Looking for minor tweaks

[Walla Walla]

I made a passing remark in someone's post  about not being able to get below 1 API. Ajack said I should post my chart so here it is. The break between 2 and 2:30 is a bathroom visit.  Background: Sleep Study showed an AHI of 97.3. With help from all the great people here I've dropped my AHI down to what you see above. I think I've found my setting at 19/17 BIPAP No Auto. I Tried 20 IPAP before and I seem to start picking up CA's at 20 or above. I bought an Auto BIPAP even though it looks like I could have used an APAP with Flex. I know there's leaks but at this point I don't think it's too bad? Any way any tips are most welcomed.   

[quiescence at last]

looks good. it is ok to have biPAP - you may eventually want a pressure above 20, and your machine will allow that.

QAL

[ajack]

If it was my chart, I think I would need more PS to get better lung volume. I would try 14 / 19, which will give a ps:5. and can see how the ca go, but would be a secondary consideration. We can lower epap till the OA start. You may need to lower the rise time number later, to help insp/exp time, to give you more breathe out time.  I would want my tidal volume better than 420 and it should lower the breathing rate.

although a different brand we are trying to do page 35 and 37, only without the timed backup
https://www.resmed.com/us/dam/documents/...lo_eng.pdf

[Walla Walla]

Thanks both for the response.   Ajack, I know normal tidal volume for a healthy young male is on average 500. But I'm not young or healthy.
Of course you had know way to know this. I was in the hospital 3 months ago and on O2 around the the clock until last month. After smoking most my life I quit 3 months ago. My lungs have improved greatly. Still there is damage to my lungs from smoking that can't be fixed. So all things considered 420 on the tidal volume is sounding great. O2 levels have been checked during sleep and they are fine. So it's come down to lowering the OA's for quality of sleep. If I go up any higher on the EPAP than I might as well switch it to CPAP with flex... or maybe not. I probably should just leave it alone.

[ajack]

no one should do anything they are uncomfortable with and why we all are under the care of doctors.
Your 95% is 580 and max ventilation was a 2000 breath. I would ask your lung doctor what volume he wants.
Given the breathing rate and your total capacity ability, when you see your doctor, your doctor may want you around your normal volume.
look at page 22 for generic restrictive lung disease and the previous titration pages.. It's one of the main reasons for using a bpap with copd
At the moment you are using it as a cpap at 19 with a pressure relief of 2. I doubt anyone would titrate you on that and why I'm pushing for you to see a doctor. He will probably do blood gasses as well.

this gives an average tidal volume indicator in height and ideal weight and an idea of what will be discussed with your doctor.
http://imgur.com/stb4tZk

[Sleeprider]

Increased pressure support would likely increase tidal volume. I don't know if that is an objective or not. It is fundamental titration practice with bilevel macihines to control OA with EPAP, then use PS to deal with hypopnea, flow limits and snores. Your results are great, and if you are comfortable and satisfied with the treatment, there is no reason to make any changes. I'll just ask how you arrived at your settings and PS of 2 cm in fixed mode. You don't need to use the auto function of the BiPAP, but I'm interested in how you arrived at these settings.

[Walla Walla]

Sleeprider, Well when I started the pressure was 20/15 per the sleep Doctor. Than dropped to 18/15 two days later after talking with the Doctor and telling her 20cm felt like it was too much for me. From there I just started playing with the pressures and trying auto Bipap. I kept a chart of my day to day settings and looked for patterns. I noticed every time the pressure hit 20cm I started getting CA's. Not alot maybe 4 or 5 events. But I didn't like it so I dropped the IPAP pressure to 19cm and kept it there. Than I started to raise the EPAP to knock out the OA's. I've been at 17cm on EPAP for two days and it seems to be working. I stopped using the Auto because as you have said many times the Dreamstations are slow to respond. So I had a bad night on Auto and just went with Bipap without auto after that. I know Auto helped me get close to the numbers I needed. But for me a steady Bipap seemed easier to get dialed in. I wasn't put on a Bipap by the way. The Doctor was going to put me on an Apap until I told her I already bought the Bipap. Got tired of dealing with the equipment provider and insurance. Sorry I rambled on so much! Ajack, Thanks for the concern. I've already seen a Pulmonologist.

[ajack]

What would normally happen is that you would also lower the epap, keeping the PS:5, you have reduced to PS:2
Most people would find a PS of 2 is harder than a PS of 5. I don't know what doctor advised you, but I would see  your lung/sleep doctor to advise you better.

[Walla Walla]

ajack, OK. I'll switch to your recommended setting tonight and see how it works out. If I can keep the OA's under 2 I'm happy.

[ajack]

I don't know what the AHI will be, I think that will depend if the OA will happen with an epap of 14, by the sound of it you need 17, but see how you sleep tonight, I may be able to suggest you slowly raise both the epap and ipap up 1cm a day, keeping the PS:5.
I just thought the ps:2 wasn't right, the default PS is 6 on the titration guide page 22 and then it is adjusted from there.
"Patients with restrictive lung disease have a difficult time maintaining the inhalation phase long enough to ensure adequate tidal volume and gas exchange. This can be caused by a physical restriction of the lungs or by neuromuscular weakness. The recommended settings use a low cycle sensitivity and a longer Ti Min time to provide a longer inhalation time to help increase tidal volume and gas exchange."

the best outcome for me to have a smile, is to see if you have better volume tomorrow, I think you will breathe easier with PS:5
It would be nice to see if the leaks can be helped a bit
Do you have a sleepyhead chart of when you were on 15/20?