My Wife Keep Waking up at Night!

[ajack]

I will try the Spontaneous "S' mode on the machine later as suggested and keep you posted!

I wouldn't use S mode, unless you want to do the work to use the titration guide, to adjust it. I think the S mode would be better for your wife's condition, but I would get a lab to do it. She has both obstructive and a restrictive lung. They will work a lot with the PS. The Vauto has variable epap and it doesn't matter if the min or fixed epap number isn't spot on. You also need most of the positional stuff resolved. Or you will have the epap high enough to cover an hour of positional obstruction, for the night.

[gumleafau]

Thanks you Sleeprider for your response!

I feel comfortable that your comment on the I:E ratio of 1 to 2.9 is correct!

Obviously, my wife is now very conscious of the the correct positions for the modified soft cervical collar and the
pillow. Since I change the PS=3, the AHI is staying below 3 and there are fewer central apnea as you noted!
I will stay with the PS=3 for the time being, and review it in a few weeks time!

Thanks everybody in the forum for the comments and recommendations!

Yours people are champions! It is really helpful, when someone like me don't know much in optimize the settings
of the machine to treat my wife conditions!

[gumleafau]

Hello "ajack"!

I will keep the setting of PS=3 for the time being and review them in few weeks time! So far the results are 
encouraging and with less central apnea! I will look at using the "S" mode after review the results in a few 
weeks time!

I am working slowly with the issue of positional stuff! My wife is very conscious of the correct position of the 
soft cervical collar and the pillow, and I keep telling her if there are clusters of CA and OA on her overnight 
result!

I will keep you posted!

[ajack]

I'd leave it in Vauto for now. It would be nice if your next post was like. The doctor rang. He's gotten the best tech is Sydney on bilevel arranged. He has been advised of the lung function. We have a bed booked in a weeks time. Or anyone can go to the public hospital, for a bilevel titration study at no cost.

[gumleafau]

Hello everybody!

After a week or so with PS=3, the AHI reading for my wife is consistently below 4! Also there are less events for 
both CA and OA. Obviously, the results are better than with PS=4!

It is appeared that she is getting more OA and CA and H creeping in occasionally, but with lesser events!

As I highlighted in one of the OSCAR image in black circles, that when she is having the CA or OA, her breathing 
stopped for few seconds!

Is there further adjustments I can try on the Resmed AirCurve 10 vAuto, or she needed a new machine all 
together!

By the way, I haven't heard from my sleep doctor about the appointment for a bilevel titration! He may thing this
is only a trivial matter and didn't bother about it! May be it is time for self titration!

[attachment=12669][attachment=12670][attachment=12671][attachment=12672]

[ajack]

They look like real CA, I would assume they have an o2 drop. They are only 1.5 per hour. The public hospital wouldn't give an ASV with that number. I guess that's a good thing that you wife is settling down. Normally with OA there are recovery breaths, The machine does the best it can, but they may miss tag an event.

Has the doctor got back to you about the bilevel titration yet?
If it was my chart, I'd raise the min epap to 9 for a few days and see if that helps the OA, without triggering too many more CA. I'd ignore the H for now.

I think I gave you the resmed guide. If you also search YouTube for, bilevel and ASV titration, pressure changes for technologists and patients. The tech talks about balancing OA, H And CA in S mode. He isn't a fan of vauto. Start it a few minutes in to miss the ads. I thought together they will help you get your head around what you càn do.

[gumleafau]

Hello Sleeprider! Happy New Year to all of you out there!
We been away on holiday in Central America in November last year. 
Since ours returned in early December, my wife AHI has shoot up to 30-40, and I need some help in bringing it down!
She is wearing a modified (to reduced shoulder pain) soft cervical collar and sleep on a contoured shape pillow, and the AHI used to be below 5!
From last night result, I have spoken to my wife, and she said she been woken up at night with puff of air forcing out from the mask near her mouth. She shut down the machine and thing go back to normal and then another puff of air forcing out of her mask again! This is on going until she wake up in the morning!
Am I setting the pressure too high on the machine?
Current setting of the machine:
Mode: VPAPauto
Min EPAP: 8 cmH2O
Max EPAP: 18 cmH2O
PS: 3 cmH2O
Ti Max 2.0s
Ti Min 0.3s
           
Trigger: Med
Cycle: Med

[Sleeprider]

The level of obstruction at very high pressure doesn't leave us much option but to find out what the source of obstruction is. We can try more pressure support to see if that makes things more comfortable, but I think that approach was not successful before. First, let's make sure her airway is protected and she is correctly using a soft cervical collar. Let's try some different settings.
EPAP min 8.0
PS 4.0
Max Pressure 16.0
Ti Min 1.0
Ti Max 2.2
Trigger sensitivity High
Cycle sensitivity Low

These settings will start IPAP pressure sooner and hold it longer giving more of an opportunity to take a breath, and it should match up with her relatively slow breath rate better. If these kind of results continue, you should get the doctor involved to determine if this is indeed obstructive apnea, and if so what needs to be done to resolve it. With this level of obstruction, any auto bilevel will quickly go to the maximum pressure and stay there. More pressure does not appear to make any difference. The use of a machine with a backup rate and higher pressure support to resolve central apnea that will come with high PS may be needed.

[gumleafau]

Thanks you for the reply!
I am reluctant to increase the PS to 4, because my wife is a tiny lady and only weigh 38kg (84 lbs)!
My wife had a overnight lab test on the suitability of the Resmed Aircurve S10 vauto machine in October last year.
The doctor confirmed the setting was correct, but somehow since then we could not get the AHI down below 5???
The lab technician must have tweeted the machine, but doesn't seem to be!
I tend to agreed with you on positional apnea, and I will try different collar/pillow/shoulder support and monitoring 
the result closely!

[Sleeprider]

Pressure support is not affected by whether the person is tiny or large, but by the amount of obstruction that needs to be overcome. Pressure support is far different from simply higher pressure and my suggested settings actually reduced maximum pressure by 2-cm. You are always free to take or leave any suggestion on this forum, but I was looking for more comfortable settings that might avoid the conditions that cause her to experience higher pressure and try instead to use pressure support.