Calling on the wizards!

[hopefulsleeper]

Hi,

I just got my first sleep apnea treatment last week, a Dreamstation Auto Bi-pap. While I thoroughly enjoyed all the cool software to check out my results, they results weren't that stunning. I'm at a 15.2 AHI, which I suppose is better than the 42.5 I was diagnosed with, but not as good as the 13.3 they were able to get me at with the titration study. Would love to get <5.

Any ideas?

Thanks in advance!

h ttp://i.imgur.com/l6mW2Xo.png

h ttp://i.imgur.com/rA90FF9.png

[Sleeprider]

Well, I don't know about wizards, but we have played in this rodeo before.   Let's start by looking at your charts from Feb 2.  These are the same day with a zoomed in look at some of the central events:





This is going to come as a surprise, but this looks great.  We just need to resolve the centrals and you should be fine. I believe your central apena is being caused by too much pressure support (PS difference between IPAP and EPAP).   I think this is as simple as reducing your minimum PS from 4.0 to 2.0, and limiting maximum PS to 5.0.  For now, I think you can leave everything else the same.  Let's start with a change in the PS settings, and see what happens.  It is possible we can reduce the EPAP min in coming days, and make some other adjustments with the inspiration timing.  You have an excellent leak control, and there isn't much sign of obstruction here, with only one episode of notable snores.  I think we're going to need to evaluate results after you change (reduce) the pressure support before moving forward.

If you have a summary of your sleep study, it would be helpful to hear those results, particularly the breakdown of events and whether centrals and hypopnea were a significant component.

[hopefulsleeper]

Thanks for the advice! I'll try that tonight and report back. Here are the results of my sleep study:

h ttp://imgur.com/a/qERJ3

[Sleeprider]

We should be able to get you dialed in. All events are obstructive and hypopnea, and apparently you only sleep on your back

[Beej]

Some individuals find the number of apneas reduce when sleeping on the side. A large pillow, such as reading wedge (ex Therapedic reading wedge) or a pregnancy pillow can help support you sleeping that way.

[richb]

Hi hopefulsleeper. Welcome to the Apnea Board forum. SR and beej have a pretty good handle on your issues. Starting with the pressure support and then adding additional tweaks should find you a sweet spot with minimal OA events and few Centrals. You really ought to try sleeping on your side to see how that can help.

Rich

[hopefulsleeper]

Sweet! This was the best night so far. Looks like no snoring at all. I didn't try to sleep on my side yet because I want to limit the number of variables I modify per night.

h ttp://imgur.com/QL85WWT

h ttp://imgur.com/i3i3Lro

[Sleeprider]

It's not the improvement I would hope for, but I would hold pat on these settings for now. Did you have centrals noted during your sleep diagnostic or titration study? Why were you prescribed BiPAP?

What we're seeing now is mixed complex apnea, and if it doesn't become considerably more controlled, then you probably need a bilevel ASV (adaptive servo ventilator), which can treat CA and H on a breath by breath basis by providing pressure support to overcome central apnea. My thought is, this was seen in your study, and that is why you ave BiPAP rather than CPAP.

[trish6hundred]

Hi hopefulsleeper,
WELCOME! to the forum.!
I wish you good luck with your CPAP therapy and also with getting it fine-tuned to best help you.
Hang in there for more responses to your post.

[Beej]

Give it several days to see how it goes, then maybe add in the side sleeping position to see what changes. In one individual here, there were about 7 times more apneas lying on his back than lying on his side.