MrIvanDrago - CPAP|Bi-PAP Therapy Journey

[Sleeprider]

Looks like that worked out pretty well. You can reduce the maximum pressure to 12 and not impact that treatment efficacy.

[MrIvanDrago]

Looks like that worked out pretty well. You can reduce the maximum pressure to 12 and not impact that treatment efficacy.

I thought about that, in doing so how will that help the therapy if it never goes up to the high pressure set of 15.0?

[Sleeprider]

I don't see it as a benefit to therapy because you really don't hit those pressures. If high pressure is a problem you can cut it back farther. Your 95% pressure is 11 cm. Anything below that starts to have a real pressure reduction effect. It's fine to experiment with these lower pressures in the 10-11 range to see how they affect your therapy efficacy and more importantly comfort. If you pursue these greater reductions, keep a log of your sleep quality to help you decide if the change is one you want to keep.

[MrIvanDrago]

I don't see it as a benefit to therapy because you really don't hit those pressures.  If high pressure is a problem you can cut it back farther. Your 95% pressure is 11 cm. Anything below that starts to have a real pressure reduction effect. It's fine to experiment with these lower pressures in the 10-11 range to see how they affect your therapy efficacy and more importantly comfort.  If you pursue these greater reductions, keep a log of your sleep quality to help you decide if the change is one you want to keep.

Ok makes sense. Thank you for the help amd insights!

[MrIvanDrago]

Sorry for all the questions, but reading and looking at others OSCAR data in past posts, what is ideal inspiration and expiratory times. 

For example, I have seen some charts where inspiration time is something like 2.3s and expiratory time is 1.2s.

Then others, like mine, where inspiration time is 1.3s and expiratory time is 2.1s or something like that. Does it matter? Do the machines get this correct? Thanks for all this board does!

[Dormeo]

This seems to be an OK web site, and there's information there:

https://respelearning.scot/topic-1-anato...-breathing

Keep in mind that the machine counts the pause between breaths as exhalation time.

When I used a ResMed Airsense 10 Autoset, I got weird ratios of inhalation to exhalation (inhalation longer than exhalation). With the VAuto, all is well. It seems that the Airsense 10 got confused by the cardioballistic artifacts that show up as little oscillations between breaths on my flow rate graphs. For whatever reason, the VAuto isn't confused by the CB artifacts.

[MrIvanDrago]

This seems to be an OK web site, and there's information there:

https://respelearning.scot/topic-1-anato...-breathing

Keep in mind that the machine counts the pause between breaths as exhalation time.

When I used a ResMed Airsense 10 Autoset, I got weird ratios of inhalation to exhalation (inhalation longer than exhalation).  With the VAuto, all is well.  It seems that the Airsense 10 got confused by the cardioballistic artifacts that show up as little oscillations between breaths on my flow rate graphs.  For whatever reason, the VAuto isn't confused by the CB artifacts.

That's interesting and thank you for the reply. I noticed the same with my last machine the Dreamstation 2 and now the Aircurve.

[Sleeprider]

I:E times are not consistent between machines. Philips almost always shows inspiration time longer than expiration time. Ignore it as it is not a metric reported by the machine. Resmed is generally correct, but can be fooled by a rapid return from exhale to a near-zero flow which gets counted as inspiration time. Don't trust anything without looking at the flow chart in close zoom to verify.

[MrIvanDrago]

What is the exact purpose of pressure support. Does it effect your CO2 levels in any way? For example, if you went from pressure support of 4.0 to 3.0 or even to 2.0, what effect would it have on CO2 levels if any? 

Or...is it more for comfort? I know someone here will give an excellent and simple answer, so figured I would ask the group. Thank you.

[Sleeprider]

PS, a difference between inspiratory an expiratory pressure, has multiple intentions and benefits. Comfort is certainly part of it as pressure support off-loads the physical effort of inspiration to the machine. At 8 to 10 cm PS all or most of the inspiratory effort is transferred to the machine from the diaphragm, however with obstructive respiratory disease, it may be higher. We want to encourage spontaneous respiration where it is present, so with the exception of central apnea, chronic obstructive respiratory disorders, asthma, or neuromuscular weakness, you won't see PS exceed between 4 and 6 cm in most people. Pressure support can treat upper respiratory resistance syndrome, flow limits, RERA, hypoventilation, periodic breathing, Cheyne Stokes respiration, and central apnea. Pressure support increases ventilation and can be used to increase tidal volume, affect minute vent and respiration rate, however increasing PS and ventilation will purge more CO2, which can affect respiratory drive and cause hypoventilation or central apnea. Individual response varies, however most people will have a threshold of PS at which spontaneous respiration becomes suppressed. For some, that may be with as little as 2-cm of PS or EPR, and with others, much higher. Read the Respiratory Drive wiki for more https://www.apneaboard.com/wiki/index.ph...tory_Drive As a side note, in ventilation we use positive end expiratory pressure (PEEP or EPAP) for oxygenation, and PS for ventilation. PS is the foundation of mechanical ventilation and all forms of respiratory assist devices, and is used for comfort and minor therapeutic effects in CPAP and spontaneous bilevel devices. When we get into bilevel with a backup rate is when we can stimulate breathing in the absence of spontaneous effort and assist in normalizing ventilation in individuals with more serious respiratory disease and impairments.

That's kind of an introduction, so ask any questions.