Bipap Titration advice needed.

[amafra]

Should I move freely to the sides on my bipap titration tonight? Is it possible to fix aerophagia that happen at high Epap pressures? Pressure above 12 require me to tight down the mask to very uncomfortable levels, what makes prolonged use hard. Move to the side always leak if not very tight. I think most of my leak happen at that time.
Tks

[Rubicon]

Should I move freely to the sides on my bipap titration tonight? 

No.

No no no no no no no no no no no.

You need to make sure supine REM is covered.  If supine REM is covered then everything else will be covered.  There's going to be a small window there so you have to take advantage of it.

It re: leaks let them take of it.  That's what you're paying them for.  And if you're sleeping (as you're supposed to be) they'll find them before you will.

[amafra]

I will keep supine as much as possible. My girlfriend said I was just like dying on the choke when on the side before putting the mask on. I rarely sleep with her in the same room because she can’t sleep at all, my snoring level is too high. She is not used to apnea.

Not sure why side sleep was not recorded on sleep study. 
Thank you very much on advising.

[amafra]

[quote pid='440539' dateline='1648468090']

Hospital just called me, someone will not attend polysomnography and I can go tonight for Bipap titration that was scheduled for end of may. 
Any recommendations?

(updated SD card) https://drive.google.com/file/d/11hWeEtK...sp=sharing



[/quote]
Forgot to say,trigger is set to high as CrimsonNape recommended.

[Sleeprider]

If you have a clinical bilevel titration appointment opening, take it unless you have a reason to decline it. It sure beats guessing.

[amafra]

It would be in two months, rescheduled because someone is not going to attend. I’m here at the clinic already. Thanks

[amafra]

Hey buddies, Bipap titration update
Device: Respironics Bipap Auto Bi-flex is what I could see.
Mask: ComfortSelect Nasal Cpap Mask Large (my size is M, but no M there)
I went to the clinic , around 9:40 - 10:10 pm I took zolpidem and put a mask on. Took me 2 hours to sleep. I woke around 1:35am, took another 10mg of zolpidem and slept until around 3:35 or 4 ish. I don't recall exactly, thanks to zolpidem.

The mask leaked all night below the chin or below the eyes, sometimes I manage to prevent eye leak, always in supine, basically not moving. I have more wires that time than previews. The specialist said some leak will happen and is acceptable like 15. I felt  it was more than 15, but I can't guarantee it, especially considering pressure was at baseline of 4 because I was awake. Bipap settings caused me discomfort when I tried to breathe for a longer period.  I asked the specialist what TI max settings were, seammed 2 to me. He doesn't know what it means and does not know you can change inspiration max time. 
I tried to breathe slowly and longer, the bipap stopped pushing the air around the 2s mark. 

Note:
I'm not sure if I do have any other undiagnosed lung issue. When I was a kid my father usually said that while swimming I got cyanotic bluish skin tone.  My saturation is normally 92-94, it only reaches 97  if I practice some breathing exercises like butenko or box breathing. In the morning I feel I can't fully inhale, I need to force full inhale for a few times, than It seems to open. Using cpap when I wake up it seems it is at full capacity already. I practice sports, cycling, gyn with no problems, always at the beginning, even 2 blocks walk feel like I need more air, and I can't breathe enough, since start forcing or working out, lungs open and I can't fully inhale, It has been always like that so I believe it is normal.

I asked for the pressures and I was informed that it was 10/6. I'm a bit skeptical. I do not have the report yet, but even though I have 8-10 IPAP / 5-6 EPAP on ASVauto mode that can independently adjust Epap and IPAP, it was during good sleep, not preventing apneas afterwards. 

I like to point out that any ASVauto data before 14/15 should be disregarded, patched firmware had issues so I did modifications to it. Not saying it is working correctly, but we need to find inconsistency on ASV after 15. We had doubts if patched firmware would allow incorrect ASVauto to work correctly, a sudden drop on IPAP has been noted on my graph and I decided to look for another ASVauto in the forum, I found the same drops on unpatched aircurve 10 ASV. 
Here is the link to the post, I will be adding the print screen below. Not saying ASV is the correct for me, but it may be working correctly after 15.

Dreamless Post: http://www.apneaboard.com/forums/Thread-...auto+oscar

So I think I can have bipap working on those pressures until apnea happens. At least this is what happens on ASVauto, it sustains very low pressures and needs to respond to apneas that will happen.  I have a screenshot that shows ASVauto increasing pressure on leak and tapering down afterwards. I think constand swing in pressure is not helpful, so ASV must be for someone that really needs it. I just like to validade if that mode is working or not, based on 15 and beyond graphics compared to unpatched Aircurves.

I'm going to try 10/6 tonight according to the titration on Vauto sudo-S mode as Crimson recommended. Let's see if it is correct. If so it would be great to use such low pressure.
Thank you very much. I see the great contribution here and I would help others as I learn more, for now I will keep my posts restricted here. 

For sake of working check, low pressures for some time than events happen.


The mask:




Dreamless Post ( IPAP sudden drops exists), Unpatched Aircurve 10 ASV (ASVauto Mode)

[Sleeprider]

Why are you quoting the Dreamless charts? Those are atypical for ASV, and we eventually worked out that she was starting therapy while breathing slow and deep which gave the machine perverse minute vent targets. Look at the tidal volume and respiration rates which are ridiculous for a female. This chart has no meaning for your therapy, or any relationship to a proper ASV algorithm pattern. This is a distraction from anything useful to you

[amafra]

Why are you quoting the Dreamless charts? Those are atypical for ASV, and we eventually worked out that she was starting therapy while breathing slow and deep which gave the machine perverse minute vent targets.  Look at the tidal volume and respiration rates which are ridiculous for a female.  This chart has no meaning for your therapy, or any relationship to a proper ASV algorithm pattern.  This is a distraction from anything useful to you

Hey buddy, thanks for your feedback always.

I do the same, breathe slow and deep. That is maybe why I do have high tidal volume and asvauto seemed crazy. I do it especially when awake and that is why last night at the sleep lab I asked for a MaxIPAP change. Mine Vauto is on 4. My mask is usually pretty tight, to prevent leaks and when machines switch to EPAP while I'm slow deep breathing, it creates a vacuum. S mode with easy-breathe on, 2s TImax does not apply, Vauto does not have easy-breathe so I set it to 4.

Even though I have no intent to fall back to asv, out of curiosity I would like to know if the sudden drops and high tidal volumes and other behaviors were caused by the patch. Seeing the same behavior on an OEM device, it can indicate that it may not be airbroked, it may simply be a completely incorrect mode for me like you, crimson and others have been pointing out.

In regards to 10/6 what you think about? may I use it fixed on Vauto or S or give Vauto some room?

[Sleeprider]

The ASV algorithm remembers your breathing pace and volume with a lookback of a 3 minute moving average. If you intentionally breathe deeply and slowly, that is a problem because ASV will continue to target that pace and volume, and may be unable to return to your normal breathing if you respond to the "learned" pace and volume.

Rubicon last suggested a fixed pressure of 11/8.  That is a slightly lower pressure and pressure support than I had observed to be a likely target for you, but it's a great starting place if you will have the patience to stick with it for a while.  Your long sleep latency gives you way too much time to think of alternate schemes you could be using for pressure or therapy, instead of just sleeping.  We know from your chart on 3/27 you have very good efficacy once you settle down and just let it happen.  By using a fixed pressure, we learn a lot more than with all the flipping around on pressures, settings and modes.  We can  see that you started this night off with deep breathing, but 00:15 to 01:05, and again from 01:29 to 01:35 and 02:25 to end, you did great here. The pressure all falls into the range we are talking about.  I'm not interested in seeing 10/6 until I see 11/8 and see where that takes us first.