MrIvanDrago - CPAP|Bi-PAP Therapy Journey

[PeaceLoveAndPizza]

Looks positional to me as well. The best advice is flatter pillow and cervical collar. 

The only pressure adjustment would be to increase the top end to 15 so the machine has a bit more headroom to work with controlling apnoeas. It of course will not use it unless necessary.

[MrIvanDrago]

Last night used PS 4.0 over 6.0-15.0 (cmH2O). Felt a bit better overall. Wanted to share with the group if anyone sees anything or adjustments that may need to be fine tuned.

[attachment=56631]

[PeaceLoveAndPizza]

Looks good. Touch nothing for at least a week to give you time to settle into these settings.

[MrIvanDrago]

Ok thanks for the help. I will update in a week.

[MrIvanDrago]

So I have been using the recommended settings for a while now and I find that I am having a few CA's toward the end of the night before I wake up. I have my trigger sensitivity on 'High', but wondering if something like PS should be adjusted. I have attached the full screenshot as well as a zoomed in portion towards the end of the night. Any insights would be great! Thank you.

[attachment=57105]

[attachment=57106]

[Sleeprider]

The level of CA you're experiencing is not a concern. These are minimally disruptive compared to obstructive events and you don't have a lot of them, nor are they of long duration. That said, if you want to try very-high trigger, or reducing PS in increments of 0.2 cm (3.8, 3.6, 3.4) and see if you find more comfort and better results, I don't see any harm in experimenting.

[MrIvanDrago]

Thanks Sleeprider, I continue to wake up around 3-4am mark every night and was wondering if it is due to the CA's, or something like it. What will 'Very High' vs. 'High' trigger sensitivity do? Would that be a better option than experimenting with pressure support? I sleep well the first half of the night, but then seem to have multiple arousals towards that backend of the night.

[Sleeprider]

Arousal can be the cause of CA or result from CA. It's actually more common for the kind of CA you have to arise from arousal rather than the other way around. I realize that arousals can be stressful if you have obligations to get going in the morning, so it's important to stay calm and realize that arousals are a normal part of sleep for most people, and that they tend to become more frequent as we get older. While some arousal events can be improved with therapy modifications, I think most people using CPAP therapy tend to blame a problem with CPAP therapy rather than accept the arousals may arise spontaneously out of good therapy. I guess I'm suggesting you keep an open mind that the problem does not originate from the use of CPAP, and our objective is to mitigate respiratory event arousal to the maximum extent possible.

Very-high trigger sensitivity works the same way as high sensitivity did. It lowers the flow threshold to spontaneously trigger IPAP. This can further reduce CA evehnts by giving you a nudge when you have a breathing pause with weak inspiratory effort. You had a positive response to high trigger sensitivity and you're simply trying very-high to see if it resolves remaining events, or creates more disruption. You will be the ultimate judge of its effectiveness. My advise is to try one change at a time, whether it is PS or trigger changes, so you can isolate what works. Your therapy is really good and optimization should be methodical, slow changes to one variable at a time.

[MrIvanDrago]

Ok great, thank you for your input as always. Very helpful. Will keep you posted.

[SarcasticDave94]

I believe the idea behind Trigger is that it'll trigger or fire off IPAP with less breath input from you. So if airflow from your breathing diminished to X it'll fire IPAP. Diminished airflow in this case would be due to a CA.

Keep in mind that teeter totter effect I've noted in others with both obstructive and central apnea. If you actively go after centrals, obstructive events may increase, and vice versa. The reason is treatment of centrals opposes obstructive, and again vice versa.

And respectfully your CA are pretty mild. If this cluster was closer to the session end/waking area, I'd probably toss the SWJ (sleep wake junk) flag on them.

Adding in this item. I copied it from the ResMed ventilator info sheet.

"The trigger sensitivity determines how easy or difficult it is for your patient to initiate a breath. The cycle sensitivity determines exactly when your patient starts to expire."

https://www.resmed.com.au/healthcare-pro...%20expire.