BiPAP ST to ASV - Optimizing

[fikus56]

Hi - So after my sleep study showed though I was having central and obstructive apnea I was prescribed a BiPAP ST with a pressure of 20/16 - We have since adjusted it to 16/10. 

I have had a few really good nights showing AHI <1 but most nights I've been around 4-10.  Now I'm showing a lot of unclassified and hypopnea. My suspicion is they correlate with the mask leaks (nasal pillows with chin strap)

Can someone take a look at my Oscar chart and see if there are any recommendations you can make?  The difference in daytime drowsiness between getting a <1 and a 5 AHI is vast.

[SarcasticDave94]

I saw your other thread with the ResMed ST, and if I'd have come across the other thread, I'd have mentioned you likely need ASV. First, you'll need an ASV titration, second you'll need to exchange the ST machine for the ResMed ASV.

A few questions about the ST machine and your path to therapy. Your diagnosic was posted on the other thread.

Was this a home study or a lab?
Did you wear a wide Velcro belt across your chest? This is referred to as an respiratory effort belt.
Do you have other medical conditions, like heart or lung disease?

Your answers help tell us if ASV will actually be a good choice.

[fikus56]

That thread is what prompted me to request an ASV titration. 

The pulmonologist basically said that the path insurance will approve is to do a regular titration. 

I did an in lab sleep study.  I had stuff strapped to my head and chest. 

The result was that I needed a BiPAP ST but they never actually tested me for an ASV.

Ive brought up the ASV to the respiratory therapist and they basically said in order to get one , I have to fail at using the BiPAP first, then do another study, then get an ASV.  

Anyways, we have gotten the BiPAP ST to get my AHI under 1.0 so I feel like this should work.

[Gideon]

A 10 minute zoomed view of the UA please. I suspected CA but let's check for sure. I'm off to find your other thread. You should always keep your therapy posts together. Dave's comment makes me suspect CA even stronger. If so you have 3 paths

1. Decrease PS to avoid the CA/UA
2. Significantly increase the PS to treat the CA
3. Get an ASV to treat the CA. This machine is designed to treat CA/OA combos.

An ST is very appropriate if you have significant pulmonary conditions such as COPD, CHF, and others.

[fikus56]

here you go. 

I don't have any significant pulmonary issues.  My main issue is excessive daytime sleepiness, brain fog, etc. 

Originally I had an AHI of 20 at the at home test and was diagnosed with obstructive. 

did the APAP for 6 months and I was having centrals ...

Now Im on BiPAP - I have had a few nights where its been totally treated and my AHI was like. 7.  Other nights are like this one.

[fikus56]

Here is my old thread.

In the future, Ill keep this stuff all together.

http://www.apneaboard.com/forums/Thread-...a-included

[Gideon]

Your mode is ST what is your backup rate?

Only after the last UA is there an indication of CO2 induced breathing resulting from excessive flushing of CO2 (typical of treatment emergent central Apnea. The rest look ideopathic, not obstructive because there is no larger recovery breath.
A 10 minute view toward the start of the UA showing the transition please

[fikus56]

backup rate is currently 9

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here is the 10 min zoom where the UA starts

[Gideon]

My take on the UA is that they are ideopathic central Apneas

Look at 1:48:00 to 1:48:30 approximately.

See the taller breaths, those are the timed backup breaths, see the very much smaller breaths between them, those are you trying to take a breath without the machine's help. Show these two 10 minute segments to your doc, tell him this just isn't working for me. What can be done. Can we set up an ASV titration. Trial to see if that does a better job.

Note the plural pronoun to indicate you are in this with him.

I want your doc to correct this or attempt to and push a bit for the ASV.

I would try 2 changes
1. Set PS = 5, with intent to increase more.
2. Set backup rate = 10

An ASV sets an minute vent target to a 90 second average then adjusts PS on the current breath to hit that. Backup rate is again set automatically based on your recent history. It doesn't mis Apneas,especially central Apnea

[fikus56]

Thanks for the help.  I will push the RT and the doctor for a trail on an ASV. 

In the meantime, I can change the backup rate to 10.   What do you mean by change the PS to 5?

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Here is a screen shot of Saturday night where it worked really well and I got a 0.49.  This 6 hour stretch of sleep had me more refreshed than most other 8-10 hour nights.