Appreciate help adjusting settings (UARS)

[slowriter]

BTW, @cmcphee - note the improvement in your FL?

[cmcphee]

Thanks everyone! I will monitor and check back in in a week. Excited to see things trending to the positive. Do I leave PS alone for the week or tinker with moving 4 up to 5 or 6?

[Gideon]

Increasing PS is for managing obstructive events, hypopneas, flow limitations, RERAs, UARS and at times it is changed, not always up, to help with comfort, not enough air or aerophagia.
I would leave it as is unless you can give a reason to change it. Increasing it is also likely to increase the central apnea.

[slowriter]

... Do I leave PS alone for the week or tinker with moving 4 up to 5 or 6?

Your FL results currently look similar to mine at 6, which is to say really good.

I'd give it a week, or a couple/few weeks, stable. See how you're feeling, and what happens to those CAs.

[mper6794]

Hey team,

On the vAuto now. Here is my first night. Please let me know any additional charts that would be helpful. Could you please help me update settings?


Hi, cmcphee
It looks promissing your first night on BPAP, with EPAPmin: 5.0 and PS:4.0. It appears you, finally, has given the first step to treat and overcome your AFR (air flow reductions); P95 FL(flagged): zero, Max < some 0.10. My suggestions for now would be:
1- raise EAPmin to 6.0; maybe….it appears your flow were asking for some more pressure?
2- start exploring why you keep awakenings so many times, as first appears (let us see ten-minutes windows to explore this);
3- aiming at exploring what is going to be your ultimate optimum PS and (EPAPmin+PS), I would suggest your start plotting three excel graphs: (a) (EPAPmin+PS) x RR (respiratory rate), (b) PS x RR; and © CA’s (has to be recounted by yourself, no Resmed report!) x PS
4- sorry, if I have missed: do you have lab studies?
I was wondering if could post some charts and scales of your full night, from top downward: (1) Pressures (including events; don't need events themselves as soon as they appear on the others); (2) FR (-85 to 85); (3) FL (compressed); (4) TV (max 750, bearing the median reference line as essential); (5) leak. Also some 6 ten-minute window trying capturate constrats on your tidal volumes.
good luck

[alexp]

Updating with a few screenshots of what I think might be RERAs from last night? Let me know if I'm getting this right and I'll post more.

Ex. RERA 1: https://drive.google.com/open?id=1mTZI-b...pV0RIIednB
Ex. RERA 2: https://drive.google.com/open?id=1Z57VYv...1Q7H0HFUsl
Ex TBD??: https://drive.google.com/open?id=1u-F70h...pT1wbJ9oBF

1. Not a rera but several flow limitations resulting in having your body work harder to breath. You see'll in theses cases that the inspiration is a bit longer and the pause between exhalation and inhalation is shorter. Your body does this in order to keep  your tidal volume about the same as if you were breathing normally. 

The little spike you see happens from time to time when you work hard to breath. It's probably your lungs succeeding in opening your airways for a split second.

2. Yes that's look like a RERA. Flows limitations followed by an irregular breath.
3. Looks like you are in REM sleep but hard to tell without seeing the entire night. REM sleep breathing is irregular compare to NREM sleep.

There are two ways to fight flow limitations and RERA. 

1)Reduce the airways resistance by raising the cpap pressure. 
2) Add an external ventilator (what we call pressure support). In simple terms, the ventilator will act like an external lung helping you breath at night. It will increase your flow rate without having your body work harder which results in less RERA.

Hey team,

On the vAuto now. Here is my first night. Please let me know any additional charts that would be helpful. Could you please help me update settings?

Full view: https://drive.google.com/open?id=1tBVmBM...h_PNP_RpQ8
Full view advanced: https://drive.google.com/open?id=1TFL1WA...1IeLYZjaDp
Wakeup 1 - 1 hour (when likely was awake?): https://drive.google.com/open?id=1Yp6Hgj...m54itLoFL6
Wakeup 2 - 10 min: https://drive.google.com/open?id=1zHOpF3...Itfm1W6Qui
Wakeup 3 - 10 min: https://drive.google.com/open?id=1Yp6Hgj...m54itLoFL6

I asked my doctor about a titration to get them right, but she said the machine will titrate itself. I asked the DME, and she said I really need to seek the opinion of a pulmonary sleep specialist (my doctor is a neurology sleep specialist). I am seeing a pulmonary sleep specialist in a week. Should I push for the sleep lab again (insurance rejected last time) or anything else when I meet him?

Huge thanks!

Most of your CA were likely during REM sleep according to your minute vent curve. The same thing happened to me each time I raised the pressure support. Central apneas during REM sleep are extremely rare so I don't think it's central apnea.It's probably your body getting used to the pressure support. I wouldn't worry about it if the events are under 10 seconds.


A clear airways event is just the machine reporting that you stopped breathing for some time and that there was no obstruction preventing you from doing do. That's it. It doesn't mean it was a central apnea. There can  be lot of reasons why you stop breathing for 10 s. REM sleep, especially when you are dreaming, is one possible reason. Just wait one week before doing anything else and see if the number of CA goes down.

[cmcphee]

I'm really struggling to adapt to the bipap. I feel like I'm sleeping even worse because I find it harder to fall asleep on it. Aerophagia still is a huge problem for me. Anyone have any tips on comfort settings I could try modifying?

[cmcphee]

Whoop posted too early, sorry.

Here are the first few hours of last night. After I woke up, I was unable to get back to sleep for the rest of the night. I wore the mask from 330a on, but I found it really hard to breath and couldn't stop focusing on that - almost like the air was overly inflating my nostrils (?).

Couple thoughts:
- Isn't 17 centrals is a lot for two hours of sleep.
- I also noticed that my previous APAP tidal volume 95% (420) is now the median on the bipap. My 95% tidal volume (800) is really high for my BMI.

Charts attached - thanks for any ideas.

[cmcphee]

Another chart that might be useful (sorry for the repeat posts)

[slowriter]

Those CAs the machine is reporting: they are mostly around when you're awake; right?

If yes, I wouldn't worry about them.