Turn off Easy Breathe for faster rise time?

[jgriz]

I'm on a Resmed 10 Vauto (S mode), EPAP 4.8, IPAP 9.8 (PS 5), Resmed F40 mask. Most of my events are hypopneas or RERAs. I am sensitive to aerophagia and found I had to turn EPAP down quite a bit. Then I gradually bumped up IPAP until the events went away, but at these high IPAP I get aerophagia again.

When looking at OSCAR, I see the Easy-Breathe waveform doesnt reach full IPAP pressure until the end of inspiration. It seems kind of pointless because I'm already having airway resistance at the beginning of the breath, but there is basically no extra pressure at the beginning! Look at these shallow breathing "flat-tops" and the mask pressure in the attached image to see what I mean.

My first thought is, what if I had more IPAP pressure earlier in the breath? Maybe then I wouldn't need as high of IPAP and could reduce aerophagia. But to change the "rise time" of IPAP, I have to turn off Easy-Breathe. With Easy-Breathe off, I can set the rise time to say 500ms. However, I tested this during the day and the pressure increase feels abrupt and somewhat jarring. Additionally, there is no setting for "fall time" so the pressure just drops to EPAP instantly when inspiration ends. Basically Easy-Breathe off feels like one more point of annoyance I have to deal with trying to fall asleep. I get why it was invented. But if I can reduce the IPAP and reduce aerophagia while still eliminating hypops/RERAs, it might be worth it.

Another option is to reduce IPAP while increasing EPAP, to try to provide more pressure at the beginning of the breath with Easy-Breathe on, but I've already experimented quite a bit with higher EPAP/lower IPAP and did not find suitable settings. Basically the whole reason I went to bilevel in the first place.

I have also tried nasal masks but still got just as much aerophagia and had a hard time keeping mouth shut with chinstraps, tape, etc.

Anyway, I just want to hear from anyone who has been in a similar situation or has turned off Easy-Breathe. Or would I be the only person in the world on a ResMed without Easy-Breathe? Am I going down the wrong path? Or does anyone have any other tips for eliminating shallow breathing/flat-tops?

[Deborah K.]

I don't know what Easy-Breathe is. I'm guessing others don't as well. Are you referring to raising your PS (pressure support)?

[SarcasticDave94]

ResMed Easy Breathe, Per Sleeprider in post about an Easy Breathe thread inquiry called What does EasyBreathe do? (thread), and is located here:

Easy Breathe description (post)

"Easybreathe™ shapes the transitions in bilevel machines fro square wave (on-off), to a wave-form that looks like the familiar cresting wave you see in the Oscar mask pressure chart. With easybreathe, the pressure rises very quickly from EPAP with the rate of increase decreasing near the apex of inspiration (IPAP). Pressure from IPAP drops off very quickly as expiration begins but slows near the nadir of expiration. These wave shapes actually nearly mirror each other. Easybreathe is used in both VPAP pressure support and CPAP EPR. It can be turned off in VPAP S-mode and is not available in ST."

[Sleeprider]

I'd like to see a more complete graph with the respiratory statistics and settings included. Our preferred format is linked in my signature "Organizing your Oscar Charts". I am seeing some pretty severe flow limits in the included graph followed by an arousal. That is RERA. The real question is how frequently does this level of flow limitation occur and does it occur in clusters with a relatively open airway at other times. I'm not going to speculate until I see some better data. Turning off EasyBreathe™ is not the answer.

[jgriz]

Sleeprider, thanks so much for taking a look at my data. I'm glad to hear that messing with EasyBreathe isn't a good way to go. I have attached some additional OSCAR data as requested:

11-22-24.png: Overview of a recent night which demonstrates several common events. I only used the machine half the night due to aerophagia however.
11-22-24_event.png: A zoomed in view of some events that look like hypopneas or RERAs.
11-11-24.png: Overview of an earlier full night at a lower IPAP with similar events.

Many thanks to anyone who kindly offers some insight into how best to proceed dealing with these events while minimizing aerophagia.

[Sleeprider]

Your are using VPAP-S mode which is fixed pressure, and in spite of your settings for PS, your actual PS is at 4-cm with 8.8/4.8 (IPAP/EPAP) on the November 11 chart and PS 4.8 on November 22 (9.9/4.8). I'd like to see you go back to Vauto mode because we don't get an accurate reading of flow limitation in S-mode. I think you need a slightly higher EPAP min and we will let the pressure vary automatically until we find what works best. For starters, lets use these settings:
Mode Vauto
EPAP min: 5.0
Max IPAP: 14.0
PS: 4.0
Trigger Sensitivity: high
Cycle: medium
Ti Min: 0.3
Ti Max 2.8

I want qualitative feedback on how you feel and charts similar to the one on 11/22 with the data in the left column.