BiPAP Induced Central Apneas for New User (help)?

[STB123]

Thanks for all the great advice!!!

I took the EPAP min to 5 and PS to 3 and my AHI dropped to 8.8 with 4 CA's/Hr.  AHI was 26.25 with 18/Hr the night before I posted this.   Clearly this is a large improvement ,although I am still fighting with removing my mask in the middle of the night.

Attached are nap+last night's results, and further input is greatly appreciated.


https://imgur.com/a/lFZK7

[Sleeprider]

I'm going to start wit a couple suggestions on the chart.  Minimize the monthly calendar by clicking on the triangle in the date line at top left.  It's generally preferable to have the details tab showing rather than events.

The results of the changes has reduced CA and what you have left is mostly CA and H events.  I think these are central, and as a result, I don't think there are additional optimization settings you can try.  If we allowed PS to increase, it would increase the CA, and perhaps reduce H events, but that is not a great trade.  I also think the events flagged as OA are more likely CA.   In my first post I suggested another thing you could try was variable pressure support.  The settings for that would be EPAP min 5.0, PS min 2.0, PS max 4.0, IPAP max 9.0.  As said in my first post, I think your long-term solution may be to use ASV, but in the meantime, this looks remarkably better.

[STB123]

Sweet, thanks again for the reply! Most of my events are very short. It seems like there could be a logical evolution from simple AHI to account for more variables, such as event duration, desaturation, etc at some point. Not sure why these machines don't have built-in oximetry (maybe some do?)

If I take out events shorter than 20 seconds, my AHI would be 2.

I have a Contec CMS50F oximeter arriving tomorrow, so I think I'll focus on O2.

[Sleeprider]

Sounds like a great plan. Also important to keep in mind that as you adapt to the therapy and progress, the events naturally diminish. I expect that you may end up after a month with very acceptable results. BiPAP can work for people like yourself with predominately short, central type events, but it's important not to have the machine setup with high pressure or pressure-support that can actually make things worse. Glad to see you have made such good progress and have a positive attitude.

[STB123]

Should I even be including these events?  Any way to raise the threshold in sleepyhead, so events under, say, 15 seconds are excluded?

[attachment=3900]

[STB123]

Take your EPAP min to 5 and PS to 3 and see what happens.  I think these are machine induced, and you would not be the first one on the forum to have altitude related centrals.  I'm thinking this change will help quite a bit.  Your Dreamstation is capable of variable PS, and using a range of 2-4 is another option.

AHI of 3.4 yesterday, based on this advice, and possibly partially mask changes. Tried 5 masks now, currently on pico nasal mask. 

I really wish the Dr took a little more time to dial these settings in rather than leave a new user hanging, as I was floating around 25 due to centrals, and I can't see any doubt they were machine-induced with this vast of an improvement in such a short time.

THANK YOU!!! 

[Sleeprider]

Wow! That is great. Better than I expected. Really glad this is working out for you, and it should bet better from here.

[STB123]

Another great AHI night, as I was compliant for 8+ hours, and AHI was 3.8.

First night with my oximetry, and got some strange results.  I apparently had one massive desaturation, looked like about 30 seconds, and my original study had me as low as 86, while this was 77.  So just like my transition from moderate study to tons of centrals, I went from decent ODI on my study to what appear to be worse results.

To recap, I live above 6,000 feet, I'm fairly young, in shape and exercise frequently.  I did a little waking test and my O2 was around 97%.  I ran on the treadmill for 10 minutes, HR up to 150 and O2 remained around 96.

I do have a *mild* occasional cough right now.

Any input is appreciated! Love you guys!

[attachment=3909]

[Sleeprider]

I would suggest you zoom in on that desaturation spike and see if it might just be a dislocated sensor, or if it corrolated to an event. That looks a lot like movement to me and the time is extremely brief. I think the event at 04:10 looks more credible.

[STB123]

We looking for a correlational spike in HR?

[attachment=3910]