AHI very high after switching from Dreamstation to Aircurve 10

[mu50256]

Hello, 

I recently switched from my Dreamstation bipap to an Aircurve 10 because my Dreamstation was randomly shutting off.  I wasn't well controlled using the Dreamstation, but I haven't been able to get the right help from my doctors either.  

Since switching to the Aircurve my numbers have gotten much worse.  My AHI with the Dreamstation was around 10-15.  Now it's around 20 - 30.  My 02 would drop at times into the low 70's with the Dreamstation.  That is still happening.  

I have been playing with my Ipap and Epap settings to see if I could improve my results, but they have gotten worse.  

Can someone please take a look at these screenshots and see if you can help me figure out where I may need to make adjustments.  My prescribed settings are 17 ipap/10 epap.  I used the Auto feature for a night and it had me as high as 22 ipap and 18 epap and my AHI was around 10 that night, but my 02 was dropping a lot.

Screenshots viewable here:
https://imgur.com/a/S1vJ8FQ

Thank you.
Melanie

[SarcasticDave94]

Welcome to Apnea Board,

As you see yourself, you have a lot of CA flags, and the events are also clustered. This equals two possible separate issues, but they also can be within the same issue. One possible at a time below.

You'll need to obtain your detailed sleep study to help determine what's going on, specifically with the CA, as the machine labels these clear airway or medically are Central Apnea. If they're on your sleep study in abundance, you have to address getting a different machine if you can't avoid enough with VAuto. So you need to get your doctor's office to provide that report. HIPAA law gives you the right to request and receive it period.

Second issue, and pending the info in the sleep study, either it's separate or not from CA, you have a clustered Positional Apnea pattern. Please read up on this in our wiki. Basically it's a scenario where your chin is tucking towards your chest and kinking the airway, which then restricts air and brings out clustered Apnea events. The 2 ways to fix this, if applicable, use a thinner pillow if yours is thick, or one pillow vs two. If this doesn't work, a soft cervical collar to restrict the chin tucking will be helpful.

This Positional Apnea is not the same as the medicals are concerned over. They refer to positions as back, side, stomach, etc. The Positional Apnea can happen in most body sleep positions and is mostly unrelated.

The important piece of data I'm after on your sleep study is the diagnosis itself and the table with events and count listed.

[mu50256]

Thank you so much for your response.  I will see if I can get the detailed report from the place I had my sleep study performed.  I am an active sleeper and tend to side sleep with my chin tucked towards my chest in a baby like position so that also may make sense.  I am going to look into that cervical collar. 

Melanie

[staceyburke]

2 other notes.  I would put the machine on mode VPAPAUTO and many people including myself have found we can limit centrals using the trigger setting.  Set it to very high and see if that helps your centrals.

And I do agree it could be positional apnea.......

[mu50256]

Thank you.  I will give that a try.  I have an adjustable bed so I am going to try sleeping in a more upright position tonight to see if that may also help.

[SarcasticDave94]

On the adjustable bed, this comes from a person that has a home hospital adjustable bed, consider as flat of a pillow as possible for your body sleep position. If you side sleep always or almost, go a bit thicker than back sleep only. Then adjust bed to a small angle for the head area. Possibly don't go to a more sitting up setting. I don't have actual measurements, but a few inch elevation would be fine.

[HalfAsleep]

Sleep less upright, not more! Upright has a tendency to kink your airway, causing more apneas.

If you have gerd, make the whole bed slant, instead of just the top half of your body. This allows you to sleep flat while your head is above your feet.

[mu50256]

Thank you.  I was always under the impression that sleeping in a more upright position helped with apnea, but this does make sense and I have been more aware of it since I made this post.  I have ordered a soft cervical collar and am waiting for it to arrive to try that as well. 

Melanie

---

I had a virtual appointment today with my Pulmonologist/Sleep doctor this morning. She reviewed my results and is scheduling me for a new titration study. She may change my machine to the ASV one and possibly add oxygen once she sees those results, but she is hoping that a good titration study will be all we need.

[SarcasticDave94]

OK that's good news for you. Don't be too concerned over ASV settings. I've had to run my own from day 1. Had it for about 2 years until COPD got in the way of it doing well.

If you do get it, it'll eliminate CA. Other events except flow limits will also be well controlled. The FL are a byproduct of the ASV in CA combat mode.

If the doctor gets to the place of ordering an ASV, it can accept mode (CPAP, ASV, ASV Auto), will use EPAP and PS settings to manage. IPAP is the sum of EPAP and PS. Difference between ASV and ASV Auto mode is EPAP becomes a range of 2 bookend values in Auto. CPAP is static, single pressure.

To clarify I'm referring to a ResMed AirCurve 10 ASV. If the doctor had an issue with a backup breath rate setting, the ASV does this full Auto.

Oh by the way, don't accept the ST. This is a ResMed timed bilevel for lung disease. It can be used to treat CA but ASV is much better for it.

[mu50256]

Some bad news. They were not able to schedule my titration study until 12/18. I can't wait that long to get these setting adjusted to work for me. I have been using VAuto. The neck collar will hopefully be here in the next couple of days, but I have changed my sleep position to try to keep my chin from tucking by moving to a thinner pillow and adjusting the way I lay my head on it to have my head and shoulders on the pillow instead of my head on the pillow and neck at the edge. I have been playing with the VAuto settings to adjust pressure, etc. and have also taken the trigger to high, very high, and back to medium over the last couple of days. I was feeling like I could not get a full breath in before it was pushing me to breathe out.
My results are still pretty bad. Lots of low O2 drops, very high AHI. I am hoping the collar will help at least some.