New on Bipap ASV, have a few questions

[tcolar]

Got it, thanks., here are those graphs.

   

   

[Sleeprider]

There is a lot of stuff there, and some of it is confusing. I really want to know your complete settings including BiFlex or rise time and Ti min and Ti Max.

At 01:10:10 we see what appears to be poorly supported inspiration which may be in part a timing issue. There are many instances where a positive flow value drops back to zero and is followed by the supported inspiration. This positive pressure ahead of inspiration can be due to BiFlex, trigger sensitivity or Ti min being too short. We see a number of very flow-limited inspiration (IFL) in the first two breaths at this time-stamp. We then see a series of productive breaths that seem to be supported by IPAP, then at 01:11:00 inspiratory flow fails again. In this sequence, expiratory flow appears to be clearly defined and relatively short.

At 01:30:20 we see three triggered breaths followed by what appears to be expiratory flow limitation (EFL). This can be expiratory puffing through the mouth or other limitation that decapitates the exhale flow. There are a number of EFL breaths with IFL.

[tcolar]

Here is what Oscar reports the settings to be for last night (charts I gave you)
Pap mode: asv
min/max epap: 6
min/max ipap: 9
ps min: 3 -> I set that to 0 yesterday, not sure why it was back to 3
ps max: 3

Current settings (on machine):
pres+: 9
epap+: 9, epa-: 6
ps+: 3
ps-: 0 
BPM: 12  
TI: 1.2
Flex: Biflex 3

I don't want to change too much, but I'm thinking to change this:
- Epap+ : change max to 11, 9 just doesn't seem to enough 
- ps+ : 5   - I'm not clear as to why ps- would not be 0 ?
- BPM .... the first day that was off completely (100% pat trigger breath), and oscar says my average BPM was 12,
so I'm guessing the backup rate should be lower than that, say 10 ?


A max of 11 might still not be enough, but hoping to at least see improvements. For reference my bets results (AHI <5)
were in May last year when I was using ABAP 11-14, eventually developed aerophagia more and more though :-/

Does that make any sense ? I don't want to deviate too much from my prescription yet, but at the same time I need better sleep, l
last two nights were very poor with headaches in the morning.

[Sleeprider]

Change BiFlex to 1 and all is good for now.

[tcolar]

Thank you, I will change the biflex to 1

just to be clear do you want me to leave the rest as it s right now (epap 6-9, with ps of 0-3) or to what I suggested (epap 6-11, with ps 0-5) ?

[Sleeprider]

Let's stick with current EPAP and only change PS to start. I think EPAP will need to increase to resolve OA, but most events are CA and H and I would rather see the pressure support do its job on those.

[tcolar]

sorry for all the questions, but I can only set the PS within the 0-3 range, my understanding is that's the difference between epap max and epap min (9-6=3), so for me to increase the PS, I would have to use a higher epap max (or potentially a lower min).

[Sleeprider]

Be sure your max pressure is at least equal to EPAP max + PS max. As I recall:
Mode ASV auto
EPAP min 5.0
EPAP max 6.0
PS min 0
PS max 6.0
Max Pressure = 12.0
BPM Auto or 10
BiFlex 1

[jaswilliams]

Worst, yesterday evening it was definitely set to 6/9, I even have a picture of the therapy screen set to that, yet this morning it was back to the (useless) setting the tech had set  (6/6, ps-0, no backup), I had a terrible night (17 AHI) with CA's (4.5) and tons of hypnoeas (12.5), not sure if they reset it remotely or what :-/

I'll make sure it's correct before going to bed tonight ... I might also use 11 instead of 9 (with PS=5), because 9 really doesn't seem to cut it.

I wonder if your settings are 'Locked' on the SD card on Philips machines if clinical settings are configured on the SD card than the machine will revert back to thosee set by the tech, a format of the SD card or a 'new' SD card normally sorts that little issue.

[tcolar]

Here is what I got last night ... I feel like I slept better, even though the AHI is still quite poor and still lots of hypnoeas.

Note: I tried biflex at 1, but that made me feel like I could not inhale properly, felt like it was restricted as if I was breathing through a straw if that makes any sense, I used 2 which was ok, I can try 1 again tonight if that's important.

You can ignore before 11:30, and most of around 5am, both swj.

It seems the machine did try to kick the pressure to 12 to fight the hynoeas but that it did not work ... it even looks as if made them worst somehow.

Let me know what you think, thank you.

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