BiLevel Help Spikes

[Tiz12]

can someone look at my charts?
my breaths look very spiky to me. 
what can i do to round them out?
i had until now a resmed 11 and the breaths were not pointy like this.

thank you.

[coutherino]

If you are on the same pressure (which I assume you are) my guess would be something to do with rise time. Do you know if you had a set rise time on your AirCurve 11, or if you had Easy-Breathe on? If you don't know what either of those things are I'll do a quick explanation, feel free to skip the next paragraph if you already do.

Rise time is essentially just the time it takes to go from your EPAP to your IPAP once your machine senses you breathe in. If you have a fairly low rise time at, say, 200 ms, the switch will be very quick. And if it's something higher, say 500 ms, it will obviously be much slower. If Easy Breathe is on, it disables the rise time setting, as it basically just automates that process. It's a ResMed based algorithm that adapts to your breathing rate to try to provide a smooth switch between your EPAP and IPAP. I'm pretty sure Lowenstein machines have some variation of Easy Breathe, but I don't know what it's called. Changing these settings can definitely affect the waveform of your breaths. 

If the slight flattening of the waveform isn't causing you to have arousals it shouldn't be a problem. Your flow rate graph looks pretty good for the most part to be honest. If it's something you really want to fix, raising your IPAP by 1 or 2 should smooth them out more. It would probably be more difficult to mess with your rise time if you aren't experienced with that, and even then it might not fix it. That's just my theory on what's causing the difference on presumably the same pressures.

[Tiz12]

Thanks so much
Actually I had a resmed apap not a bilevel. But never had such high spikes with any settings on the apap.
Will raise the ipap and see what happens.