I can't exhale very well.

[mraroid]

I tweaked my numbers and tried on my mask.  It has hard to exhale.  So I put the numbers back the way they were before I changed them.  The next night I put on the mask, and my breathing seemed OK.  But I woke up breathing through my mouth.  I closed my mouth but the pressure from the machine seemed too strong for me to exhale.  I struggled with it for a while and finally gave up and took my mask off. 

I don't know if my machine is going south (it already is 1/2 dead) of if my numbers need more tweaking. 

Here is data from my short, under 6 hours of sleep last night.

http://imgur.com/a/Z1wi5

Any advice welcome. Thanks everyone

mraroid

[Sleeprider]

Charts should show Events, Flow Rate, Pressure and Leaks. Most of the information on the posted charts is not very useful. A closeup of your Flow Rate graph (2-minute segment) showing normal breathing and another of the obstruction cluster may help.

[mraroid]

A closeup of your Flow Rate graph (2-minute segment) showing normal breathing and another of the obstruction cluster may help.

Thank you.  Let me figure out how to do that, and then post.

When I received my first machine, it was called by the sleep doctor a "CPAP" unit. I tried and tried to use it.  If felt like a hurricane was blowing down my mouth when I tried to exhale.  After as few months, they said I needed another type of machine.  They called this one a "BiPAP" machine.  When I used that unit, it seemed like it would stop blowing for a while and let me exhale, then it would blow again. 

So, the EPAP number is the pressure number for exhaling, correct? Am I correct in thinking that the lower the EPAP number, the less pressure my lungs have to push against?

Do I need to turn Bi-flex on to make the above work?  

mraroid

[mraroid]

I think this is a 2 minute shot of normal breathing:

http://imgur.com/a/NbvSa

I could not find a graph for obstruction clusters.  Could it be clled something else in Sleepy Head?  Sorry - new to this.

mraroid

[Sleeprider]

EPAP is exhale pressure, but it is also the pressure we use to control OA. The difference between IPAP and EPAP is called pressure support (PS). Adding more PS to EPAP gives a higher IPAP. The contrast between the IPAP/EPAP pressure can make EPAP seem lower. Right now your machine is only set to a minimum PS of 2.0. Your median pressure is 8/6 and the 95% is 13/11. That is not much contrast, and may be the reason you "feel" pressure is high, and I did suggest changing to PS min of 3.0.

Your pressure is rising due to many obstructive events, and you have not limited how much it can rise. When I originally suggested settings I did limit your IPAP max to 15 cm. You left it at 25 which is fine until you can't tolerate the pressure. Your original settings were something like 13/5 fixed BiPAP S and the PS of 6.0 caused you to have many centrals. So can you see how increasing minimum PS to 3.0 and limiting max IPAP to 15 may make all this a bit easier.

It would help if you could "mark" periods where you feel you are having a hard time exhaling. You can do this by letting the mask leak momentarily, and that large leak will be visible in the graphs so we can identify where the problem is. Most of all, we need to see the graphs I talked about above so we can correlate events to pressure.

BiFlex can make the transitions between inhale and exhale easier by rounding out the flow curves.

[mraroid]

>EPAP is exhale pressure, but it is also the pressure we use to control OA. The difference between IPAP
>and EPAP is called pressure support (PS). Adding more PS to EPAP gives a higher IPAP. The contrast
>between the IPAP/EPAP pressure can make EPAP seem lower. Right now your machine is only set to
>a minimum PS of 2.0.

Looking in EncoreBasic I see that the min PS is set to 2.0 and the max PS is set to 7.0

>Your median pressure is 8/6 and the 95% is 13/11. That is not much contrast, and may be the reason you
>"feel" pressure is high, and I did suggest changing to PS min of 3.0.

OK.  I will change min PS from 2.0 to 3.0

>Your pressure is rising due to many obstructive events, and you have not limited how much it can rise. When
>I originally suggested settings I did limit your IPAP max to 15 cm. You left it at 25 which is fine until you
>can't tolerate the pressure.

I am sure I was confused. Looking in EncoreBasic, I see that IPAP max is/was set to 14.0.  I am unsure when I changed that setting.  I can change that to 15.0

>Your original settings were something like 13/5 fixed BiPAP S and the PS of 6.0 caused you to have many centrals.
>So can you see how increasing minimum PS to 3.0 and limiting max IPAP to 15 may make all this a bit easier.

I am going to take your word on this.  I am just not there yet. 

>It would help if you could "mark" periods where you feel you are having a hard time exhaling. You can do this
>by letting the mask leak momentarily, and that large leak will be visible in the graphs so we can identify where
>the problem is.

OK.  I will try that tonight.  It seems that things are OK when I put the mask on and go to sleep.  But then, I wake up with my mouth open and when I close it, it feels like I can not exhale. 

>Most of all, we need to see the graphs I talked about above so we can correlate events to pressure.

Can you tell me where to look for this data in Sleepy Head?  I could not find a graph for obstruction clusters.  Perhaps I have that graph turned off?  In Sleepy Head, under Daily, and under the Events tab, I find "Obstructive Events" (51 of them).  Is this what you are referring to?

>BiFlex can make the transitions between inhale and exhale easier by rounding out the flow curves.

Perhaps that would be helpful?  Looking in EncoreBasic I see that I have BiFlex turned off. Should I turn that on?

mraroid

[Sleeprider]

As far as current settings and max IPAP I was going by the Sleepyhead chart: Min EPAP 5.0, Max IPAP 25 PS 2.0 to 5.0.

I was suggesting a minor change to Min EPAP 5.0, Max IPAP 15.0, PS 3.0-5.0.

[mraroid]

I see discrepancies between what Sleepy Head and EncoreBasic report. I can see my data change in EncoreBasic.  And when I put the SD card in my unit I can see the changes.  So I tend to trust EncoreBasic more.

Here is what I see in EncoreBasic

http://imgur.com/a/Bro4Z

I have made the changes you outlined.  I am going to take the machine on a test run for 30 minutes and then try it tonight.  I will report back.

Thanks so much!

mraroid

[Sleeprider]

I agree the discrepancies are there, and I would have to give the benefit of the doubt to Encore.

[ajack]

The sleepyhead has that glitch with some machines and show max epap as the max of the machine pressure, even though you can't set it that high.

I read a 3cm PS has a 50% reduction in breathing effort, if you are still finding it hard to breathe out, you could set the min PS higher. As your tune your bpap, you may need to raise the min epap for the oa/h a bit at a time, keeping an eye in the CA. You need to treat the oa/h and at the end of the day if the ca are too high, you may need to swap to an ASV if your heart is ok. Given you have just bought a new machine, it is the last option on the list.

are you using a nasal mask and mouth breathing? your tidal volume is low. you may be better in a full face mask while you are setting up your machine.