Help Needed

[joeyjernigan]

Hello Everyone.  My first time posting but I have been around for awhile.   I am looking for help getting the settings tweaked to get my AHI down and this is the best place to go.  Some of the best advice around. Would you guys take a look at the information (sorry can't post pictures yet) below and and make some recommendations for me.  I think I would feel alot better is I could get the AHI below 2, preferably closer to 1. Any suggestions or help would be welcomed.  Thanks. 

Machine: Phillips Respironics BiPAP autoSV Advanced (System One 60 Series)
Mask: Resmed P10 nasal pillows 
PAP Mode: ASV 
Min EPAP: 12.0 
Max IPAP: 25.0
PS 5.0 - 11.0

AHI: 4.08
Large Leak: 0.00%
Clear Airway: 0.29%
Obstructive: 1.31%
Hypopnea: 2.48%
Flow Limitation: 0.15%
Vibratory Snore: 0.73%
Vibratory Snore (VS2): 3.50%

Edit:  Realized the information in my profile to the left is incorrect.  Please disregard.  I will change that.  The information listed above is accurate.

[Sleeprider]

It is going to help us tremendously if you will download and install the free OSCAR software. You are using a Philips Respironics System One BiPAP Auto SV Advanced (PRS1 960) with EPAP 12.0, and PS 5.0 to 11.0 unknown backup rate, auto or set. The best part of that is your machine is probably due for replacement soon, and you can move up to a Resmed Aircurve 10 ASV which is more comfortable and responsive. First impression is that you are using fixed ASV mode rather than SV Auto mode which can modulate the EPAP pressure as needed for obstruction. With your current PS range, your pressure can vary from 17/12 to 23/12 (IPAP/EPAP). You have some room left for more PS if it is needed.

Read the links on Organizing Your Oscar Chart and Attaching Files in my signature. Even though you cannot post links until you have transitioned to "Member" in about 5 posts, you can attach files. Let me know if you have any questions about OSCAR. It can do much more than Encore to help you optimize your therapy. You can access your profile information at the User CP Link http://www.apneaboard.com/forums/usercp.php

[joeyjernigan]

Thank you for the quick reply. Got OSCAR downloaded and setup and I got my profile updated. I have a screenshot from OSCAR but I am having problems adding an attachment.  It says I need 4 posts.  Am I doing something wrong?

---

I believe you are right about the ASV vs Auto ASV.  Under PAP mode in OSCAR it just show ASV not auto ASV which I am assuming it should show if it were in auto mode.  I am going to see if I can figure out how to change that.

[joeyjernigan]

   
OK I think I got it.  Please see if this is what you need.

[Sleeprider]

Chart is coming along. You can minimize the monthly calendar by clicking the triangle in the date line. That should create room for the respiratory statistics. The posted chart shows us the mess at 8:20 but we need the full night unzoomed to put it in perspective. We can see the machine attempting to deliver breaths during the OA and failing, there is a similar poor response to pressure support at the hypopnea at 08:21:35 and the missing breath at 08:22:00. I think this is where SV Auto mode might be helpful. I assume you had ASV titration in a clinic. When was that?

[joeyjernigan]

When I get home from work tonight I will make the adjustment to chart that you recommend and repost.  

Background:
To be absolutely honest with you my titration was about 8 years or so ago.  I don't even remember what my original settings were.  I was having similar issues with not being able to get the AHI down or feel better and wasn't getting much support from my doctor.  So I foolishly gave up shortly thereafter.  Over the last 5 years or so I have been off and on the machine not sticking with it for more than a few weeks are so.  I have made a commitment to myself to figure out my optimal settings with the help and advice here so I can feel better and have a better quality of life and I am going to see it through this time.  I am determined.  I usually buy all my supplies out of pocket and not through insurance because it is cheaper for me to do it that way and I can afford it. I have not been under as sleep doctor in a long time.  My initial sleep study back in the day showed I had mild to moderate sleep apnea.  When I initially started on CPAP I experienced complex sleep apnea and pressure related central sleep apnea (pressure was at 16).  I switched over to a Bipap and from that point on I have been doing it on my own.

edit for clarification:
When  I was put on Bipap I did not receive an in lab titration.  It was pretty much set to the min/max pressures on auto, with a here ya go.

[joeyjernigan]

Any idea how to put it in auto sv mode?  I have the clinician's manual but it doesn't reference any modes just how to set the pressures (EPAP, PS, etc.).  I just assumed it was in auto mode this whole time with the pressure ranges.

[Sleeprider]

Based in what I have seen, I think you need to change the mode in settings from ASV to Auto SV. You can then set EPAP min to 9.0, EPAP max 12.0, PS min 4.0 PS max 14.0. This will put the machine in an auto SV mode with a range of pressure. It might be helpful to observe in the OSCAR data how you respond to a range of EPAP and a different range of pressure support. I'm not promising this will be an improvement, but will allow us to better compare some alternative conditions. Be sure the backup rate is set to Auto.

[joeyjernigan]

I will make those changes you recommend tonight.  Tomorrow afternoon I will post the before and after screenshots (properly optimized of course) and get some more opinions.  I can't thank you enough for your help.  Will post back soon!

[jaswilliams]

Good luck with the changes