Jimbu - Treatment Thread

[jimbu]

Hi All,

I'm revisiting PAP therapy and hoping to get a little help interpreting my data. Looking forward to upskilling myself with the help of you all!

Background

• 41yo Male.
  
• Restless and unrefreshing sleep for 2 decades, sleep maintenance insomnia, low arousal threshold.
  
• Sleep study in 2014 concluded mild sleep apnea; 29% SWS, 8% REM, 6 respiratory events per hour increasing to 15 in REM, predominantly obstructive hypopneas of mean duration 22s, no significant leg movements, no significant oxygen desaturations, sleep was fragmented.
  
• Tried and failed CPAP in 2014.
  
• Septoplasty and turbinate reduction surgery in 2015, did not significantly improve sleep, although nasal breathing much improved.
  

Given my sleep study results, I suspect my primary issue is UARS. After my insomnia has deteriorated recently, I came across the work of Dr Krakow and purchased a PR BiPAP AutoSV, figuring I could experiment with Bi-level and then if unsuccessful also try ASV.

I'm working through discomforts right now such as chipmunk cheeks (hoping this with sort itself out with a bit of training) and the Dreamwear Pillows Mask being way too loud for me to tolerate (going to find another mask today).

I've attached Oscar data from the 1.5 hours I managed to keep the machine on last night. I figure the first cluster of CAs are sleep onset ones and not concerning. Are the problematic areas of breathing look like typical flow restriction and do I simply need to try increasing the minimum pressure?

Cheers,
Jimbu

[Sleeprider]

You appear to be using the Auto SV in an auto BiPAP mode with EPAP 6.5-10.0 and minimum and maximum PS at 4.5. Events appear to be clustered, and I suspect the three clusters of uneven breathing are positional obstruction causing some airway resistance as well as the events. https://www.apneaboard.com/wiki/index.ph...onal_Apnea The Philips algorithm is notoriously slow to respond to obstruction and flow limitation, so you first need to read the wiki linked above and see if avoiding chin-tucking and tall or multiple pillows or positions that restrict your airway to see what that accomplishes. If you need more help, we can look at increasing EPAP a bit and maybe adding some range into the PS.

I'll disclose, I am not a big fan of the Philips devices which are all recalled in the U.S. and not available for sale based on a consent agreement. This is why they are available at a bargain price. I consistently see better results on the Resmed Vauto or ASV. I don't really see a need for ASV for you, but I know there are some advocates in using ASV for UARS or flow limitation.

[jimbu]

Thanks for the feedback, Sleeprider.

I'm in Australia, so the Philips units are still available here. I may end up selling this unit and buying a Resmed, depending on how things go.

[SarcasticDave94]

If there's a need for some timing control, unless you absolutely need the ResMed ASV, you may find a surprise. The ResMed VAuto might be all you need. You will not find timing settings anywhere accessible with the ResMed ASV.

That's why the ASV didn't work for me and my complexities.

[jimbu]

If there's a need for some timing control, unless you absolutely need the ResMed ASV, you may find a surprise. The ResMed VAuto might be all you need. You will not find timing settings anywhere accessible with the ResMed ASV.

That's why the ASV didn't work for me and my complexities.

Thanks, mate. Yeah, I was thinking that if I find any sort of success with this machine with a fixed PS on Auto Bipap mode, I'll probably end up selling it and getting the Resmed VAuto.