[CPAP] Newbie ready for guru input

[C0mbe]

Just to add, I believe PR calls it's version of Ti, "rise time." Rise time is only available as a setting when biflex is set to off.

[SarcasticDave94]

OK I copy. Thanks.

[SarcasticDave94]

I need you to consider whether you might need to improve your neck and head alignment a bit.  The OA are in clusters suggesting you might be getting into a position where your chin tucks towards your chest.  If not that's fine, but it makes a big difference in some people.

We are all different, but thanks to a similar observation from Sleeprider, I experienced significant and immediate decrease in OAs by stabilizing my head position. In my case, what worked was a buckwheat chaff pillow which can be configured to stabilize your head position and support your neck. Mine is the CPAPfit which can be purchased from amazon for $50. If you google buckwheat chaff pillow you will find lots of info. It sounds strange but it's the most comfortable pillow I have ever used. I have it configured for side sleeping which worked well for me initially. Like you, I move around some and I have noticed an increase in flow limitations which associate with rolling onto my back. To control that I have been using a soft cervical collar, also from Amazon for $10, which seems to be working well. I thought it might be uncomfortable but I'm generally not aware I have it on.

I hope you find these suggestions helpful.

Thanks for info on the pillow. As funds allow, I'll get one and I'll check into the collar as well. I'm not wanting to only go half way in my therapy. At least I've got info to base the decision on.

[SarcasticDave94]

Just to add, I believe PR calls it's version of Ti, "rise time."  Rise time is only available as a setting when biflex is set to off.

OK this adds a question: which is more needed/important, biflex or access to Rise time? Or is it not so simple as that, AKA it's personal preference or some such like? 

Here's most recent Sleepyhead report. Notes to consider in the review of this: I did not sleep but 2 hours or so at at a time, and yesterday/Sunday I took a trip to the ER for heart palpitations, very fatigued, bit of dizziness, and breathing difficulty-more than my "normal", the breathing difficulty was likely (but not certain) attributed to my COPD. Monitoring, blood testing, chest x-ray all negative answer on cause. Due to fatigue after these episodes, I took several naps. I expect to report an actual night's sleep report sometime, it just hasn't happened yet. FYI it is not due to the BiPap therapy or settings, I go through these phases where I cannot sleep well, and now happens to be one of those phases. Yippie! And I'm getting better at posting the Sleepyhead info, woohoo.  
(   Why can't he sleep? No I really don't drink coffee very much anymore, just an inside joke with myself, real bad news, he talks to self lots...)

[SarcasticDave94]

Quick note on your last session, your PSmin was 2.0 and max was 2.5.  Move that PSmax to 5.0 so it's there if you need it.

Also note that the session prior to 20:00 was from the old fixed settings...I think I got my AHI of 8 prediction if that is not included.

Tom

BTW that was a "my bad". I incorrectly wrote setting as 2.5 instead of 5. It was not you suggesting a PS min 2 - PS max 2.5.

[SarcasticDave94]

...
Let's increase EPAP min by 1 to 10.0. If you can find the setting for Ti, record the reading (probably 1.8) and let's go to 2.3. Other than that, I think we leave other things alone.

See C0mbe quote below for reference: If I turn the BiFlex setting to "Off" in Configuration mode, the "Rise Time" option takes its place in patient options and it gives me a choice of 1, 2, or 3 within, no decimals.

Just to add, I believe PR calls it's version of Ti, "rise time." Rise time is only available as a setting when biflex is set to off.

You are correct. It is labeled "Rise Time" on my PR Auto BiPap. It replaces BiFlex as a patient option. AKA one or the other only, not both is what I'm seeing.

[Sleeprider]

Dave, rise time is not the same as Ti (inspiration time minimum). If you need to go down the BiFlex / Rise Time path, we can deal with it then, but both settings affect the time it takes for the pressure to transition from EPAP to IPAP. Ti actually gives you more or less time at inspiration pressure, and the thought was that since you have a slow respiration rate and long inspiration time, we could try to match the machine up to that. This is a setting I have on the Resmed machine, but I just checked the PR BiPAP Auto and it is not there; so let's push on.

When we began all of this, you pressure settings in fixed BiPAP mode at 15/10 and were getting a remarkable 36 AHI. Currently we are at EPAP min 10.0, IPAP max 17.0, PS min 2.0, PS max 5.0. In your most recent results, the PS is working correctly and is increasing when hypopnea can be treated, but for the most part is holding at 2.0. Pressure did reach the maximum IPAP of 17 during an extended cluster of OA, but your best results were during a period where pressure stayed below 13.

Before going further, I'd like you to answer the question I posed earlier regarding the frequency of centrals in your sleep study. Do you have the study results or titration results for CA?

[SarcasticDave94]

Not the detailed report yet. I'm working on getting my report. Similar story as others post, pulmonary doc doesn't think I need the report on me. I'm trying the primary care request method and asking same primary care to supply a copy of their copy, assuming it is a full detailed report. Otherwise, pulmonary doc will have to get me one. I will show it here when I do.

[C0mbe]

Dave, rise time is not the same as Ti (inspiration time minimum). 

Well, sorry for muddying the water with that.  But at least I learned something!  Thought they were similar.

[SarcasticDave94]

No worries with me. I'll Ditto the learning thing.