fishfinderG - Therapy Analysis

[fishfinderG]

Hi everyone,

I've been on APAP for 5+ years and recently came across a used VAuto for a decent price and decided to give it a try. My Resmed Airsense 10 is getting pretty old and I want to see if BiPAP is useful before it's time to replace my Airsense 10 through insurance.

The reason I'm interested in BiPAP is that I have very few events on APAP but need to use EPR=3 to avoid aerophagia and I'm hoping that on BiPAP additional pressure support can can further optimize my treatment without waking up feeling bloated. 

I also have very bumpy inhales and exhales and want to see if more pressure support helps smooth out my flow. I know cardioballistic effect is not an issue but I also have bumps on the inhale and exhale flow which I think is either flow limitation or soft tissue flapping around?

   



Here are my sleep study results from 2018. Nearly all hypopneas. 

   



And here is a recent night

   



What settings are important to configure on VAuto when translating from my current settings?

Thank you!

[Crimson Nape]

Based off your AS10 chart, I would start at a VAuto setting of:
EPAP: 6.4
IPAP: 12.0
PS: 4
TiMax: 3.2
Don't change any other parameters just yet.

Over the years, I find it rather intriguing that most people seem to gravitate to a pressure area around 10 to 12 and a PS of 4.  

Good luck!
- Red

[fishfinderG]

Thank you so much, Crimson Nape. First night at these settings was a little rough with insomnia and waking up a bunch but I know that it takes a few days to adjust to a new pressure support and algorithm. Overall, it felt much better on exhale than APAP and my flow is much less bumpy on inhale and exhale which is exactly what I was hoping for.  It looks like my inhales are more rounded when IPAP is above 11 but I'll check if that holds true a few more nights before adjusting anything.


   

[Crimson Nape]

Very nice! You might try setting the Trigger to High to address those occasional CAs. Also, please post a 2-3 minute zoom so we can see your Flow Rate waveform. Anywhere in the graph will suffice.
- Red

[Crimson Nape]

As an afterthought, I am changing your thread title to "fishfinderG - Therapy Analysis" so it will be a more inclusive title. That way, you can use it for all your therapy related posts.
- Red

[fishfinderG]

Thanks. 4/5 of the centrals appear to be real. I'll try setting trigger to high if they persist tonight.

Here's a zoom of flow from a part of the night where tidal volume was relatively stable while using the Aircurve 11 at IPAP of 10.72

   

Looks better than what I'm used to seeing in previous APAP nights at similar IPAP on Airsense 10
   

[Crimson Nape]

The waveform looks good, indicating that you are at or close to the optimum PS value.   The second one looks like it may be positional. Stay off your back.

Good job!
- Red

[fishfinderG]

Second night I didn't struggle with insomnia at all and don't remember waking up as much. CAs are up so I'll try setting Trigger to High for tonight to see if that helps.

   

[fishfinderG]

Here's my first night with Trigger set to High. I woke up feeling quite groggy and around 30 minutes before I normally wake up. I did have a beer an hour before bed which I know negatively impacts my sleep so I'll have to see if future nights are better when I'm not drinking. Heartrate was 70-85bpm as opposed to my regular 58-85bpm - but I know drinking also impacts that.

With Trigger=High, the excess CAs are gone which seems like an improvement even if I woke up feeling extra hazy. 

   

[Crimson Nape]

Looks good!  I'd let these settings ride for a while.  

I hope you're not expecting an AHI of 0.0 as the final target, please don't.   While they can happen, it is not a realistic goal to expect to see.  Just savor them when and if they do occur. I just thought I would throw this in here, as many new pappers see this as the ultimate goal and become disillusioned when they can't achieve it.

You're doing great, just lay off the beer so close to bedtime.

- Red