Revised Post Regarding "I need help with SH data" - with data included!

[Jeffo1]

Hello AF,

As per my pulmonolgist's advice, I have switched from a ResMed Aircurve 10 where I was having very inconsistent AHIs, 3 - 16 with five events over 10 (for the past two and half weeks) to the PR System One Bipap Auto SV Advanced.

Max pressure 25, Max EPAP 5, Max PS 15, Min PD 3, Rate 14, Timed insp i. 4. Rise time 3.

I would appreciate it if someone could steer me in the right direction regarding my SH data from last night. I have been using the PR machine for three days with AHIs ranging from 6-7.

[img] http://oi67.tinypic.com/10h4u9k.jpg[/img]


Best,

Jeffo1

[Jeffo1]

Hello AF,

As per my pulmonolgist's advice, I have switched from a ResMed Aircurve 10 where I was having very inconsistent AHIs, 3 - 16 with five events over 10 (for the past two and half weeks) to the PR System One Bipap Auto SV Advanced.

Max pressure 25, Max EPAP 5, Max PS 15, Min PD 3, Rate 14, Timed insp i. 4. Rise time 3.

I would appreciate it if someone could steer me in the right direction regarding my SH data from last night. I have been using the PR machine for three days with AHIs ranging from 6-7.

[img] http://oi67.tinypic.com/10h4u9k.jpg[/img]


Best,

Jeffo1

Hi!

Here is a screenshot with the AHI graph:



Best,

Jeff

[robysue]

Jeff,

To help you we need to know a bit more about your sleep apnea history and we need to see some data that you have not yet shown.

In particular it would help us if you could answer the following questions:

1) Which Resmed AirCurve 10 were you using? There are several machines in the AirCurve 10 family and we need to know specifically which one you were using. The machines in this family include the:

• AirCurve 10 S, which is a fixed pressure bilevel (Resmed VPAP)
  
• AirCurve 10 VAuto, which is an auto adjusting bilevel (replacement for the Resmed S9 VPAP Auto)
  
• AirCurve 10 ST, which is a bilevel with "backup rate"----i.e. it can attempt to "trigger" breaths
  
• AirCurve 10 ASV, which is the Resmed equivalent of the PR System One BiPAP ASV you are now using

2) Why were you switched to the PR System One ASV machine? You said that with the AirCurve 10 you had "very inconsistent AHIs", but I'm not sure what you mean by this. Do you have a history of central sleep apnea? If you were using the AirCurve 10 ASV, do you know why that machine was prescribed for you? If you were using the AirCurve 10 VAuto or AirCurve 10 S, do you know why you were switched to an ASV machine?


3) Was your original diagnosis plain old OSA? Or was it central sleep apnea (CSA)? Or some of both?


Next you write:

I would appreciate it if someone could steer me in the right direction regarding my SH data from last night. I have been using the PR machine for three days with AHIs ranging from 6-7.

It would help us help you if we knew what you mean by "steer [you] in the right direction regarding your SH data". Do you mean interpret what you've posted? Or do you mean help you figure out what settings should be tweaked to try to improve that overly high AHI?

If all you want is someone to tell some of the basics, here's my take on both pieces of data.

The first jpg link has some useful data:

I believe the gray background and the black overbar on the Flow Rate graph are both highlighting the periods when the ASV machine is "triggering" breaths. In other words, during the periods with the gray background the machine is vastly increasing the IPAP on a timed basis in order to attempt to get you to inhale (when you are not inhaling) AND in an effort to keep you properly ventilated (when you are inhaling, but not sufficiently deeply enough to satisfy the machine). I also believe that the Timed Breaths = 656.23 statistic on the left sidebar indicates that the machine is triggering an average of 656 timed breaths per hour. Given your RR, you are averaging 840-1140 breaths per hour. So it looks like the machine is triggering about 60-60% of your breaths.

Without seeing the flow rate zoomed in enough to see the individual breaths it's hard to say much more than that: The machine is triggering a lot of breaths on this night, but we really can't see why the machine thinks it needs to trigger so many breaths.

The second image you posted doesn't have any additional useful information:

The AHI graph doesn't really tell us anything new: The Event table tells us that those clusters of OAs are pretty bad.

The Exp. Time graph is largely irrelevant unless you've got some kind of known respiratory problem that primarily affects the length of your expirations.

To get a better sense of what your data might indicate about what's currently wrong with the efficacy of your therapy, we need to see the following graphs from the Detailed Daily Data:

• The Event table
  
• The Flow Rate graph
  
• The Mask Pressure graph since you are using an ASV machine
  
• The Pressure graph (optional, but nice)
  
• The Leak Rate graph
  

If you change the vertical size of the graphs and turn off all unwanted graphs, you should be able to get 4 graphs plus the event table to show up in one screen shot.

It would also help us help you if you could zoom in on two hour period from just before 6:00AM to just after 8:00 when you have the very long cluster of OAs mixed.

Finally, if this is what your data is looking like every day, it's time to call the sleep doc back and ask him/her to please evaluate all the data your machine is recording instead of just the summary data. Be sure to specify that the doc look at the detailed daily data as well as the summary data. You might ask if you could bring in a screen shot of what the data looks like.

[Jeffo1]

Hi robysue!

Thank you for looking at my SH data and asking me to clarify a few things.

I was diagnosed with OSA ten or twelve years ago when I had done a sleep study and I had been using a CPAPP consistently ever since.

After years of feeling tired in the mornings and foggy all day, I did another sleep study in August 2015 and it was found that I had OSA, Complex SA, and CSA. I was prescribed a Respironics Bipap ST which brought my AHIs down from 78 to 20s+. It was better, but not great and I was still feeling tired in the mornings.

After another sleep study titration at the beginning of April 2016, it confirmed both OSA and CSA and my pulmonologist prescribed the PR System One Bipap Auto SV Advanced which was what was used in the titration study.

Even though my doc prescribed the PR System One Bipap ASV Advanced, the DME that I had been using gave me the ResMed Aircurve 10 ASV instead. Because I was still having relatively higher AHIs with the Aircurve 10 ASV after 2.5 weeks, my doc thought that since there were differences between the two machines, it might be prudent to see if the machine that was used in the titration study, in which my AHIs were 0, would be a better fit.

The data which I posted was after 3 days of using the PR machine.

Regarding my comment asking to be "steered in the right direction," yes, I was asking for help navigating SH as well as considering thoughts related to the efficiency of my therapy and the wisdom of looking at changing the settings, listed above.

I will adjust my Detailed Daily Data to reflect your suggestions.

Thank you, again, for your time and observations!!

Best,

jeffo1