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+--- Thread: IVAPS vs Vauto BPAP - Tidal Volume Question (/Thread-IVAPS-vs-Vauto-BPAP-Tidal-Volume-Question)
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - Sleeprider - 04-26-2023
We have been through this before on your therapy, and found you tend to obstruct more at higher EPAP.. I believe our first effort was to get you off the iVAPS at high pressure your doctor also recommended, then titrate you on VPAP S to a lower more effective therapy.
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - cmpman1974 - 04-26-2023
(04-26-2023, 10:20 AM)Sleeprider Wrote: We have been through this before on your therapy, and found you tend to obstruct more at higher EPAP.. I believe our first effort was to get you off the iVAPS at high pressure your doctor also recommended, then titrate you on VPAP S to a lower more effective therapy.
I am off the iVAPS Sleeprider. Haven't been on that for quite a while now. This 17/9 pressure was recommended for BPAP-S (same as before). Would you guess just a poor night of sleep or is it truly possible to have that much worse results changing from 16/8 to 17/9. They seem so close. Since I continued to have obstructive events at 16/8 to a degree, I figured the increase in IPAP may help eliminate a few, but this result was opposite. It seems more complicated then one would think.
There are so many factors sleep studies don't account for. In the lab, the bed is flat. At home, the head of my bed is inclined significantly. That has to change things some too. I told them that, but they didn't think much of it.
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - cmpman1974 - 04-29-2023
Still struggle with O2 levels even on 2L of supplemental O2. It seems like the apnea episodes, though AHI is pretty good, bring O2 down regardless. I really wish I could 100% trust the Checkme Max O2 wrist monitor. I have some doubts about the actual numbers, but not as much about the trends in general. It looks like my 17/9 pressure I was prescribed doesn't take care of all issues.
If I see a cluster of apneas around an SPO2 drop. a result is more believable. It happens often, but I still see some drops not tying out to apneas/hypopneas. That's what makes me question data some.
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - Jay51 - 04-29-2023
Cmpman, I see OA's lining up with most of your large drops in SPO2. A soft cervical collar might prevent these.
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - Sleeprider - 04-29-2023
I agree with Jay51 and have argued many times these appear positional. I know your SpO2 was better with a bleed rate of 3 L/min. As you know, leaks are a major source of dilution of supplemental O2, and the leak rate is high during the periods of desaturation. So far I don't see any benefits to 17/9 pressure compared to your previous 16/8 setting. I think you will have to be the judge of the efficacy, but the AHI was a bit lower with the lower pressure, and it might have helped with the leaks which are clearly bad for SpO2.
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - cmpman1974 - 04-29-2023
(04-29-2023, 12:35 PM)Sleeprider Wrote: I agree with Jay51 and have argued many times these appear positional. I know your SpO2 was better with a bleed rate of 3 L/min. As you know, leaks are a major source of dilution of supplemental O2, and the leak rate is high during the periods of desaturation. So far I don't see any benefits to 17/9 pressure compared to your previous 16/8 setting. I think you will have to be the judge of the efficacy, but the AHI was a bit lower with the lower pressure, and it might have helped with the leaks which are clearly bad for SpO2.
I am putting the O2 back up to 3L tonight. I will try the soft cervical collar next as it's a logical step given the pattern. It is pretty obvious they are clustered. I was wondering if REM sleep could play a part in the clustering, but I'll never know obviously.
I agree I see no benefit with 17/9 compared to 16/8. To be fair though, I'm guessing the proposed pressure wasn't even titrated during the test as the tech made it crystal clear they never ever titrate a PS more than 4.0. That begs the question, how the heck did the doc arrive at 17/9 for an optimal pressure, right? It never would've best tested under the tech's mentality. It has been a battle to get a copy of this report. It really shouldn't be this difficult to obtain considering I paid for the study. I really don't like that. I hope to get it soon, but in my opinion it should be mailed to the patient when requested no questions asked.
I am pretty sure having a bed at home that has the head inclined significantly more than the facility beds that were 100% flat will make the pressure needs a bit lower as one's airway is probably opened up a tad more.
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - cmpman1974 - 04-30-2023
All was going great last night and then at 7:30 AM, all hell broke loose with the apneas. I watched the video. I was on my back during the period but saw no unusual movements / chin tucking. I just don't get it. Bad apnea clusters with many lasting 16-18 seconds each. Not encouraging. I went back up to 3L of O2. The leaks got worse as well out of nowhere at this time, but even the max leak isn't far over ResMed's acceptable 24 L/min threshold so I doubt that was the culprit. Again video shows no evidence of anything odd. The clusters come so fast at times.
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - cmpman1974 - 05-01-2023
Better night for sure. Something must happen to me at 7 AM spurring apneas! Not as severe and clustered but it seems like a time I always struggle relative to the rest of the evening. Makes me curious why it occurs.
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - cmpman1974 - 05-03-2023
All the supplemental O2 makes zero difference if you can't get mask leaks under control. I'm kind of lost as I have great mask leak numbers much of the night and then out of nowhere, they elevate terribly cascading to apnea events which leads to low O2 regardless of the O2 bleed. 29 minutes under 90% last night and almost all of that time ties to apneas and leaks. I feel like the Vitera mask fits well. It's so hard to solve an issue you literally are not awake to experience. Feels kind of hopeless honestly.
I see so many here get these great mask leak rates every single night. Many are on low pressures like 10/7 though so maybe that helps a lot?
RE: IVAPS vs Vauto BPAP - Tidal Volume Question - Sleeprider - 05-03-2023
If you have video of these leaks, do you know how they arise? I know they are a recurring challenge for you.