[CPAP] System One

[ldanielle01]

hello, I have been using the ASV for probably over ten years.  I have recently been extra tired and have been trying to see what's going on with my sleep.  I seem to have a pretty high AHI even with the ASV.  Any suggestions?

I tried putting the imgur link here but it says I can't post links yet...


Thanks in advance!

[Marillion]

Welcome to the forum and hang in there for answers from some of the more experienced people soon.  Your AHI looks too high to me and there are definitely some improvements that can be made to your settings.  The range of 4-20 is far too wide and should be narrowed down, for one.  But again, I'll let the experienced people tell you what to do as I don't feel comfortable doing that yet.

In the meantime, take a look at my signature area and try to organize your Sleepyhead data as shown. You can reduce the size of each graph by hovering your cursor at the horizontal line and then dragging up to make the area smaller.  You need to be able to show the leak rate as that is an important factor.  I would follow the instructions in there and arrange all of your data accordingly.  What you posted is helpful, but you can make it even more helpful if you modify it just slightly.

[ldanielle01]

Thanks for your reply!  Here is my second try at the screenshot...see if it's any better?

[Marillion]

Much better!  Though the last item on your graph should be "Flow Limit."  Hang in there.  I'm sure you'll be getting some advice on adjustments soon.

[ldanielle01]

I can't find a flow limit graph in my results for some reason...this is all I could find that relates to flow limits...

[Marillion]

Strange...should be there.  You just need to scroll down a bit and then drag it up higher when you click and hold on it.  Maybe take another look and scroll down further?  "Flow Limit" should be somewhere in there mixed in amongst all the graph results in Sleepyhead.

[ldanielle01]

i used up my attachment limit...I scrolled through the whole thing and just don't see it there.  Could I have hidden it somehow by accident?

[ldanielle01]

http://imgur.com/yYdvyVY
http://imgur.com/vm2ch7H

oh ok, maybe I can use the imgur now...

[Marillion]

I'm sorry Danielle. I can't explain why it would not show up properly. It's possible something was changed in the settings inadvertently... I'll need to let those answer that are more familiar with Sleepyhead. I'm sure they will be along soon.

[Sleeprider]

The Philips machines do not have a flow limit chart, they are shown as events. What would help on the charts is if you turn off the pie chart in the menu File/Preferences/Appearance and uncheck the pie chart on the right side. This will allow me to see more respiratory data and settings.

You're using a specialized BiPAP Auto SV Advanced, and it appears your pressure support ranges from 4.0 to 7.0 with a minimum EPAP of 4.0 and maximum IPAP of 25. These machines are typically dispensed to people with central and complex apnea. It would be helpful to hear more about your history. Here is what I can tell you about your settings so far, however I'd like to see the additional data. Your EPAP of 4 is barely moving. If you feel fatigued, it may be you just don't get enough oxygenation with this low EPAP. I'm going to suggest that it be increased to 6.0, and see if that helps. Some people have more centrals with higher EPAP pressure, but you need adequate support of the respiratory system, and 4.0 cm is very low and does not give good positive end expiatory pressure.

The machine is recording hypopnea, but not flagging them in the events chart for some reason. I can see them in the flow rate line. These hypopnea may be incompletely treated centrals. I'm going to suggest increasing the PS Max to 12.0 cm. I don't think you have enough pressure support at 7.0 to overcome the respiratory effort during hypopnea. As you can see on your charts, the IPAP pressure rarely moves from a range of 8-10. You can see on the mask pressure line where you are getting some minimal assistance during hypopnea events, it's just not enough. Finally, I need to know your remaining settings including mode, backup rate (if not auto) and trigger sensitivity. If you can go through your settings and record what is present, it may help. This result is not uncommon for the Philips BiPAP Auto SV, and I usually see people on the Resmed Aircurve 10 ASV or S9 version have far fewer events and more response from the machine.