MrIvanDrago - CPAP|Bi-PAP Therapy Journey

[MrIvanDrago]

I'm currently running in S-mode, so flow limits do not show, just my user defined UF#2. My pressure is fixed at 16.0/12.0 PS 4.0.


   

[Narcil]

Can you show the pressure graph tho?

to me it looks like positional issues. your flow rate noticeably diminishes during event clusters. what position do you fall asleep in? most events seems to be right after you fall asleep?

[MrIvanDrago]

I did notice this as well, but I always sleep on my side at night. The pressure is set to 16.0/12.0 in S-mode so there are no variations in pressure.

Looking to see if I can lower the pressure or pressure support to have less arousals.

[MrIvanDrago]

I received this analysis from another member who seems to have excellent knowledge to CPAP/BiPAP therapy. I wanted to bring it here to get opinions on this, someone like SleepRider or another expert to weight in.

"What I believe I can see happening, is that you have slightly low tidal volume and raised respiratory rate, which equates to a low alveolar tidal volume and elevated nervous system.

We can see you go along for good periods with perfect breathing, until I think your lowered alveolar volume finally asks for some big breaths to redress the balance, which unsettles your breathing rhythm for a bit as well. This can trigger a position change where things worsen. The pattern just repeats all night.

I think your exhalation looks fantastic on the lower EPAP and apneas are still nowhere in sight. The trouble with your machine (VAUTO Aircurve 10)  is that when your disturbances or whatever, causes you to shift and position does bring on some flow limitation, then it is raising epap and ipap together. You don’t look so hot to me on the higher epap. Giving it a 2cm range I thought was too much. 1.5 -2 cm extra IPAP is a lot different than 2cm extra epap during flow limitation.  Having said that you only had serious pressure rise a couple times, and the events that brought that on would likely have woken you anyway.

I think you would do much better on a machine that increases IPAP thereby increasing pressure support just for the flow limitations and the dropping tidal volume, while maintaining a steady EPAP. But, on this machine I would be trying what you described, increase pressure support again on the lower EPAP. If you want to add a small bit for those bad periods just give yourself a little tiny bit. You could try increasing it slowly to see at what point you wake with rising epap.

This is what a Resmed ASV can be leveraged to do with lower settings and is how Dr barry Krakow treats flow limitations if he can, not sure exactly what the highest end Resmeds can do, but Lowenstein bi-levels have autoranging IPAP or PDIFF whichever way you like to look at it."

This comment was in regards to the nights I was having with higher pressures 16.0/10.0 PS 3.0 in VAUTO mode. Example below:

   

I lowered my settings last night to 14.0/10.0 PS 4.0 in S-mode, first I have tried this. Last night was a good night of sleep and less arousals. Last night:


   

[MrIvanDrago]

Hi, I am using an Aircurve 10 and the past few weeks running in S-Mode with 15.0/11.0 PS 4.0 as my settings. Why does my flow limit read .04 across the entire night? Is this a bug or is something possibly wrong with my machine? I have attached a few OSCAR screenshots to show what I am talking about.

Thanks in advance for the help.

   

   

[PeaceLoveAndPizza]

In BIPAP-S mode you do not get flow limitations measured as in a fixed pressure mode the machine has no adjustments to make to pressure. If you want to see them, use VPAPauto mode with a fixed range.

[SarcasticDave94]

Since S mode won't report FL, this should be considered a reporting artifact machine error.

[MrIvanDrago]

Ok Thanks, what if I put the machine in VAUTO mode 15.0/11.0 PS 4.0, would it be the same or does the 'EasyBreathe' setting do something else?

[Crimson Nape]

I concur with the posts above. Also, I see you have the Flow Limit range set to 0.0 to 2.0. The maximum Flow Limit reported by Resmed, when it does report one, is 1.0.
- Red

[MrIvanDrago]

I never set the range on the flow limits. Is there a possibility I have a faulty machine?