Bad at Breathing

[Sleeprider]

As you have observed, in Autoset mode, your pressure will rise to the highest pressure your settings allow. This is in response to the flow limitations. Higher pressure will not generally resolve the flow limits, but pressure support will. It may be useful to look at a zoomed image of your flow rate. Try zooming in on the chart to where you can clearly see the wave-form for your respiration. This will generally be a 2-3 minute period of time in the zoom. What I'd like to do is to give you a more graphic idea of how flow limitation is interrupting your sleep. Ideally the zoom will include both flow rate and mask pressure graphs.

[Haldir]

I've attached last night's data and a zoomed in one.  I can definitely see the flat or double peaked flow rates on the inhale.  I also notice that it seems like the EPR isn't quite in time with my breathing?  Like maybe the pressure needs to come up quicker?  Maybe that's how it's supposed to look? 

[Sleeprider]

Nicely done with the graph. As you can see you have flattned peaks with a jagged top with 2-3 peaks. This shows that during peak flow, your airway obstructs and vibrates, most likely with a snore. The ragged peaks suggest a vibration of upper respiratory tissue that alternately opens and closes. While higher pressure may help this, more pressure support (difference between IPAP and EPAP) will support a normal breath and prevent the peak flow obstruction, without necessarily requiring higher peak pressure. Clearly, this peak flow obstruction or flow limit is very disruptive to your sleep, and we see an arousal after the really nasty FL at 03:14:10. I will stay with my recommendation for bilevel, that will increase pressure support from 3-cm to a level that will mitigate the peak flow limit. It's a really common problem, and Deborah who has active in this thread can offer good personal experience of how bilevel helps, and how to get a bilevel.

[SeePak]

Hi all.
Welcome Hadir.

Seems to me that the OA events need to be controlled .
The EPR is causing the pressure to be reduced to below the point of controlling the OA events.
( I did not see a titration study/test to confirm this, but Oscar shows it pretty good i think?)

Short story i would like to suggest...

Min. pressure 8, max pressure 10 EPR 1
Or
Min pressure 9 max pressure 10 EPR1

I am thinking the huge pressure swings are giving you problems, causing gasping and contributing to the 'aerophagia'.

I too used to like the feeling of the EPR3, so soft and easy going.
Trouble is, and i have the statistics in OScar, my OA events went up while using EPR! ( mostly because the pressure went lower than my sleep study of 6 cm !)

Hadir, as your post is labelled 'Bad at Breathing, i would also suggest checking out some breathwork exercises online.

I notice on your Oscar results you have a nice minute ventilation of around 5.5 and nice inhalation/exhalation times.
Seems to me you clear out the CO2 during exhale, without EPR.
I believe you will get less CA and OA events.

Will your FL go up?
Possibly, however, time in apnea will hopefully go down and a more restful sleep should be possible on most days.

[Sleeprider]

While I agree a higher minimum pressure is needed, assuming you tolerate that, the need for higher EPR or pressure support still remains. If you try the settings recommended by Seapak, you should see fewer OA events, but higher flow limits. I agree a minimum pressure of 9 or 10 is going to work better, but with EPR 3. You may want to try minimum pressure 9.0, maximum pressure 12.0, EPR 3.

[Deborah K.]

Do what SleepRider says.  He knows more than anyone else on this forum.  Have you looked over the link I gave you about my journey from AirSense to AirCurve?  SleepRider helped me get better machines for me and then my husband.  You will love the AirCurve 10 Vauto if you get one.  We both love ours and can't believe how much better we sleep now.

I sound like an advertisement for ResMed, but Alan and I both started with Philips Dreamstations.  I bought an out of pocket ResMed Airsense (which in theory I will be reimbursed for by Philips).  I could not believe how much better the ResMed machine worked than the Philips!  My therapy and comfort were both soooo much better.  And then we got the Vautos and things are even better.  

Okay, enough gushing.  

[Haldir]

Thank you, I really appreciate all the help I'm getting here!  I'll see if my doctor will agree with the BiPAP when we meet on Tuesday and definitely try to get the AirCurve 10 Vauto. Is there an AirCurve 11 now?  Should I stay away from it if there is one or is it the same?

Last night I got a nasal pillow mask (p30i) because my DME recommended it during my trial period (They don't make me send back the other ones so it's free to try).  Breathing through my nose was a very strange experience.  Somehow my tongue knew what to do to block it from my mouth.  I think I might have actually slept for 30 min. before leaking (I'm assuming from my mouth).  I wasn't expecting to sleep at all with it so I'm actually impressed.  I let the auto mode have 7 to 20 cmH2O out of morbid curiosity.  When I woke up I pulled the mask off to have a break and breathe freely from my mouth.  I accidentally fell asleep for the rest of the night without my mask on.  I proved that my O2 takes a dive without my mask, so that's fun I guess.  I might try the nasal mask again, haven't decided yet.

[Deborah K.]

I would opt for the 10 rather than the 11. The 11 has a smaller motor and seems to have more complaints. The 10 has a good long track record, and should you be paying for it, I think the 11 costs more because it's the newest model.