One Year Anniversary and Perplexed

[Spy Car]

At least the doctor will be able to read the Oximetry data. Dissapointing that I won't be able to.

[pholynyk]

I seem to recall seeing somewhere that SleepyHead does indeed import the ResMed Oximeter data along with the othe sleep data - no extra import step. You are the first person I've heard of to get the ResMed oximater (made by Nonin, I've heard), so I hope you will try SleepyHead and report back to us.

[Spy Car]

Horrible. awful, terrible night!

Way too much IPAP pressure. I don't think I slept a wink and still had very bad numbers. Feeling wrecked.

I need to communicate with my sleep doc, who seems open to me doing what I want (which means this is "on me"), so I all ears on advice. But last night was a wipeout.

Bill

[Spy Car]

I seem to recall seeing somewhere that SleepyHead does indeed import the ResMed Oximeter data along with the othe sleep data - no extra import step. You are the first person I've heard of to get the ResMed oximater (made by Nonin, I've heard), so I hope you will try SleepyHead and report back to us.

I tried to import Oximetry data from the SD card (assuming that is where it is stored), but was unable to get the Sleepyhead Oximetry Wizard to see a compatible device. Sorry.

Bill

[Sleeprider]

I hate to say I told you so, but...

I think this was predictable. I still thought it best to follow the suggestion of the doctor and at least have a reason for rejecting that prescription. You were showing indications of CA with the limited pressure support/EPR of the Autoset.

[Spy Car]

I hate to say I told you so, but...

I think this was predictable.  I still thought it best to follow the suggestion of the doctor and at least have a reason for rejecting that prescription.  You were showing indications of CA with the limited pressure support/EPR of the Autoset.

What do I do now? Last night was torture. The pressure impacted my ability to sleep, felt unnecessarily high, and drove up my numbers.

Previous attempts at reducing the EPR on my AutoSet (something I tried a number of times) also had bad results for me.

The 5/13 setting with the AirCurve (PS4) gave a very weird imbalanced quality to my breath. "Exhale" seemed like it might have been OK, but for the contract of strong inhale pressure. Together it was bad.

I'll need to write my sleep doctor an email soon. Based on past meetings I suspect I will hear: "what do you want to do?" with respect to the settings of this Bi-level.

So what do I do tonight? 

Bill

[Sleeprider]

Spy Car, if we were trying to resolve hypopnea, I'd be very supportive of the idea that a bilevel might help.  If you want to resolve CA, the correct machine is an ASV.  In your case you are probably marginal for getting insurance coverage of ASV due to low events, but i'm confident that if you had it, your events would be near zero.  

The trial of the Aircurve 10 will be interesting, but I agree with Walla Walla that pressure support is more likely to increase central events.  Anyway, the bilevel works to maintain your EPAP to prevent obstructive events, then can apply pressure support for hypopnea, flow limitations and other inspiratory obstructive events.  I will be interested to see the difference (if any) in how it responds to your needs.

That is what I posted previously, and I think that about covers your experience.  Let's try this:
EPAP min 6.0
PS 2.0
IPAP max 12
Trigger Low
Ti Min 1.0
Ti Max 2.0


This lowers pressure support, and requires the trigger at low delays onset of IPAP.  The Ti settings should give you plenty of time to complete inspiration.

[Spy Car]

Spy Car, if we were trying to resolve hypopnea, I'd be very supportive of the idea that a bilevel might help.  If you want to resolve CA, the correct machine is an ASV.  In your case you are probably marginal for getting insurance coverage of ASV due to low events, but i'm confident that if you had it, your events would be near zero.  

The trial of the Aircurve 10 will be interesting, but I agree with Walla Walla that pressure support is more likely to increase central events.  Anyway, the bilevel works to maintain your EPAP to prevent obstructive events, then can apply pressure support for hypopnea, flow limitations and other inspiratory obstructive events.  I will be interested to see the difference (if any) in how it responds to your needs.

That is what I posted previously, and I think that about covers your experience.  Let's try this:
EPAP min 6.0
PS 2.0
IPAP max 12
Trigger Low
Ti Min 1.0
Ti Max 2.0


This lowers pressure support, and requires the trigger at low delays onset of IPAP.  The Ti settings should give you plenty of time to complete inspiration.

I don't really understand the intricacies of these settings the way I know you do, so please allow me a few questions/comments.

First, is there a way to get into "airplane mode" if I want to experiment with the settings during the day for comfort?

When I tried EPAP at 6 (briefly) in the office yesterday it felt strong to me. Not sure I could take it.

The IPAP of 13 last night was so strong that I fear 12 won't be much more comfortable. What makes you not support lower?

I don't fully understand the PS support function. I do know with EPR at 2, 1, or 0 my experience has been poor with my AutoSet 10.

I also have no idea what Ti numbers accomplish. What I do know is if I can't get a complete exhale and half-a-beat after before I begin inhalation, I can't sleep. Of all the comfort issues I have, being "beaten to the punch" is the one that seems most problematic. Do these settings speak to this issue? Or is the "Trigger" setting involved?

I appreciate the help immensely!

Bill

[Walla Walla]

Spy Car, Nothing is really going to work to fix your CA's except an ASV machine. Sleeprider is giving you a EPAP that will try and knock out some OA's while at the same time trying to keep your Pressure Support to the min. The more you increase Pressure support the more CA's you'll have. He's trying to help you in a no win situation.

[Spy Car]

Spy Car, Nothing is really going to work to fix your CA's except an ASV machine. Sleeprider is giving you a EPAP that will try and knock out some OA's while at the same time trying to keep your Pressure Support to the min. The more you increase Pressure support the more CA's you'll have. He's trying to help you in a no win situation.

I'm just trying to understand my therapy. I'm open to the idea that it may take an ASV machine to fix the problem.

Meanwhile, I need to get some sleep. Last night was worse than no machine at all (by a wide measure).

I've also tinkered enough to see how my system responds to changes. Reduced EPR on my AutoSet has not led to good results in the past, so I raise the experiences.

I also know that being "beaten to the punch" is a bad feeling for me, so if there are settings that control this aspect of timing I'd like a beat after a full exhale.

I don't think I got any sleep at all last night. On top of already feeling bad, it didn't help.

I do not understand the intricacies of machine stratagies—and doubly so with Bi-levels—the only thing I have going is that I've paid attention to how I feel and have watched my charts over the last year.

So I'm seeking to find the compromises that take into account my experiences thus far, and can't get there without the help of people with more expertise than my own.

Bill