gettingbetter - Therapy Thread

[gettingbetter]

Hi everyone!  Need help please.  I have attached charts for review.

I worked my way up to IPAP 7, EPAP 4 (with use of EPR of 3).  I'm using FFM and sleeping on my left side. 

Questions:

1.  There are still flow limitations and my machine's PS is maxed with EPR of 3.  I'm thinking this looks like UARS and could maybe benefit from Bipap for more PS and to address flow limitations.

2.  What's going on (on my chart) just after 02:11.  Cardiogenic artifact or PP (on the 0 line)?   followed by significant flow limitation?  



Thanks for any information.

[ArcherNeedsSleep]

Has anyone ever had aerophagia from too low of a pressure?

Yes - I find that when the pressure is too low I inhale with more force because I feel air-starved, and it causes bad aerophagia.  I've bumped up my minimum slowly to offset this issue and have found a sweet spot that minimizes aerophagia most nights.

[gettingbetter]

I've been using Resmed Airsense 10 Auto for Her.  I've been able to use pressure of 7 cm with EPR of 3, however, I'm still have lots of flow limitations.  The aerophagia at 7 cm has been better than when I was at 5, and I feel a little better with more pressure.  

Tonight I'm going to use a ResMed AirCurve 10 Vauto.  I'd like to start out with settings very similar to what I used on the Airsense, and will slowly progress from there (slowly because of the tendency for aerophagia).  

Can anyone help me with a good starting point for the settings, please?  Thanks!

[gettingbetter]

Does anyone have any suggestions on my previous post?

[Gideon]

Mode VAuto
EPAP min=4
IPAP Max=9
PS=3

[gettingbetter]

Thanks Gideon.  Does the PS of 3 allow the IPAP to go to 12?

[Gideon]

No The IPAP Max =12 allows the IPAP to go to 12

your initial EPAP = 4, IPAP = 7 (4+3)
your max EPAP = 9, IPAP = 12

Once we see your nightly charts we can work on optimizing them

[gettingbetter]

Is there a way to lower the IPAP max and still use PS of 3? Just for the first night?

[cathyf]

I know that you are afraid of the pressure, but I think you need to give it a little room or it can't fix the problems, either. If you wanted to move gingerly,
min EPAP=4
max IPAP=7.2
PS=3.0

And then edge up max IPAP by 0.2 at a time

Here is my experiment with ps=3
https://www.dropbox.com/s/31z11h2wz2330vr/PS3.png?dl=0

Now what I think you want is something like this:
https://www.dropbox.com/s/h6adf366269cg0...o.png?dl=0

It's not just the maximum pressure, but also how long it stays up there. If you have very short bursts of higher pressure, then the total amount of air you swallow won't be much. You may need to free up the machine and allow it to goose the pressures and stop the FLs quickly and then the pressure falls back.

Here's what "uneventful" looks like on the autoset -- even those relatively low levels of FLs drive the pressure up some, and integrated over the whole night I spent lots more time at the higher presseure.
https://www.dropbox.com/s/nc2uwfmmj100hl...t.png?dl=0

[gettingbetter]

Cathyf and Gideon:  

I can't thank you enough for your suggestions on the vauto!!!  Newbie here, still learning. 

Only because of my history of aerophagia, the first night I went with vpap-s mode (7.4 cm/ 4 cm), just to see how my system would respond to the new machine. I realize I'm restricting the machine's capabilities in vpap-s mode, plus I don't think vpap-s measures flow limitations.  A couple of questions:

1.  The breathing seemed A LOT different on the AirCurve 10 vs. Airsense 10 (tight APAP for her mode).   The Airsense always felt like the machine went into exhalation mode before I was ready to exhale.  On the Aircurve it seemed much different, perhaps easier, to breathe naturally (I'm still get used to the difference in machines).


2.  I had A LOT less aerophagia on the AirCurve vs. the Airsense.  I had mild burping during the night but no sore stomach today so far.  Does the type of machine reduce aerophagia in some people?

Tonight, on to Vauto mode, per your prior suggestions!  Thanks again!!!