Bilevel machine - advice needed

[LookingForward]

Currently my settings are:
Mode: S
IPap: 18.0
EPap: 12.0
Easy-Breathe: On
TI Max: 2.0s
TI Min: 0.3s
Trigger: Med
Cycle: Med


Mask: Nasal
Ramp Time: Off
Climate Control: Auto
Tube Temp.: Auto

Although it's really tempting to switch it to Auto, I'm going to do it again like it is tonight and see what SleepyHead shows in the morning. I haven't gone to this doctor long and I don't know if he will be upset with me if I switch it without his approval. I guess after I see the data in the morning, I'll decide tomorrow night if I will switch it. Thanks for looking and helping.

I thought I knew how to attach the screen shot but I'm getting the message that my attachment is too large. I'll check the instructions again.

[LookingForward]

[attachment=7719]

I figured out how to resize a photo on my Mac but I'm not sure I did it right. Hopefully you'll be able to see it.

[Sleeprider]

Helpful to see the graphic. It’s early in your bilevel therapy and CA events are predominant. This can be from the PS. Auto pressures would allow lower pressures until higher EPAP is needed where we see OA events. I agree with your inclination to use the prescription but your graph presents a good argument for Vauto mode and possibly a lower PS during adaptation.

[LookingForward]

Thanks SleepRider for your advice. I'm only 3 nights with the new AirCurve 10 VAuto So I don't have the months or years of experience that many of you have. But I have been pouring over this thread ([split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea) as well as several others regarding Central Apnea. I'm still very surprised to see my data from the last 3 nights and all three show predominantly Central Apnea. I still don't have any of my official results from my two sleep studies in May and June. The first being a CO2 study and the second the sleep titration study. My doctor assured me that my sleep apnea case was very normal with no concerns expect just getting onto a BiLevel machine.

Based on the other thread that I added the link to, I'm seeing the wisdom in keeping my settings where they are for a little while so that I can show my doctor what I'm seeing through SleepyHead. I also want to show my doctor that I am willing to work with him. He seems to be totally clueless that there are online forums with so much valuable information available. My doctor is a nice guy and I don't want to loose him as a doctor but he was very much against me pushing for the BiLevel Auto, yet I did. I don't know how angry he will be with me just to show him the actual Sleepyhead print outs let alone suggest the possibility of switching my current machine to Auto mode or even exchanging it for an ASV Auto.

But I am concerned after seeing the combination of the last three nights SleepyHead results. Is three nights even long enough to be this concerned? I used my mom's only machine for a month with no data capability. But that still qualifies me as a newbie basically. How many nights of SleepyHead data do I get before expecting my doctor to want to help me? Is he going to want 2 -3 months that he can see first?

My other question is, from the data my machine sends out through WIFI, what can the DME and/or the Doctor actually see? Are they only seeing the AHI and how many hours I used it for compliance or are they seeing more?

I'm going to try to post last nights results. There is still so much on that chart that I don't understand. I have so much more to learn. But the only change was not in the machine but I usually have to sleep in a recliner do to pain a night. Last night I slept flat in bed, on my back. The details shows 61 Centrals and 1 Obstructive. I know that some of the Centrals are probably not real but I know that a fair number of them are, at least based on the YouTube videos that I've been watching. 

[Sleeprider]

With your current settings, you are experiencing unacceptable levels of central apnea. This is most likely due to the pressure support being too high. I think you would see immediate improvement if PS was reduced to 4.0, or in VPAP S mode 16 IPAP, 12 EPAP. Personally, I think you could do very well in Vauto mode at EPAP min 9.0, PS 4.0 and IPAP max 16.0. I have no idea how your settings were selected, but they are not working.

Is there a reason that a high pressure support is being used, like hypoventilation? If no, then it would be best to dial that back.

[LookingForward]

There is a possibility of hypoventilation, but the doctor hasn't officially told me that. That's what I thought was happening when I first went to this pulmonary doctor. I think he thought that was possible because my first sleep study was just to watch the CO2 level at night. I was told everything was fine yet he ordered another daytime CO2 test then incorporated the overnight CO2 the second time when I did the sleep titration. That's when I was told that the regular Bilevel machine was needed at the pressure setting of  18 to 12. I saw part of the raw data in his office but the test hadn't yet been officially read so I wasn't allow to get a copy yet. I've since asked for the results but was mostly brushed off stating the bilevel machine would take care of the sleep apnea. I was going to give him until my next appointment to give me the results but it's looking like I shouldn't wait that long.

I'm still trying to decide if I should change the pressure tonight before hearing from the doctor. I fully agree that the amount of Centrals I had last night alone is unacceptable but if I don't know the answer to the hypoventilation question, maybe I should wait.

Thanks again for your input, SleepRider.

[LookingForward]

SleepRider, if I changed my settings tonight, keeping it at spontaneous mode for now, would I only change the IPap and EPap settings and leave the rest alone?

The rest are like this:

Easy-Breathe: On
TI Max: 2.0s
TI Min: 0.3s
Trigger: Med
Cycle: Med

Also SleepyHead isn't recognizing that I am using the ClimateLine Heated Hose set at Auto.

[Sleeprider]

If flushing CO2 is a priority in your therapy, then high PS is the answer, but you will need a backup rate to maintain it and avoid CA. This does not make your doctor's recommendation wrong, rather you don't tolerate the low CO2 levels without triggering central events. This is a pretty common problem. The ideal solution would be ASV with EPAP min 9.0, PS min 6.0, PS max 15.0 and IPAP max 30. This would enable PS 6.0 on every breath at EPAP that stabilizes OA and enough PS overhead to resolve any CA events. I don't know if that is where you're heading, but that is the therapy that would resolve all issues.

I think you will find the lower PS resolves most of the problems, but you may need to add a SpO2 recording monitor to verify oxygen is maintained at desired levels.

[LookingForward]

If flushing CO2 is a priority in your therapy, then high PS is the answer, but you will need a backup rate to maintain it and avoid CA.  This does not make your doctor's recommendation wrong, rather you don't tolerate the low CO2 levels without triggering central events.  This is a pretty common problem.  The ideal solution would be ASV with EPAP min 9.0, PS min 6.0, PS max 15.0 and IPAP max 30. This would enable PS 6.0 on every breath at EPAP that stabilizes OA and enough PS overhead to resolve any CA events.  I don't know if that is where you're heading, but that is the therapy that would resolve all issues.

I think you will find the lower PS resolves most of the problems, but you may need to add a SpO2 recording monitor to verify oxygen is maintained at desired levels.

At this point I'm guessing that flushing the CO2 is needed. That explains a lot as to why I've been waking up so tired and short of breath for quite a while. Of course I'll need to get that confirmed by my doctor.

Based on this conversation though, I think I probably shouldn't change any settings tonight as I might need the higher pressure setting. Can you recommend a specific name of a SpO2 recording monitor that I should look into? Is there one that works with SleepyHead? I've been thinking of getting one anyway because of the shortness of breath I still have when I wake up.

[Sleeprider]

The CMS unit monitors are compatible with Sleepyhead and let you see a full night recording of your oxygen against the apnea events and machine settings, so that's a winner. I think I would consider the CMS 50F from Supplier #19 or another source for a better price. I'm not your best source for oximeter information and hopefully one of the members that use one will offer a suggestion.