Machine is hyperventilating me!

[Sleeprider]

If your respiratory and machine pressure timing is in sync, then don't change trigger. That is sensitivity to your spontaneous breathing. Low is less sensitive, and the machine takes longer to trigger pressure changes. If you want the machine to be more sensitive to your staring and stopping of inhale/exhale, then medium or high are appropriate choices. Get the setup or clinical manual, and all of this is explained.

Pressure support is the difference in pressure between IPAP and EPAP. To increase pressure support, just increase IPAP, or decrease EPAP. In your case, small increases in IPAP are probably best.

[Josephdfco]

Last night's data.  https://imgur.com/a/f3YlZ   I tried raising the rate to 9, but it seemed like the machine was "breathing" me too fast, so I went back down to 8.  I did raise IPAP to 15.4, and seemed to tolerate that ok.  One thing I noticed at about 5 am was that the high pressure portion of the cycle would stop before I was done inhaling.  I was able to get past it and fall asleep eventually, though.

[Sleeprider]

You may wsant to change TiMax to 2.4.

[Josephdfco]

I changed Timax to 2.4, as you suggested. Here's data from the last few nights.  I don't feel all that bad, though I woke up yesterday feeling inadequately rested, and napped for 3 straight hours between classes in the middle of the day!  I still feel like I could sleep all day and night if given the chance.
https://imgur.com/a/pSofF

You'll notice I posted 2 screenshots from the 4th. In the second one, I scanned down on the left side of the screen, to see if there was anything there that might be valuable to you.  Thanks as always for all of your time and help!

[Sleeprider]

You are having fragmented sessions and unrestful sleep which is a problem. I notice on some charts one or more sessions is not highlighted, so the AHI statistics may not be including the events in that session.

I think you would ultimately benefit from ASV which is a more advanced machine than ST, however your results are going to be viewed as completely acceptable by your VA doctor, whom I expect to be unresponsive to your lack of restful sleep. You may want to to save up and self-finance an ASV. You should have a written copy of your prescription to facilitate future purchases. Provided the script is for bilevel with backup rate and not too specific, it may be sufficient to purchase an ASV unit from Supplier #2. Of course it may also be worth contacting Amazon sellers directly and asking them to quote ASV.

[SarcasticDave94]

Hi y'all, especially Josephdfco,

Welcome to Apnea Board first off. Not that I'm attempting to upset the cart or anything, but I was checking in to see how the ST-A is doing for you. Is it working for you? If it's working OK or better, then skip to the end of this post where I say "Have a nice day y'all".

I just this morning came across this thread BTW. A couple of things I'd like to mention, the first is that I'm on an ASV because of my central/mixed apnea status. So, how did I get to the ASV? An overview is that in '15 I was diagnosed with OSA at 70+ AHI via an overnight PSG that was to be split, but became 2 separate nights. It seems that is more normal than my following PSG's of one night, all of which were titration. I couldn't handle the constant CPAP 18 the DME set me on, although the pulmonary Duck prescribed 20. Neither setting allowed me the ability to breathe out. I took '16 off from Apnea concerns to go through the process of bariatric surgery to lose weight. I was 300 # at the beginning, and am now about 213 #. Weight loss basically halved my AHI to around 34.

In '17 I started again on getting Apneas under control via a new PSG and a BiPAP, a PR DreamStation. It really seemed like it was working, but I felt fatigue increasing. I also enrolled here on the AB to get things dialed in better. Sleeprider pointed out that my machine was making me worse because of central/mixed apneas. We did our best, but the flat screwdriver cannot turn Phillips head screws.

Summer '17: I'm the squeaky wheel that the Duck has to grease. I called their office and got a next day urgent need appointment. I've had it with the BiPAP. (Compliance was going to fail anyway, so I returned the machine a day after the 90 days were up.) I demanded at that urgent need visit to learn why I'm not on an ASV with a PSG showing 124 Central to 24 Obstructive. The answer from the nurse and the doc on call: we don't know, but you need ASV. Then about 2 months of squeaking long and loud, calling the doc's office, the new DME's office, and the insurance CS DAILY at times, other times were every other day.

The squeaking paid off after the 2 month mark. I've been on the ASV for 3 months approximately. A small tweak here and there and I'm holding a weekly average AHI of 2.1. And at about the 1 month mark, my fatigue is slowly but definitely reversing.

Very short recap: low AHI is nice, HIGH sleep comfort is better. Not to mislead you, but BiPAP gave me neither. ASV gave me both. Ooohh, I forgot to mention, I have stage 2 or 3 COPD too; it just depends on who you ask and when you ask them about my COPD level I guess. ASV does work for those of us with restricted breathing as well.

Sorry, it's longer than I wanted, but there it is anyway.

Have a nice day y'all,
Dave
 

[Josephdfco]

Thanks SleepRider and SarcasticDave!  Wow!  Sounds like you had to run the gauntlet before you got the right machine!  There may be some light at the end of the tunnel for me.  I spoke to the doctor that originally diagnosed me, and got me a machine one day later, earlier today.  I told her everything that's been happening, that I've been speaking with very knowledgeable people about my issues, and that both they and all  available literature points to ASV being the treatment of choice.  She actually agreed, but said that the ST machine had worked very well for me during my sleep study.  Still, she suggested that we give it another couple weeks, and if I'm not sleeping through the night and waking up feeling rested, we would do an ASV titration if tweaking the settings between now and then doesn't work.  This is great news, considering that Dr. Yale more or less said that we would be sticking with ST no matter what.  She agreed to be my sleep med provider from now on, too, and I have an appointment with her in early January.  It's a bit more of a drive, but worth it.

[SarcasticDave94]

Good for you on this, you at least have a tentative choice if ST-A doesn't pan out well. I'm sure you'll agree that it really doesn't matter what machine gives the best results and the best night sleep. Those 2 are the important goals IMO. Keep us posted in results, etc. I sincerely want you to succeed with this, whichever direction you take.

One last piece of advisement: Of the 4 (or so) involved in your treatment be it a doc, DME, insurance or you, the YOU is the one all the others must satisfy, not the other way around. If you don't feel better, they all failed.

Happy holidays to y'all out there.

Dave

[Josephdfco]

 Of the 4 (or so) involved in your treatment be it a doc, DME, insurance or you, the YOU is the one all the others must satisfy, not the other way around. If you don't feel better, they all failed.

Sometimes it really seems like they forget this. Thanks again! I'll definitely keep you posted.

[Sleeprider]

The numbers are great! If sleep disordered breathing therapy was all about numbers, you would be done, however it's really about getting the quality of restorative sleep you need, and the numbers don't always tell the story. Your ability to function to your potential during your waking hours, to support your family financially and emotionally is the true measure of success. I don't care what machine gives you that back as long as you get to live life to its potential. Keep up your quest, and don't settle for less.