Optimal Settings on iBreeze BiPAP to reduce FL

[ewriter]

Hi Sleeprider,

Actually my sleep tech set the machine like this (we are both aware) because i was unable to tolerate the higher PS for the Autoset modes, and so we began using pressure settings that were almost the same as CPAP.

I think his plan is to gradually increase the pressure support, and hopefully i will be able to tolerate the gradual increase. I don't know what else to do because my situation is complicated by the "flutter."

Paul

[ewriter]

Hi Sleeprider,

Based on your feedback, I will try your suggested changes tonight.

(Based on your chart, the hypopnea at 15:36:20 was obstructive and caused by RERA. Following that event your breath rate was 12 BPM showing your backup rate of 17 is patently incorrect if it was to be used with effective pressure support. There are many flow limited breaths in this segment in addition to the hypopnea showing you NEED more pressure support. The other chart is zoomed in too far to be useful, but again looks obstructive. Your charts show you don't need a timed trigger, and using BiPAP S will provide good therapy.)

Since i will switch to S mode without a Timed Trigger, i won't need a Backup Rate; but I don't know what PS to use. Could you suggest one?

Many thanks,

Paul
ps i will send a sample of the results after making the changes

[Sleeprider]

We have been talking about PS 4.0, but if you want to start with PS 3.0 that would be an improvement equal to your Autoset EPR.

[ewriter]

Hi Sleeprider,

OK i will try PS of 3 tonight.

Many thanks!

Paul

[ewriter]

Hi Sleeprider,

I can't thank you enough for your suggestion to increase the pressure! On April 26 i increased the pressure to 2.5 (from 1.7) and, for the first time in 20 months, I slept through the night until the morning for about 6 hours, waking up without the dreaded "flutter" sensation! I did, however, still have some Flow Limitations and one or two Hyponeas (see attached charts. First chart is the base data and the following charts are Zooms of the FL and Hyponea).

I am also sending in a followup reply two more charts for this same date (April 26) showing Zooms of Mask Pressure and Resp. Rate (during the FL) in case they help.

In a following Reply, I am also attaching the data from last night (April 27), in which i woke after about 5+ hours with some "low-level flutter" as i have for the past many months. I don't know what happened but i did change my medication a bit (added Astorvastatin) and did not have any Propranalol during the day (i am currently taking 30 mg a day but last night i only took 20 mg at night and none during the day). I am trying to wean myself off Propranalol (since 2006) because i believe it can induce arrhythmia and/or weaken the heart over time. My Singapore Cardiologist here knows i want to get off it and is not against me doing so, though he believes i was given it in 2006 for anxiety (in the UK) and suggested i stay on it (for anxiety). The thing is, i am fairly sure the Propranalol has induced Bradycardia and my sleeping heart rate is normally in the low 50s and will usually go as low as 40. I don't think that's good. When my heart tries to come back up to the 60s etc (or as i am going below 50s), i get the "flutter" sensation and, try as i might, i find it difficult to avoid a panic attack. On the other hand, i also realise sleep apnea can irritate the heart and there's a possibility that the "flutter" was induced by chronic untreated (or porrly-treated) apneas/hyponeas; but i believe this can be resolved (as it has been just 20 months ago, when i was only on 20 mg Propranalol, living a very active life, driving 150-200 km a day in the City, and drinking two bottles of wine and several glasses of liquers every week (i don't really drink at all now).

I would really, truly appreciate your help to understand how to resolve further FL or Hyponeas (perhaps just go to PS of 4? My tech suggested we try 2.6 as he feels with EPAP already at 8, going straight to 4 would be too much pressure). 

I hope you don't think i am ignoring your advice! I am following what you advise; i just don't want to go too high (as i have many times in the past) and ruin the progress made so far. I could go straight to PS=3 perhaps?

Thanks!

Paul

[ewriter]

Hi Sleeprider,

As mentioned, here are my charts for the 26th April FL and Resp Rate during the FL, plus the base chart for the 27th when i again had "flutter" on waking.

For these results, there are no FL above 5 seconds, and no hyponeas. Yet i still experienced "flutter."

I wear mouth tape and use a neck brace. I am using a Full Face Mask. 

I do not know what else to do at this point.

Looking forward to your reply,

Paul

[Sleeprider]

Your pressure is capped at 10 cm, and you won't get the full effect of pressure support unless you provide the space between EPAP and IPAP to accommodate it. I suggest you get over your concerns about being blasted with pressure at settings of 12/8, because that is what you need.

We are currently working with OSCAR 1.5.3. You should update your version 1.5.1.

[ewriter]

Hi Sleeprider,

OK so i will try PS of 4 (8/12) or perhaps 7/11 tonight.

I don't think i am worried so much about being "blasted with pressure". I'm concerned it won't eliminate the "flutter."

I was on APAP on the Aire10 for 3.5 years at 6/13 (EPR 3) and i started getting the "flutter" while i was using both that machine and alternating with my Respironics System One CPAP at 14 (EPR 3). I alternated machines because i was living between two cities and had one machine at my apartment where i live with my wife; and the Respironics at the home i was renovating (100 km apart and i got tired of lugging and setting up the Aire10 at a single location). I was alternating for maybe 5 - 6 months but the exact split timewise between the machines, i'm not sure of.

Thanks!

Paul

[ewriter]

Hi Sleeprider,

Thank you for all your support. I tried the PS of 3 last night and it worked very well. Another night without being forced awake by "low level flutter" (more like a "pulsation" than anything else, as my heart rate either drops below 50s going into REM/dozing; or it rises above 40s when i am sleeping). I am so grateful beyond words, as this has been going on for 20 months.

Attached is the latest chart. I have upgraded Oscar and installed the Resvent software. Perhaps i should send any images in future from Resvent?

Settings right now:

Mode: Auto S/T
Rise Time: 400
PS: 3
Max IPAP: 11
Min EPAP: 7
Backup Rate: 6 BPM

I haven't changed the Trigger or other settings as I don't know what to set them to (they may be at defaults). Please note, on the Respironics and Aire10 machines, i did not have any Technical support in Canada (the DME will not allow me to make any change at all without a prescription from the Sleep Clinic doctor, and/or after another sleep study to confirm the change. That included even changing the machine to a BiPAP from the CPAP/APAP). So, i made at least 100 separate changes myself from changes to PS to EPR, CPAP to APAP to BiPAP Auto on the Respironics, several mask changes (they were quite happy to sell me a mask for another $250-300) and, as you can see, it would take months or years to ever make significant progress in a titration that has taken two plus months to make some progress.

I covet your help and respect your advice.

Thanks,

Paul

[Sleeprider]

Needless to say, you are closing in on optimum results with 0.00 events and a much smoother respiratory flow. If I may...I told you so. It would be interesting to see your charts in the Resvent software for comparison, and because it is likely more accurate.