Brianhama - Therapy Thread

[Brianhama]

Would someone please take a look at my chart and let me know if it looks like I have the correct settings? Thank you!

   

   

   

[quiescence at last]

If this was my chart. I would set the starting pressure at PS 4 over the range of 6 thru xx versus 4 thru xx. See if that feels comfortable enough to fall asleep quicker.

QAL

[Brianhama]

My sleep study diagnosed me with:

• Obstructive Sleep Apnea - Severe (pAHIo 63.1, O2 nadir 78%)
  
• Central Sleep Apnea - Moderate (pAHIc 16.4)
  
• Cheyne-Stokes Respirations present in 38% of total sleep time
  

I've been prescribed the AirCurve 10 VAuto Bilevel (Max IPAP 25, Min EPAP 6, PS 4) and I've been using it for a few weeks. I feel that it is causing me to experience even more CA events. I can actually notice myself not breathing while falling asleep.

After reading these forums and reviewing the Resmed Sleep Lab Titration Guide I am wondering if I should have been prescribed the Aircurve 10 ASV instead. Does this seem like a more appropriate machine for my diagnosis?

Thanks for your help!

[Gideon]

Since CSR is frequently associated with CHF do you have Congestive Heart Failure?

Based on the CSR being real I would say yes to the ASV.

That said we have been known to work "miracles" with the VAuto and manage to virtually eliminate CA and PB but we haven't had genuine CSr before

[Brianhama]

I don't think I have heart failure. I assume I would probably know if I did, right?

[Sleeprider]

Brian, ASV is designed to treat central and complex apnea and periodic breathing or CSR. We sometimes suggest that members with central events on the Vauto change the trigger sensitivity to high or very high. This makes the trigger to IPAP happen with a minimum of spontaneous effort and sometimes reduces central apnea. Based on your diagnostic study, I'll be surprised if your issues are resolved with the Vauto. Have you discussed a progression to ASV with your doctor? Here is a link to the Resmed Clinical Titration Manual which contains a good description of the various machine, what they treat and how to titrate settings. https://document.resmed.com/en-us/docume...er_eng.pdf

[Brianhama]

I am still within the 60-day return window for the AirCurve 10 VAuto Bilevel machine. I'm self-paying so insurance isn't an issue. Am I correct in understanding that you think my best course of action would be to exchange the machine for the ASV model?

[Sleeprider]

I think both Gideon and I would prefer to see the actual diagnostic results, but based on what you summarized as the sleep disordered breathing profile, ASV is the correct machine. Take a look at the reference I linked. It's not just my opinion, it is what works for your conditions. If you have some data from using the Vauto and would post a chart that would be tremendously helpful. OSCAR software is free, and instructions for organizing and attaching a chart are in my signature links. You will need to have a SD card in the slot during use to collect detailed data.

[Brianhama]

Here are my charts from last night. Last night was the best night I've had with the machine so far.

   

   

   

There were still events throughout the night though. Should I try tweaking the Bilevel VAuto or just opt for an ASV while I can still return the Bilevel VAuto?

[Brianhama]

This chart is a bit more typical of what it looks like when I'm falling asleep on the machine most nights.