Night 8, it's already Love - Hate. So glad I found you guys!

[thibaulthib]

Guys

I was facing the same issue when the Bipap couldn't trigger the IPAP because my breathing was really shallow.

The reason was that my trigger settings was set to "medium".

Just to improve the situation before moving to ASV (this is definitely what you need), I would strongly recommend to:
- Set the trigger settings to "very high" (ie. Very sensitive to detect an inhale attempt)
- Set pressure to 13/8 (Ps5) as a start

Also, can you provide a screenshot with mask pressure? This is the blue chart  (we will see the iPAP/EPAP change, because we cant see it with the red and green pressure)

[FE350]

Thanks Fred.  I'm trying to get you all the information you are looking for.  Please stay patient with me, its a pretty steep learning curve, with the thing called work and life a major distraction!  I appreciate your comments.

[FE350]

Thanks Dave!  I could use the comic relief, and then there are some days when I just want to be crabby...

I'm curious about making changes to the machine.  I've already figured out how to make the changes, but I see others posting concerns about compliance, and I don't want to do anything that would cause me to be unnecessarily scrutinized.  I'm guessing you don't care?! LOL

[FE350]

Hi Thibaulthib,
I only understood about 25% of what you are saying.  Sorry!  My backup rate is 6, I know that, because I thought initially that was supposed to be the rate I might breath at when I slept.  Yet my machine says RR = 12.  When i investigated, I learned my backup rate is 6.  That explains, I suppose, those 10 second spaces between "umps" by the machine, as it tries to help kick start my breathing. My gut said I should increase the pressure, but 1. I read somewhere, doing so might increase centrals, and 2. I'm concerned about compliance.  I'll add a 3. what if I mess with something and die in my sleep?? (OK, kidding, not kidding, does anybody else worry about this now that you know you are defective???)

[FE350]

Thanks Deepbreathing.  My doc is a novice.  I mean that in the nicest way, but they have basically told me that this is beyond their understanding and experience.  The doc accepted the prescription recommended by the folks who did the titration study.  Based upon my experience over the first 12 days with the machine, I'd say the young gal who sat at the controls that night, possibly spent more time with the other patient, because so far, my results are pretty horrible.  

Sorry about creating the second thread.  Even getting used to the setup of the forum has been a learning curve.  I'm pretty clumsy at this stage.

At this point, I'm not sure what else to show you all.  Is there some other view from Sleepyhead that will be useful?

What am I risking by trying some the settings changes that have been recommended?

I have felt like:
-the machine wants me to cycle my breathing too quickly, I haven't finished inhaling before the boosted pressure stops, creating a sort of "wall", which I either have to strain to continue to inhale through, or surrender, and not having a sense my lungs are full,
- i experience air hunger, where sometimes, after 5 or 6 truncated inhales, I have to do a major chest expanding inhale, in order to feel like I'm getting enough air,
- I can sometimes feel the bumps, in a kind of twilight sleep, and notice they don't trigger my breathing, I subsequently breathe of course, but have felt the bumps need to be stronger and/or longer...
-out of 13 nights in all now, my asthma has been triggered three times, causing me to stop treatment in the middle of the night, take a puffer, rest a bit (usually 45 minutes or so to allow my lungs to open, and the tightness to go away), then restart treatment.  I've had asthma all my life, and its pretty manageable these days, however, to be triggered three times in the last two weeks is pretty unusual.  What's up with that?

Last nights results saw a big drop in events, from 24.7AHI on Sunday, to just 13.4 last night.  I was thrilled to see that.  But heck, isn't 13 still really poor?

[FE350]

Hi Bonjour,
Thank you for weighing in!  I REALLY appreciate you all.  How can I show my novice doc that the UA's are really CA's?  You said that it is obvious when viewing the charts, but honestly, I have no idea what I'm looking at yet.  I'm just not sure what to present to my doc.  I've already sent the charts in this thread, and a snapshot of my pulse oximeter, which I just got, and wear on my wrist all night long.  It showed a period of about 20 seconds when my blood O2 level stayed down around 80.  That's kind of scary.  Having had to get a pacemaker last year, a failing SA node caused bradycardia and sick sinus syndrome. I'm afraid to see what dies next...

---

Thank you Opalrose.  Sorry about that!

[FE350]

Hers is the screen shot you asked for Thibaulthib.  is this helpful?

[Gideon]

Compliance.
There are 3 types of compliance 
1: Insurance compliance.  This is to ensure that you are using the machine so they can feel justified in paying for it.  This is typically for a shorter term and fewer hours and is what most mean by compliance.  If you are using your machine this is never a problem.  This does not mean effective therapy, only that you are using it.
2: DOT compliance.   A subset of users drive commercial trucks and have apnea.  Their compliance is stricter than insurance compliance and it is usually required on an annual basis.
3: Personal Just use it compliance.  Therapy, especially sleep apnea therapy is simple. If you don't use it, it will not work. This is where the senior CPAP users are, they wouldn't even think of sleeping without their CPAP.

The ST machine can be thought of as a modified basic fixed CPAP machine.  The main Pressure that lines directly up with a fixed CPAP machine in the Expiratory or EPAP pressure.  It has another pressure an Inspiratory  or IPAP pressure.  This is also a fixed pressure.  It is the difference between these 2 pressures which triggers a breath when one is not taken.  This difference needs to be a minimum 6-8 cmw difference for this to occur.  The difference is referred to as Pressure Support (PS) although an ST machine has no setting for PS.  The trouble is that with the settings being fixed they are constant and many users, including yourself, do not need that constant level of support.  When you do not breath and exceed your backup rate limit an ST machine will raise pressure to the IPAP pressure for the purpose of triggering a breath.

ASV take this a step further.  An ASV is set up with ranges similar to an Auto CPAP such as the Autoset, and manipulate the EPAP and PS and with that the IPAP pressure to manage central apnea Obstructive and Flow Limits/hypopnea via its algorithm.  Large PS when you need it and low when you don't, a high IPAP pressure when you need it and a low when you don't. 

Fred

[FE350]

Here is a screen shot, zoomed into an apnea, and with the mask pressure showing.  Check out the tidal volume. I've zoomed back out a bit, and added the second chart, to show you how my tidal volume fluctuates.  My breathing gets really shallow apparently.  My wife has told me she sometimes wakes up and has to put her hand on my chest, to make sure I'm even still breathing.  

[Gideon]

Hi Bonjour,
Thank you for weighing in!  I REALLY appreciate you all.  How can I show my novice doc that the UA's are really CA's?  You said that it is obvious when viewing the charts, but honestly, I have no idea what I'm looking at yet.  I'm just not sure what to present to my doc.  I've already sent the charts in this thread, and a snapshot of my pulse oximeter, which I just got, and wear on my wrist all night long.  It showed a period of about 20 seconds when my blood O2 level stayed down around 80.  That's kind of scary.  Having had to get a pacemaker last year, a failing SA node caused bradycardia and sick sinus syndrome. I'm afraid to see what dies next...

---

Thank you Opalrose.  Sorry about that!

This is your chart.  The Flow Rate flat lines with no activity, that is the signature of a Central Apnea in this environment.  The little tic marks are the ST trying to trigger a breath and failing.  This is a 70+ second Central Apnea event.  This is why your SPO2 dips.