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RE: Bad at Breathing - Sleeprider - 09-19-2024
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.
RE: Bad at Breathing - Haldir - 09-19-2024
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?
RE: Bad at Breathing - Sleeprider - 09-19-2024
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.
RE: Bad at Breathing - SeePak - 09-20-2024
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.
RE: Bad at Breathing - Sleeprider - 09-20-2024
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.
RE: Bad at Breathing - Deborah K. - 09-20-2024
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.
RE: Bad at Breathing - Haldir - 09-20-2024
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.
RE: Bad at Breathing - Deborah K. - 09-21-2024
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.
RE: Bad at Breathing - Sleeprider - 09-21-2024
The Airsense 11 seems to be more common than the 10 it replaced. My experience with the 11 is that it is a smaller device, but offers nearly identical therapy performance. As long as you get the Vauto, it really doesn't matter. Your Autoset is a bilevel device limited to 3-cm difference between IPAP and EPAP (inhale/exhale). That makes it one of the most versatile CPAPs on the market as the two-channel pressure of EPR is very unusual in this class and works identically to pressure support (PS) with the noted limitations. One way to help demonstrate the benefits of this bilevel pressure is to try a night without it. If you turn off EPR, your comfort level will immediately go down and flow limits, and arousal will increase. Most doctors seem to be unaware of how the Autoset really works in comparison to other CPAPs, and how true bilevel like the Vauto can further resolve the issues that disrupt sleep and cause arousals. Demonstrating the difference between a night with pressure support (EPR 3) and no pressure support (EPR 3) can make those differences very obvious and further your argument that pressure support from a bilevel will likely help your therapy and comfort. The criteria for bilevel is about efficacy and toleration of CPAP. The use of pressure support rather than higher pressure nearly always leads to better comfort and tolerance. Resmed was very early to recognize this, and that is likely the reason their CPAP is the market leader. No other CPAP has a truely bilevel pressure algorithm, which results in widespread tolerance of the therapy. I'm rambling, but we discuss this in detail in Deborah K's thread here https://www.apneaboard.com/forums/Thread-Flow-Limits-How-to-Upgrade-CPAP-to-Bilevel
RE: Bad at Breathing - Haldir - 09-23-2024
Thank you! I've printed off some days to show my doctor. I tried raising the pressure to 9 min/ 12 max with EPR 3 and gave myself some really bad aerophagia during a nap. It was probably made worse by eating a tamale with salsa an hour before... At night I changed it back to 8/9 and did OK. I talked to my grandma and apparently my grandpa was using a machine that she thinks is BiPAP until he passed away earlier this year. She might be able to send it to me after she finds it.