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[BiPAP]

Hello - 

I've been lurking for a few days and I just got around to setting up my account. I was diagnosed with extreme OSA (around 70 events per hour) in 2009 and I've been using a Respironics Auto BiPAP M Series ever since. I've been feeling a little sleepy for a few months now and last week I picked up a new Resmed Aircurve 10 VAUTO. My original Rx was 20/5 Auto BiPAP. I don't recall any other instructions, but my M series is set up with a P.S. max of 8 and EPAP min = 5/IPAP max = 20.

I used the clinical manual for the Aircurve to make a few tweaks. The settings are:

IPAP MAX = 20
EPAP MIN = 5
P.S. (I've been experimenting and I need help interpreting the SH data) but the machine was originally set to 4. I've since narrowed the range between 5-6 which tends to produce the best results according to the data from the machine as well as how I feel in the morning. I plan to post the results of 5, 5.6, 5.8 and 6 once I can figure out how to post 
Ti Max/Min = 2.5/1.5

With the above settings, the AHI is between .69 and 1.32. As I don't understand the SH charts I'm wondering if someone could take a look at the link below and let me know if I'm on the right path.

Thanks!

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I guess I need to post 4 times before I can provide a link.

[Marillion]

Welcome! It seems your AHI numbers are certainly good so you must be on the right track. If you want to post a link via imgur just put a space in the link somewhere and the fine folks here can figure it out. Looking at your data will definitely help in giving you more concrete suggestions.

[BiPAP]

Thanks for the tip Marillion!

The link to my four charts is:

https: //imgur.com/a/Me4TD

Two charts indicate a pressure support of 5.8; however, the November 4 chart should be 5.6. For some reason SH picked up 5.8 twice and I've never maintained the same setting twice. Thanks for taking a look.

[Walla Walla]

Looks good!

[Sleeprider]

You are current using Vauto mode at PS 5.8 over 5.0-20.0.  Your pressure rarely rises above the minimum settings, and nearly all events are obstructive apnea.  Your AHI is frequently less than 1, and this chart is one of the more active ones.  Based on controlling OA a little better, I suggest you simply increase EPAP minimum to 6.0 cm.   Your results are excellent and I would expect that to continue.

[BiPAP]

Thanks Walla for taking a look. I feel better now that I've changed machines. I just wasn't sure what else I should focus on with the SH charts other than AHI.

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Thank you Sleeprider for taking a look at the charts and interpreting the results. I'm assuming you took a peak at the other days as well. I've pretty much narrowed the best pressure support to between 5 and 6 but I will adjust the EPAP min to 6 (keeping P.S. at 5.8). I'll repost tomorrow once I have the results.
 

[ajack]

Other than AHI, with bpap, is you can also adjust your tidal volume with the PS, if there is copd etc. I think your's are fine. I'd like to keep an eye on the tidal volume chart, to see if any changes are needed, to minimise the dips. Going by what I can see of your chart, I'd leave the PS at 5 and like sleeprider said raise the epap.
This titration guide may give some background
https://www.resmed.com/us/dam/documents/...lo_eng.pdf

[BiPAP]

Thanks for taking a look ajack. When you say leave ps at 5, are you referring to the chart Sleeprider posted with a ps of 5.8 or do you mean the ps of 5 from one of the other 3 charts? My Ti mx/min in my original should have read 2.5/.5. I used a chart in the clinical manual to estimate Ti based on RR. I tried a few settings and settled with those values. I'm also using a setting of medium for both trigger and cycle. Looks like that is what's recommended for normal lung function.

[Sleeprider]

Your link shows four different results at PS 5 to 6 and EPAP min consistently at 5. https://imgur.com/a/Me4TD

You don't seem sensitive to PS and whatever feels best is what you should use. Your results are very good, but could stand to start at EPEP min 6.0. I think ajack and I are pretty much in agreement that PS settings can be based on comfort. You have done a good job of getting this all dialed in, and this mostly builds on a prior success with the M-Series. I imagine your long-term event rate average will end up very close to mine at about 0.5. Given how close you are to ideal settings, I would limit any changes and look for changes based on longer term trends. You will see variation from night to night, but it's really the trend and comfort that count. Since your results are so good, making frequent changes won't allow you to really see if an improvement is due to settings or just normal variation.

[ajack]

It won't matter if you go PS:5.5 or 5.8, but you were getting enough air at PS:5, I can't see any advantage to PS:5.5. You aren't running high pressure and need extra pressure relief on exhale and your Tv is fine. Your inhale exhale ratio is 1:2. I can't see anything to fix or change from default, Ti and rise.
I can see raising the min EPAP, as suggested by sleeprider, would help with the few OA/H you have left.