New member having difficulty

[Slim1950]

Sounds good. I will give that a try. My next problem is how to tell my sleep clinician in a way that he is not offended. The reason the Epap is set so low is that by starting me off higher than that caused me difficulty with my exhalation, and I would quit breathing.. but that was before I had adjusted.. we will see.

[Sleeprider]

Sounds good. I will give that a try. My next problem is how to tell my sleep clinician in a way that he is not offended. The reason the Epap is set so low is that by starting me off higher than that caused me difficulty with my exhalation, and I would quit breathing.. but that was before I had adjusted.. we will see.

Okay, that's useful to know. Let's configure a little differently then. EPAP min to 4.0, PSmin 2.0 PSmax 5.0 max IPAPmax 12.0. The strategy remains to increase minimum EPAP until the OA is extinguished, but while accommodating your sense of being unable to exhale. The pressure support, even at minimum pressure will give you the feeling that exhalation is easier. This setting will still provide a much more stable pressure and better chance at reducing events. It may still be necessary to increase EPAP, but a slower approach is just fine.

I think this resolves some of the problems with the current settings, and is a bit less aggressive. With this change, I think we're only changing the PSmin, which does not affect starting EPAP pressure. This will not likely stop the OA but it gives you more of a bilevel feel, and it's a good starting place.

[Slim1950]

Thanks. I am at the office. Tonight I will have a look at the settings.

[Slim1950]

OK, here are my settings.
Mode - Auto BiPap
Max Ipap - 9
Max Epap - 4.0
Min PS - 0
Max PS - 3
Flex type - BiFlex
BiFlex - 2
BiFlex lo - Off

What does PS stand for?

[Sleeprider]

PS is pressure support. The difference between IPAP and EPAP. There should be an Min EPAP not a max. So, I suggest:
Mode Auto B
Max IPAP 12
Min EPAP 4.0
Min PS 2.0
Max PS 4.0
Flex BiFlex
Biflex 2

To clarify what this means. When you start therapy with the old settings you are at 4.0/4.0. This is the root cause of the obstructive apnea and hypopnea. With the new settings you will start at 6.0/4.0. The machine will automatically adjust and if it detects obstruction will raise EPAP. If it detects hypopnea, snores or flow limitations it will raise IPAP. On your machine EPAP and IPAP can move independently, but with the PS min of 2.0, IPAP will always be at least 2 cm more than EPAP, but never more than 4 cm. The machine will only to to as high pressure as necessary to resolve AHI. You may need more EPAP pressure if significant obstructive events occur, but lest take our time. The settings I have outlines are very very conservative for minimal pressure and to facilitate exhalation, but give you more pressure support which I'm sure you will find more comfortable.

[Slim1950]

PS is pressure support. The difference between IPAP and EPAP. There should be an Min EPAP not a max. So, I suggest:
Mode Auto B
Max IPAP 12
Min EPAP 4.0
Min PS 2.0
Max PS 4.0
Flex BiFlex
Biflex 2

I adjusted my settings, as suggested. Here are the results from last night





Question: Although the machine tells me my leakage rate is at zero, Sleepy head shows lots of leakage. Is this significant? And is there correlation/causation between leakage and the OA event?

[Sleeprider]

If you could organize your Sleepyhead charts as shown in this tutorial, it would help a great deal. http://www.apneaboard.com/wiki/index.php...ganization

Leaks look more than acceptable from here.

Congratualtions on the improved results. How did it feel in comparison?

[Slim1950]

Much better, thanks.. more energy and endurance during the say, although it seems i have an event shortly before I wake up in the morning, and there is still a headache when I wake. I also wake up once or twice in the night; not sure what is waking me up.

WP

[Sleeprider]

You can switch the machine off and back on to mark an awakening then it might be possible to identify a cause. Meanwhile, I'd stay with these settings for a while and verify you continue to have good results. That is actually pretty exceptional.

[Slim1950]

You can switch the machine off and back on to mark an awakening then it might be possible to identify a cause. Meanwhile, I'd stay with these settings for a while and verify you continue to have good results. That is actually pretty exceptional.

If I am awake enough to remember to do that, I will!