VPAPauto to CPAP..experiment

[WW4B]

Currently using vpap auto mode and, although I experience "low numbers" I am continually waking up feeling tired and not rested or refreshed. I am concerned that arousals although not severe enough to be flagged are causing interruptions in my sleep. I have read that a constant pressure may help alleviate the restlessness that I have every morning. Given my attached chart where would a good starting point be for to set my pressure for straight cpap mode and other related settings relative to straight cpap. Would like to give it a try...thanks

   

[HalfAsleep]

How long have you been on xPAP? Your numbers are enviable. It takes weeks for your body to adjust.

[WW4B]

Have been on Xpap for over 5 years now. Yes , as I stated above my numbers and therapy look great however I continually feel tired and not refreshed as I also stated above. Just would like to try a constant pressure to see if it would ease the constant arousals I continue to experience. With that being said what pressure should I go with…a pressure equaling epap or iPap or somewhere in between. Should I use EPR as well. I can tolerate higher pressures and do not need ramp. What do you recommend.

[WW4B]

bump...no takers !

[Deborah K.]

I don't think switching to Cpap mode would make any difference, as the pressure range while you are asleep is only 13.6-14.0.  It's not your pressure range that is waking you.  

Your leaks are not high enough to cause most people the slightest problem, but they do vary a lot during the night, and some folks find their sleep disturbed by those changes.  Can you feel leaks around your mask?  Or might you mouth breathe some?  If it's your mask might the pillows be a bit worn out?  If you are mouth breathing you could always use mouth tape.

The only other thing I see is that you still have some flow limits.  Maybe try raising your PS setting to 5 or a bit more.  I suggest going to 5.4 for a start.  This would obviously be the easiest thing to try, so start there.

Otherwise, your treatment looks excellent, but waking up a lot is a royal pain.  I hope changing the PS setting works.  If not look into the ideas above that.  And perhaps someone will think of some other idea that will help.  Good luck!  

[WW4B]

Thank you Deborah K for your reply and suggestion. Lets say I explore the idea of increasing PS. Will the elevated PS setting possibly cause treatment emergent centrals to appear? Will an increase in PS cause C02 issues as well. If I increase PS what would advise for min/max settings ? Leave as is or increase or decrease. Would you leave Ti min/max as is as well as trigger at high. I want to achieve a good spontaneous rate and do not want the Vauto to breathe for me if that makes any sense. I have read that a high PS with a large pressure range is not good. What would you recommend.

[Sleeprider]

You have a device that allows for changes in pressure support in 0.2 cm increments. You can try anything from zero PS to your current 4.6 and see what works best. If you want to try settings that would replicate the Autoset with EPR at 3, then I would suggest Vauto mode at EPAP min 7.0, PS 3.0 and IPAP max 14.0. We can try anything you'd like with the idea of finding a more comfortable alternative. You seem to be one of those individuals with variable respiration rate, and it could take some trial and error to find what works best. I doubt CPAP will be your answer.

[WW4B]

Thanks Sleeprider for you input. I will give those settings a try. I know when I go below PS 4 my flow limitations go waaaay up. But I will give it a try. Is it advisable to leave trigger at high or make a change there as well. I find that my exhale seems to be a tad long, do you see an issue there? Will try any recommendation/advice as I trust your opinions and that of the forum immensely. Recommend anything else or am I now on trial and error mode?
Also, my Vauto is approaching the 22,000 hr motor issue message and it could go tomorrow, next week or months from now so trying to be proactive in securing a replacement now. Just had an appointment with the pulmonologist last week and it did not go well. I spent more time walking into the building than I did with the DR. He downloaded and reviewed my SD card. Therapy/numbers look good I see no issues here, see you later !!! Did not listen or seem concerned about my issues that I have presented here on this forum...thanks to all who have read, reviewed and replied to my threads. Anyway, I did walk out with a new prescription for a new bilevel machine. However, in trying to obtain one it seems that I may need now to have another sleep study done before a DME and/or insurance will pay for one as my last study was done in 2014. CRAP !!
Look forward to any comments. 
Sleeprider, good luck and wishes to you and yours on your relocation to FLA

[WW4B]

Deborah K...question. You mentioned that my pressure range while I am asleep is only 13.6-14.0. Since my max Ipap was set at 14 that would be as high as it would go anyway. If Ipap was set at a number higher than 14 it would be most probable that the pressure range could/should/would be wider. Am i correct in that assumption? Given this thought what would your choice of action be. Thanks ?  

[Phaleronic]

Yeah, switch over to cpap for a few nights, I have tried two vendors' auto bipaps (resmed and philips)-and have followed the titration protocols for both-as well as suggestions here.

I sleep badly on both when juxtaposed with cpap. I have to use flex, but I can't handle EPR because of its delay in inspiration pressure (when using resmed, EPR is off).

She's saying that your min EPAP at 9cm plus pressure PS of 4..6 is 13.6 and is what your max IPAP is now which is very close.

With your graphs I'd set the machine to cpap mode at 15.4cm and try it out tonight for 30 minutes and see what you think, then roll with it for a few nights.