CAs and PB on a bilevel - posting for a friend

[Dormeo]

My neighbor has been using a Philips Respironics DreamStation Auto BiPAP for about three weeks, which has been a wretched experience for him.  I set up a profile in Oscar for him on my laptop, and we looked at his data.  His AHI has ranged from 7 to 27, averaging over 14, with the great majority of events CAs.  I don't know what his sleep study said, and I don't know why he has a bilevel machine.  He will soon be making an appointment with his doctor.

I'm writing to ask for help with two things:  (1) what changes to his settings should he make?  and (2) what questions should he raise with his doctor?

I've suggested he immediately lower his IPAP to 8, keeping EPAP at 5, effectively reducing PS to 3 (or so I assume, though I'm a ResMed person so not too sure about PR settings).  I figure this probably can't hurt and might help a little.  If it does, maybe the IPAP and/or PS could come down some more.

I've suggested he ask his doctor what to do to lower his AHI and to reduce the numbers of CAs he is having, and also to review his episodes of PB.  (My neighbor will download Oscar onto his own laptop and take it in with him.)  

But I doubt whether any of this is enough, so I'm hoping the experts here can take a look. I'm posting 3 charts: a bad night (8/9), the bad night with zoomed in PB, and a less bad night (8/17).  The PB I've posted was the closest to CSR; what I see on other nights doesn't look to me like much of anything. 

Many thanks for any help that anyone can be offered.

[OpalRose]

I’d say your neighbor is on the wrong machine.  If the CA’s are that persistent, then he should ask his doctor about an ASV machine.  

The second chart is something to keep tabs on.  It looks like CSR which could be associated with congestive heart failure.  Not meaning to scare your neighbor, but do you know if he has any issues in that regard?  

If that chart is not something he experiences a lot of, or he doesn’t see that on a regular basis, then it’s probably nothing to worry about.

[Sleeprider]

Your friend is using auto BiPAP with fixed pressure of 10/5.0, which provides pressure support (PS) of 5.0. By far the most events are central. Your friend needs to obtain copies of all sleep study results for his records. It is likely the sleep study showed central or mixed apnea at a level of concern, and this is why a bilevel was prescribed with fairly low pressures. He should expedite the appointment with the doctor based on a high level of central apnea using this therapy. It is likely, that we could reduce the event rate by reducing the PS, using settings of 8/6 (PS 2). While that will provide some relief the real solution is to obtain the bilevel ASV which provides backup breaths and can even out the periodic breathing. I have come to prefer the Resmed Aircurve 10 ASV over the Philips Dreamstation BiPAP Auto SV simply because more people get better results. It appears he is in a Philips shop, so he may have to ask or insist to get the Resmed.

At the next appointment with his doctor, I'm pretty sure an ASV or ST titration will be ordered. He needs ASV, and ST will be another uncomfortable and ineffective device.

[DeepBreathing]

I agree with OpalRose - it definitely looks like he should be on an ASV (preferably Resmed). That periodic breathing also looks suspicious.

Without knowing any of the background it may be that the doc has prescribed the bipap because of a lingering reluctance to prescribe ASV. Or maybe your friend has a pre-existing heart condition which would contraindicate ASV. Or maybe the doc just doesn't understand central apnea (if it's not obstructive, they can't see it).

[Dormeo]

All, this is immensely helpful. I will be sure my friend sees everything you’ve written. Many, many thanks.