com/forums/attachm...p?aid=3239

We derived the settings you are using, based on the doctor's recommendation that you use a fixed bilevel pressure of 15/11, and adapted that to a reasonable range using auto bilevel to retain the PS-4 of your recommended prescription, but a lower starting pressure of 12/8, and allow IPAP to increase to 18 if needed. A closer review of your titration shows that your study demonstrated efficacy at pressures as low as 9/5 and 10/6 with zero events. As pressure was increased in titration, you had more events, which again went away as the pressure reached 13/9, 14/10 and the recommended of 15/11.

I'm making note of this in your thread so we can revisit the possibility that your pressure was greatly over-titrated, as suggested by the complete lack of OA, snore and flow limitation. It's a bit early to jump to conclusions, but it's obvious that the Vauto pressure you are using is not unwarranted based on the titration. Also, we need to keep in mind that in early therapy, CA can be caused by adaptation and sleep disruption from the new experience. All of this is just to say, let's stay the course and disprove the titration results before jumping into setting changes, with the most likely approach being to simply reduce PS.

[silversnore]

Just trying it out watching TV to get aclimated to the process, no sleep during those periods.  I greatly appreciate your help.  What is the rationale in dropping the PS to three?  I have had a steep learning curve and think i still have a way to go!!  I am certainly glad that I have been involved with this forum.  Kind of difficult to know if you are progessing if you don't have some understanding of what is trying to be accomplished.  thank you for the advice.  By the way the P10 is great.

[silversnore]

Bonjour, will do with posting Sleepyhead, thanks for your help.

[Gideon]

The chart you posted was essentially all Central/Clear Airway events and NO Obstructive or Hypopnea.

Central/Clear Airway events raise a be cautious flag because the central nervous system may be involved. That is why we ask for CA info from your original sleep study. During that study they match brain waves with event to determine that what we see as CA are or are not "real" CA. We cannot tell with absolute certainty if CA is real CA for not with just a xPAP machine (no eeg).

Obstructive is treated by raising the support level, the "low" number or your epap pressure. with the Inhale pressure acting in support (PS) of your breathing. In this case you are saying to maintain the support level 4 cmH2O over your exhale value. A higher pressure here frequently yields a higher number of CA events. By reducing that number we hope to reduce the number of CA events.

SleepRider has requested you hold off for a while on reducing that value and see what shows over time (caution). He also hinted at reducing your EPAP because you really have no evidence of anything obstructive occurring. I was going to wait and see if the PS reduction reduced for CA events. Again hold off and let things stabilize.

does this help.

[silversnore]

Bonjour,

I hade no centrals and no Cheyne-Stokes  episodes during my sleep study.  Should I go ahead and reduce the PS to three or wait a few days?  Yes this advice is helping greatly.  Certainly out in front of the average bear due to you guys.

Mark

[Gideon]

All of this is just to say, let's stay the course and disprove the titration results before jumping into setting changes, with the most likely approach being to simply reduce PS

Per SR above.
Let's wait a bit.  He has good reasons.
Fred