My Journey from BiPAP Auto to Aircurve 10 Vauto

[staceyburke]

I can see that the O2 and tidal volume are almost the same.  But is there anyway to increase the tidal volume?  Numbers are great and I feel a little tired all day but not nearly as much.  So I guess I am asking if there is anything to worry about with the tidal being so low?

[Crimson Nape]

I had a low TV as well.  I tried the Positive End-Expiratory Pressure (PEEP) concept and had very good results.  It consists of increasing your EPAP pressure until you get within a TV value you desire.  There are limits to this, but you can worry about that later.

[Sleeprider]

The best conventional opportunity for gaining increased tidal volume and minute vent lies in pulmonary recruitment as described by Red as PEEP. I believe we tried this earlier in your therapy by increasing EPAP min, but we ended up with lower SpO2, in part due to the way your oxygen bleed was configured at that time. Another approach we talked about was EERS incorporating both oxygen and CO2 enrichment. This should have the combination of higher FiO2 and enough rebreathing of expired air to stimulate respiratory drive.

I’m on the phone and will get back to this.

[staceyburke]

I am trying to raise my tidal volume up.  I have raised my Epap for 2 days and will continue to raise it.  Now at 10.2 tonight 10.8.  How should I share the information?  Only the tidal Volume or the left column or all of the night report?  Or any other combination?

[Sleeprider]

I think you can just track pressure, median respiration rate, tidal volume and minute vent in a table and see if anything moves.

[staceyburke]

After several nights of raising my low number, trying to increase my Tidal Volume these are my numbers.  Any suggestions - do I keep raising the bottom number- started at 9.4 now at 11.2

[staceyburke]

All my number are still very good.  I would like to ask a question and maybe sleeprider will add to my knowledge.  I have always had problems with leaks.  I have tried about every thing to stop them (mouth guard, taping).  My O2 goes down when I have leaks and that is a concern for me.  I recently cut back on my min pressure.  I have had 9.4 from the beginning using the VAUTO.  I reduced it to 7.4 and my leaks have gone down.  I have put on this post different nights.  The top ones are at 7.4 the bottom ONE is at 9.4.  The only explanation I can come up with is at the higher pressure it was forcing air through my mouth and at 7.4 it does not have enough pressure to do this.  Could this help others that have nasal pillows to reduce their leaks also?

[Sleeprider]

First, your respiration volumes and SpO2 all dropped with higher pressure and PS. I would get back to what worked best. Leaks are your worst enemy for maintaining good oxygen saturation. I don’t have any suggestions for reducing them other than what we have already discussed.

[staceyburke]

As you can see my numbers are great.  But I have not been sleeping well and the amount of sleep is not as much as I had been.   This was my longest night of sleep in a week.  Most times I am up around 5 and have about 6 hours of sleep.  I was looking at my breathing and I don't know if this is just turning over in bed or if it is something else.  Could one you please take a look and give me some advice.  If you need other graphs let me know.  Thank you!

[Sleeprider]

The disruptions in flow rate appear to be arousals. There is nothing there we can really do to improve on AHI 0.00 or your respiratory stats. The oxygen desaturations are all related to leaks as the oxygen bleed becomes highly diluted during leaks. I wish I had a magic bullet for everyone that seems to have optimized therapy, but don't feel as good as they think they should. I don't and can only suggest if there is an answer, it lies in health solutions outside of the PAP therapy.