[CPAP] New User w/ ResVent iBreeze 20A

[rstark13]

Hi,

I have been wearing my CPAP consistently for the past few months, and I have worked to get my leak rate, aerophagia, and comfort with the device under control.  My AHI is typically below 5 but usually between 1 to 4.  Leak rate lately has been good and most nights is 0.  A bad night for me it will spike up to like 13 but that's uncommon.  My main issue is that I don't feel much better from using my CPAP.  So, any help you all can provide would be great.  My sleep doc is on board with getting me a Bi-PaP, but I am unsure if it would be a more effective treatment for me.  So far, I have messed with my min/max pressure, EPR, and switched between CPAP and APAP.  I also tried an oral appliance but it didnt seem to work at all.  I feel terrible most days regardless of whether my AHI is 1 or 5.  Most days I am dead tired and get by by slamming two cups of black coffee in the morning and then napping for 20 mins at lunch to make it through the workday.  I do seem to get some benefit from the device like I am slightly less irritable but that is about it.   Anyways, here are my charts from last night.  I am happy to follow up with my titration or original sleep study or zooms.  

I am totally open to any ideas or suggestions.  Thanks in advance. 

Currently doing the following:
mouth tape
nasal strip 
ear plugs
soft cervical collar
Phillips Respironicss wisp nasal mask
ResVent iBreeze 20A
I side sleep


I typically have the machine set to 9.5 min / 11.5 max / EPR3.  Last night, I experimented with 10 min and 13 max with EPR at 1, and I feel pretty terrible today.   

           

[Deborah K.]

Your flow limitations are high.  I don't know anything about the ResVent machines, but if there is some setting for Pressure Relief I think you should set it to its highest setting.  You would be more comfortable and have better therapy.

[rstark13]

Okay, I will set EPR to 3 which is the highest setting and then report back.

[TechieHippie]

How did EPR 3 go? If you haven't tried it before, try EPR3 with a lower minimum and see what happens. I think you probably need the BiPAP, those flow limits are really high and your graphs are spikey... You probably need the higher pressure to resolve events and the higher differential between inhale and exhale to resolve flow limits.

Have you tried evening out your breaths when you're starting to get the machine into a rhythm that it follows that's very smooth?

I find this machine very sensitive to my breathing. I have this same device and I ended up going up to a BiPAP of the same brand, which I would only recommend in certain circumstances, I like it but it's pretty complicated. I don't have my settings. All that much different but I think I have pressure support (Similar to EPR) set to 3.7 and it made a huge difference. You have higher pressures than me so you might need 4 to 5.

Lisa

[rstark13]

Way better !  Here are screen shots from the last two nights.  I raised my min/max pressure range up to 11.5 to 13.5 and set iPR to 3.  This seems to have made a big difference. For the first time ever I actually felt a noticeable difference between sleeping with my CPAP vs sleeping with out it.  I suspect the raise in the min pressure had more of an impact on this because I previously experimented with iPR at 3 before, but at lower min/max pressures, and it made minimal to zero difference.  

I am guessing here but I think the P95 of 12.7, which is the highest it has ever been, was the difference.  Seems like I need the higher support.  My AHI and flow limit data don't seem to be much different than my average but I feel WAY better so that is what matters.

I am unsure of where to go from here?  

Here are a couple ideas:
1. Keep iPR at 3, but experiment with incrementally raising my pressure to see if I feel an increased benefit
2. Keep iPR at 3, but experiment with incrementally lowering my pressure to see if I can keep the same level of benefit but at higher level of comfort.  With my P95 at 12.7, I am getting some aerophagia and nose congestion in the morning upon awakening.  

My Doc is onboard with trying bi-pap.  I am going to call him today and ask him to order it.  They are stating they can get me a ResMed Aircurve 10 (i think).  

           

[TechieHippie]

Make sure the Aircurve is the Auto. Given his willingness to order it, maybe consider just sticking with these settings for a while and reap the benefits of the improved therapy, even though it's not perfect. I suspect you are right that you need the higher pressures but I think you will also need more than the 3 iPR to make those higher pressures not come with tons of flow limits. I've sometimes changed settings and gone back to them and don't always get the same results.

One area to refine though is your leak rate, it jumped with the higher pressures if I'm reading that right. If so there's a guide on mask fitting in the wiki I believe. That will translate to the bi-pap too if you keep the same mask.