Could use some help

[Sleeprider]

Moved flex to 1. No COPD or anything of that nature, just the usual fat guy deep/heavy breathing. What is an average tidal volume? I will have to look back to see if it's usually that high, or if that was just an abnormally high reading.

Tidal volume is usually related to height and ideal weight.  Yours is above anything I have ever seen.  I have a very high volume and currently average 620, but have averaged as high as the mid 700s.  A larger tidal volume is usually a good sign, but you are off the charts, and I have no idea if that is significant or not.  What is notable is that the machine is reporting an inspiratory time of over 4-seconds and expiratory time of less than 2-seconds.  That does not match the closeup image you posted.  Read this section of the Beginner's Guide to Sleepyhead that I wrote for how to read the flow rate graph http://www.apneaboard.com/wiki/index.php...Rate_graph 

As you will see your inspiratory time is rather brief at slightly over 1-second, and your expiratory time is long at about 4 seconds, including a pretty good period of zero flow. So based on the 11 breaths per minute in this graph, each breath is about 5.45 seconds, so the correct time is about 1.4 seconds inspiratory and 4 seconds expiratory.  Since your Philips machine tries to add and subtract pressure at these critical trigger to inhale and cycle to exhale instances, it it totally messing up your respiration, and you'd be better off without it.  Just saying, for some people the Philips Flex algorithm is completely screwed up.

[ShaunBlake]

broken665, I'm glad that Sleeprider made his observation before I chimed in because I'm in no way an expert.  However I did see that your complaints of misery date from the wonderful advent of a new, very modern machine.  One that I've read provides great relief and positive therapy for lots of folk here — but for some it's a Tasmanian devil.

In looking at the charts you posted of Sep 5 & 6 I couldn't figure why your AHI was so high.  I think SR hit the head on the nail — he's pure genius in my mind!

I'm hoping he and the other gurus can get you going with your DreamStation.  Yet I urge you to explore an opportunity to switch to a ResMed AirSense 10 AutoSet.  While it's not better, pretty equivalent to the DS, the AS does use radically different algorithms and responds very differently than the DS, which sometimes makes an enormous difference to the patient.

And please keep us posted on your progress!

[broken665]

Changing the Flex setting didn't have much of an effect on Tidal Volume, unfortunately. At some point during the night, my cervical collar came unlatched and was just laying open on my neck. Not entirely sure what time that happened, the only thing I can say for certain is it happened before 3 AM. About the only thing I noticed that was different was that it seemed like my mouth was opening slightly on exhale. Not sure there's much I can do to fix that issue aside from taping my mouth or changing masks, so I'm going to try mouth taping to try and limit that issue. I'm not sure if that would affect tidal volume or any of my other issues, but it's worth a shot.

I'm guessing a machine change would be my best option. Not sure how much of a fight my insurance will put up against replacing it, but if it isn't effectively doing what it needs to do, there's no sense in sticking with a failed solution. I'll keep using it until I can get a replacement, because I'm reasonably certain it's doing something, but the evidence seems to be pointing to Respironics algorithms being incompatible with me.

When I approach my sleep doc, is there any evidence for what sort of machine I should request to replace it?

[MitchS]

Eventually all users end up with a full face mask for those few times you end up with a cold or some congestion problem. 

Just to clarify, this statement is not true.  I and many others are able to force ourselves thru about 5 minutes of pressure and the congestion clears with just a nasal mask.  In the past I stated that all pap users should have a FFM as a backup for the exact reasons you state.  I found this to be absolutely not true even with my occasional severe congestion.

I agree with bonjour on this. I find it much harder to use a FFM when congested.

[Sleeprider]

Let's focus on a new machine. Here is your argument. My pressure is at the maximum pressure of 20 cm for long periods of time every night. I am still experiencing very high numbers of obstructive apena. I have done everything I can with this auto CPAP, including using a soft cervical collar to correct my positional apnea and try to keep my airway aligned. I am uncomfortable and need to solve this problem to restore some normality to my life and to function better.

I want to try bilevel therapy. I would prefer to get a Resmed Aircurve 10 Vauto machine, but would like to hear your opinion. A bilevel machine has higher pressure capability and I think a lot of my problem comes from flow limitation as you can see in the attached charts that show my respiratory flow wave form. I think having a bilevel machine where I can use pressure support to correct these flow limitations may be just what is needed to correct may still unacceptable obstructive apnea and give me some rest. Please help.

[broken665]

Sent the message to my doc this morning, so for now it's the waiting game. Thank you for all of your help, I really appreciate everything. I'll keep you updated on how things progress.

[Sleeprider]

If your doctor does not simply approve a VPAP/BiPAP machine I think he will schedule you for a new titration that will evaluate CPAP and bilevel therapy. This will be progress assuming your insurance covers the test. I don't see how your current machine can possibly achieve the results you desire and need, and will be interested to hear the direction your doctor wants to go.

In the event costs of testing are prohibitive, please consider buying the Resmed Aircurve 10 Vauto from Supplier #2 at $799. It's a very good deal and I think it will get you where you need to be very quickly

[broken665]

Doctor replied last night. First, she thanked me for telling her about Sleepyhead, as she had never come across it and she's ordered a card reader to try it out. She wants to schedule a sleep study with BPAP, so it looks like things will progress (hopefully quickly) down that path.

Thanks again for all of the help. After 6+ years of treatment, it will be great to finally get it under control.

[Sleeprider]

I think that is the result we were looking for! Good luck, and let's keep working towards better sleep.