BiPAP Therapy

[nearenough]

Hi everyone,

Thanks for the suggestions on making the switch to BiLevel.  Gideon suggested starting with a baseline, so here's last night's data; more will come as more is collected.

Initial impressions - The prescription settings yielded an AHI of 3 which is high for me compared to my AirSense 11 settings (13cm, EPR=3), and I'm seeing my typical pattern breathing episodes with Central Apnea clusters.

The out-of-the-box settings on my AirCurve are:

Mode  - VPAP Auto
Min EPAP - 7
Max IPAP - 13
PS - 4
Ti Max - 2s
Ti Min - 0.3s
Trigger - Medium
Cycle - Medium

It was suggested previously we can try and titrate out the CAs.  My understanding is to incrementally set Trigger to High & evaluate, and then if necessary Very High & evaluate.  

Is that the correct game plan?

As far as settings, does it appear that I need to change Ti Min, Ti Max, or Cycle?


Thank you for the help as I begin dialing in the new machine!

[Sleeprider]

Looks very promising! I think the CA events merit moving trigger to high at this point. I:E times look very good, and nothing suggests a need to change from the defaults. We don't ever change cycle unless there is an overriding COPD or other concern. You seem to have a fairly long expiratory time, but that is not generally a problem. We're looking for comfort and a sense that you are synchronizing well with the machine and not experiencing sleep disruption.

[nearenough]

I'll make that change and post the results tomorrow.

I'm glad you saw the long expiratory time - I missed that.  A quick scan of the last couple months showed an average Median of about 1.85s and an average 95% of about 2.4.  

I'll be curious to see if/how it changes with pressure support that's broader than what the AirSense11 was able to provide.  My PCP hypothesized that my fatigue was from working to exhale for 7 hours per night, and that BiLevel PS would make it easier to breathe naturally.  It's my understanding that apneas never happen when exhaling, so who knows.

Regardless, I'll up the sensitivity on Trigger only and post a fresh set of charts tomorrow morning.

[nearenough]

I think the CA events merit moving trigger to high at this point.  I:E times look very good, and nothing suggests a need to change from the defaults. 

I set Trigger to high - here are the results.  A few CA events, but they're spread out instead of in a cluster.  I still see the sawtooth pattern breathing between the CA events.  I'm not sure how common that is.  Does it make sense to make further adjustments?

Leak rate is higher given I'm trying a new mask.  Exp. Time is still higher than typical, but it feels to me like I'm not fighting to exhale.  Maybe the increased Exp. Time is related to the reduced EPAP as compared to my APAP machine.

[Sleeprider]

Looks pretty darn good and the variable breathing is not very pronounced. I think you stick with this to develop a baseline for any future changes. I think the period you show in the close up would have had several additional CA events without the trigger, but you are being stimulated to spontaneously pace your own breathing at a relatively stable volume and rate, and are not showing a persistent CO2 feedback loop that we associate with the apneic threshold.

[nearenough]

That's fantastic.  I'll keep collecting baseline data and reach out if anything goes sideways.

Thanks again!

[nearenough]

Looks pretty darn good and the variable breathing is not very pronounced.  I think you stick with this to develop a baseline for any future changes. I think the period you show in the close up would have had several additional CA events without the trigger, but you are being stimulated to spontaneously pace your own breathing at a relatively stable volume and rate, and are not showing a persistent CO2 feedback loop that we associate with the apneic threshold.

Here's what I have so far as a baseline with trigger set to High, still at 13/7 cmH2O.

I'm experiencing more centrals and a higher AHI than usual, also trying to adjust to nasal pillows (instead of an F30) and wondering if I should try the Very High trigger setting to further reduce CAs.

Thoughts?

[Sleeprider]

Set trigger to very-high and let's see if that resolves this. If not, we may gently back off on pressure support. Please consider updating your profile to show the Vauto. I sometimes take a quick look and realize from the charts you're using a different machine than appears below your user name.