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10-22-2022, 03:00 PM (This post was last modified: 10-22-2022, 03:09 PM by RainbowFish.)
Finally got the BiPAP!
Thank you to everyone for their help so far! With it, I got off my O2, got comfortable on the APAP, and found my perfect goldilocks mask. (See Newbie thread)
So, finally the BiPAP came off backorder and I'm... Well, I'm underwhelmed so far. My tidal volume is up a tad but the O2 is somewhat worse (back on 1 liter for now) and my AHI is the same or somewhat worse. After some adjusting, I like them both about the same re comfort.
My new provider (Yes! I have a provider again!) wants me to give the BiPAP a 3-month trial and see how I settle in and if I still need O2. That sounds fine, as, perhaps predictably, I am getting more treatment emergent centrals with the higher pressure support. Here are results from the APAP and the BiPAP.
The number of centrals does not appear to be a concern here. I'd like to get a close-up of the flow rate (3-minute zoom) to be able to visualize the respiratory flow wave. The changes in tidal volume and minute vent are not significant. You can reduce the central event by changing trigger sensitivity to high or very-high. To improve oxygenation, you need to increase EPAP min. This will raise the "Positive End Expiratory Pressure" (PEEP) which is what improves oxygen saturation, while pressure support is used to increase ventilation. These are two different goals and if you objective is to increase oxygen saturation it is PEEP that will do that, rather than pressure support.
Change trigger sinsitiveity to high and increase EPAP in 1-cm increments until you see the oxygen saturation SpO2 that is acceptable.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I also included 2 nights. The first is with the initial settings my inpatient study suggested and they set the machine with. I should note the sleep lab is 2000 feet lower than my 7000-foot home. I felt so bad I went back to the APAP and then tried it again after turning the pressures down (second night) which was worse. Then I got the present settings from my new provider who also added a liter of O2. To me it looks like the biggest change is dialing down the pressure support from 5 to 4.
I think I will try changing the trigger sensitivity. and see how that goes.
Your Aircurve 10 is capable of producing the same pressure support (EPR) as your Airsense 10 at under 3 cm. It is far superior due to the ability to adjust trigger sensitivity and inspiratory timing. I would not have suggested a 5-cm PS for anyone in the absence of flow limitation, which is the case with your results. Don't forget you have the capability of changing PS in 0.2 cm increments to fine-tune your comfort. Altitude has a significant effect on increasing CA events. The respiratory wave looks good here other than the events, and changing trigger sensitivity to high will improve your CA results. All it does is allow the machine to switch from EPAP to IPAP with less inspiratory flow (spontaneous breathing) from the patient. This is usually enough to stimulate a breath where a CA event might otherwise occur. A 1 LPM oxygen bleed is very low due to the dilution of PAP flow of about 30 LPM. We have a wiki on oxygen bleed with CPAP if you're interested in understanding how we use supplemental oxygen to increase the fraction of inspired oxygen (FiO2).
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Whoa! Let's see if this is a sustained change. I have never had anything close to less than 1 centrals before. All I did was change the sensitivity to high. Not sure what happened at 3 am. That is usually a time when I have a bunch of events though - maybe a REM or positional thing. Before CPAP I would wake up from a nightmare like clockwork at that time.
I am going to increase the EPAP by one and see what that does. I'm leaving the O2 on for now.
We commonly see this result with idiopathic central apnea responding to a faster IPAP trigger. I think these results will hold. Considering the residual events are obstructive, I agree with your decision to increase EPAP min.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-25-2022, 01:56 PM (This post was last modified: 10-25-2022, 01:57 PM by RainbowFish.)
RE: Finally got the BiPAP!
Ok, I am a believer now! AHI of 1 and I slept like a log through the night. (10.8 with PS 3 was my sweet spot for the APAP, with 11 giving me more aerophagia, which is why I picked the goofy 6.8.) Thank you!
