megabill - Apnea Therapy

[megabill]

I feel a kinship with this poster.  I too have been on CPAP with great success  until 2022 when switched to BIPAP after 2 totally botched sleep lab tests.
I may post the saga of the tests later.  We all need to watch out for botched tests!!  We also need therapy that is comfortable enough to not deter us from using the therapy!!  The original settings produced a great AHI, but I was only able to sleep infits and starts,  never longer than an hour at a time before being awakened by pain and suffering!  Sleep deprivation is not a viable solution.

I have learned a lot from reading the forums and have improved my experience to a point.  Having now run into a wall, I need the benefit of external wisdom.

I am going to start by posting the 'daily' from Oscar.  I would appreciate advice on where to go from here.  My goal is better results without jacking up the pressure to absurd  levels.

My thanks in advance!

[Crimson Nape]

megabill - In order to avoid hijacking another member's thread, I have split your post into its own thread. I have renamed it, megabill - Apnea Therapy. The new title should be more inclusive of your posts as your therapy progresses.

I am sending you a PM outlining the splitting of your post into its own thread too.

- Red

[Sleeprider]

Megabill, it will help if you will give us some medical history so we know why you are using ST therapy. On your charts, we are going to need to see the flow rate, events, Resp rate, minute vent. I think especially the flow rate chart will give us more insights, and I will probably ask for some zoomed images so we can figure out why your respiration rate varies so much. Your median respiratory statistics look great, but it's obvious there is a great deal of variation. With some medical history, especially any cardio-pulmonary issues and some better charts, I hope we can give you some insights on where this therapy needs to go. If you are being treated for central or complex apnea you are using the wrong machine.

[megabill]

I am relatively new to BIPAP after nearly 20 years on CPAP.  I am having difficulty with how the various settings affect therapy.   I have a resmed aircurve 10 ST.  

Specifically, for this post,  I am interested in the trigger settings.  There is one for start of a breath and one for cycle.  How do they work? Does a LOW setting make it more sensitive to a patient initiation or less?  What affect do these have on AHI or therapy in general?

My thanks in advance.

[Crimson Nape]

megabill - As I stated in my post above and in the PM I sent you, please keep all your therapy questions in the same thread. I have merged your latest thread into this thread.

- Red

[megabill]

Hello Sleeprider,

I had a heart attack in 2005, ultimately resulting in 3 stents in LAD. Stable since. Regular visits with cardiologist, (most recently two days ago, and both rhythm and ejection fraction are fine.) Was sent to a sleep specialist by the cardiologist who treated me, she seemed to think sleep apnea was involved.  
Have since been on CPAP and same sleep doc.  Treatment was great and AHI was nearly always under 5 until suddenly not.  (I also have continual nasal congestion and drainage into the throat sometimes so thick that it results in a cough until it is expelled.)  Was sent to new sleep study April '22. Sleep lab was told I needed an articulating bed or recliner due to back problems. Tech running test insisted on spending time from 9:30PM til 2:30AM having me in a flat bed.  I did not sleep.  He then brought out a broken "rocker" recliner in which I sort of slept.  Turned out doc had ordered  bipap titration and tech performed CPAP titration which did not provide any new data. 
Doc then sent me to a sleep lab run by a different hospital group.  The same dork was the technician  who again wasted time with a standard bed until  at 3AM finally bringing out -- gee -  a broken recliner (does every lab have one of those?)  This one would stay reclined until I fell asleep. Then it would pop into sitting position, waking me. Therefore the results of this test are suspect. 
Using the lab recommended  high pressure settings gives good AHI, but terrible sleep - too harsh.  dries out mouth, and nasal passages feel like they are host to impaled goose feathers.  Humidifier works (at least it uses up most of the water) but none of the humidifier settings doc and I have tried make any difference.   Mask farts also waked me often.  After that, it was nearly impossible to get back to sleep.  Have averaged less than 5 hours per night whereas regularly slept all night while on CPAP.
Doc is retiring in a month and has referred me to the sleep medicine clinic at University of Michigan, but I have to wait until late July for their first available appointment.  Meanwhile, he has encouraged me to reconfigure the settings so that it is comfortable enough for me to use the machine and still sleep.  And that's why I am here.
Where is the best place to get the data you've requested?  I could take photos of the settings screens, but I suspect there may be a better way.  Please advise.
Thank you.

---

Hello Sleeprider,

I had a heart attack in 2005, ultimately resulting in 3 stents in LAD. Stable since. Regular visits with cardiologist, (most recently two days ago, and both rhythm and ejection fraction are fine.) Was sent to a sleep specialist by the cardiologist who treated me, she seemed to think sleep apnea was involved.  
Have since been on CPAP and same sleep doc.  Treatment was great and AHI was nearly always under 5 until suddenly not.  (I also have continual nasal congestion and drainage into the throat sometimes so thick that it results in a cough until it is expelled.)  Was sent to new sleep study April '22. Sleep lab was told I needed an articulating bed or recliner due to back problems. Tech running test insisted on spending time from 9:30PM til 2:30AM having me in a flat bed.  I did not sleep.  He then brought out a broken "rocker" recliner in which I sort of slept.  Turned out doc had ordered  bipap titration and tech performed CPAP titration which did not provide any new data. 
Doc then sent me to a sleep lab run by a different hospital group.  The same dork was the technician  who again wasted time with a standard bed until  at 3AM finally bringing out -- gee -  a broken recliner (does every lab have one of those?)  This one would stay reclined until I fell asleep. Then it would pop into sitting position, waking me. Therefore the results of this test are suspect. 
Using the lab recommended  high pressure settings gives good AHI, but terrible sleep - too harsh.  dries out mouth, and nasal passages feel like they are host to impaled goose feathers.  Humidifier works (at least it uses up most of the water) but none of the humidifier settings doc and I have tried make any difference.   Mask farts also waked me often.  After that, it was nearly impossible to get back to sleep.  Have averaged less than 5 hours per night whereas regularly slept all night while on CPAP.
Doc is retiring in a month and has referred me to the sleep medicine clinic at University of Michigan, but I have to wait until late July for their first available appointment.  Meanwhile, he has encouraged me to reconfigure the settings so that it is comfortable enough for me to use the machine and still sleep.  And that's why I am here.
Where is the best place to get the data you've requested?  I could take photos of the settings screens, but I suspect there may be a better way.  Please advise.
Thank you.

[quiescence at last]

hey. hope you can get good ideas for trigger and pressure and what sort of PS pressure support will be the most comfortable, and hope that is also most effective at reducing sleep irritants. slightly higher pressure should reduce the H count (Hypopnea), and the higher PS values can increase CAs.

my biggest tools for combating face-fart are (1) fabric pad between the mask and skin and (2) regularly obtain new elastic straps. A worn out strap can make the length change too much between low and high pressures, and that leads to overtightening in an attempt to find enough tightness for the high pressure.

I imagine many of us have problems with the mouth nose and even throat and tracheal goose-feather bone-dry surfaces, and all that too dry to move phlegm crust. I do alot. The level of trouble this causes in directly related to the amount it prevents or disturbs sleep. My example is probably the best of all worlds (besides no problems at all); I generally waken about 1.25 to 1.75 hours after falling asleep, nearly always after finishing a sleep cycle thru REM. I generally fall asleep initially within 7 minutes and often quicker. I can sleep anywhere, and get back to sleep easily. So, getting up and visiting the bathroom or the kitchen, to clear sinuses and wet the throat, it doesn't bother me getting back in bed and falling asleep. There are so many things that make it much harsher for those who cannot fall back asleep, or wake up in pain.

throat dryness does not hit me as much if I have a few nuts or nut oils before bed or upon waking. macadamia or cashew work the best, and I have never tried fish oils or non-descript omega oils.

Best of luck,

QAL

[Sleeprider]

Bill, I can't see from the full-night view what is giving rise to the high event rate. It would help to look at a zoomed view of your flow rate and mask pressure to see why you have such poor efficacy. Usually a 3 to 4 minute segment gives us a view of the respiratory flow wave that lets us see if you need more or less pressure support and if the timing is a problem. I will say I am not a fan of the ST machine for most patients and prefer the Vauto for spontaneous breathers, ASV for those with central or complex apnea, and in severe cases of hypoventilation or pulmonary disease (COPD) the ST-A is a better machine. See if you can produce some zoomed images and I'll do my best to suggest something.

For most people the TiMin does not need to be changed unless we see the patient often initiates a breath but does not complete it, or has a double-inspiration wave. In this case we may increase the TiMin to an appropriate value to ensure a minimum time for IPAP pressure to ensure a breath. TiMax is changed when inspiration is longer than 2-seconds and we are not concerned with expiration time. Trigger and cycle sensitivity affect timing of the changes between EPAP and IPAP. These are things we can see better with the zoomed flow rate images I asked for above.

[Lucid]

Hello, megabill

Here are links (stolen from Crimson Nape's signature   that will help you organize and post your charts:   

OSCAR Chart Organization
Attaching Images and Files on Apnea Board

With respect to dry nose, try Ayr Saline Nasal Gel No-Drip Sinus Spray.  I try to remember to use it a couple of times during the day or a few hours before bedtime.  It's not medicated, so you can use as much as you want.  For me personally, though, if I use it right before I go to bed it feels like I need to blow my nose, but that could be just me.

For dry mouth I've been using Biotene Dry Mouth Moisturizing Spray.  I think it may be discontinued, but there are other similar products.  Many people like Xylimelts.

[megabill]

here are snips.  If these are not suitable please advise how to get better ones.