First night with new Bipap after sleep study and 37 AHI mostly CA

[PandaZA]

Hi,

I previously (about 10 years ago) was diagnosed with OSA and was prescribed a BiPap ASV machine. I have not used it for a few years and doctor suggested I get a new sleep study to get a new machine. I have attached new titration report. Last night was my first night with the Aircurve 11 standard Bipap and results were 38.83 AHI - all CA. I did not struggle falling asleep and not aware of waking up. Prescription pressures were 16/11. Let me know any other information needed. Please help - thanks!!

I have added my titration report and Oscar for first night.

Thanks,
Craig 


           

[SarcasticDave94]

Welcome to Apnea Board,

With the 29 Central to 7 Obstructive Apnea, and then 13 unclassified Hypopnea, you can try High Trigger on the VAuto to help avoid more CA. Ramp should be minimized possibly to Auto instead of static 20 minutes, and both Ramp and base EPAP likely needs to go up from 4 cmH2O.

It's possible the VAuto isn't the correct tool for your therapy due to these Central Apnea predominantly appearing on the PSG sleep study report. If it's not the right device you'll need to move up to ASV.

[PandaZA]

Thanks, settings have been changed to Vauto for tonight and we will see how it goes.

[PandaZA]

    Attached Oscar for last night. Still quite a bit of CA. This is with setting of Vauto. 

Suggestions? Thanks!!!

[SarcasticDave94]

Given the bit of info I failed to see in post 1, specifically that you used to have an ASV, you're likely headed back to that. This doesn't imply the old ASV unless you have it and want to demo it. Regardless, you'll probably need to tell this doctor, if true, your new therapy isn't working well for you. This can be subjective, your opinion, and/or objective, the test and OSCAR charts.

Your CA therapy success may require the return to ASV. Take note that Central Apnea typically presents themselves as consistently inconsistent. Translation is they will be up and down in appearance or absence and varying amounts without regard to therapy that hadn't changed.

Dave missed an important bit there. Sorry.

Is the current therapy helping or not? And this is your subjective opinion not based on this chart, but by how you feel.

I would venture your therapy requirements from the past are roughly the same now, meaning the ASV is better for you, if it's set-up right.

[PandaZA]

Thanks - I will be chatting with DME respiratory therapist in a little bit.

[Crimson Nape]

Let's do a couple of things to allow displaying a little more information. First, go to OSCAR → Preferences → Clinical and set it to the Passive mode. Now, when you have those little sessions like the 14:50 and 17:40 sessions, you can turn them off in the lower left under Session Information. Next, stretch the left panel to the right until all reporting parameters under Statistics uses only one line. You might even change the Application font size down about 2 points from its current value (OSCAR → Preferences → Appearance) and consider using a narrow font.

To acquire an image, use the key combination of the Fn + F12 keys. This will eliminate the calendar that doesn't have any bearing on your therapy and just eats up valuable image real estate.

Now on to your current chart. . . Your CAs could be partially caused by either a too high PS and/or an improper Trigger setting. That is why I was wanting you to change your display in order to see things like the Trigger setting. Also, a 3-minute zoom of your Flow Rate graph would be helpful. Try to avoid including an event when choosing this image. I want to see the normal waveform.

- Red

[PandaZA]

Thanks so much.

I don't see the trigger setting on there but was set to medium last night. I was planning on changing to high this evening.

I have attached update Oscar screenshots.

       

[Sleeprider]

This is nuts! Your new sleep test clearly showed predominately central apnea. You were previously treated with ASV, and that remains the appropriate therapy for you. Do you still have the ASV from your first prescription? If so, let me know the brand and model (i.e. S9 VPAP Adapt) and let's set it up. Your doctors made a big mistake here, and you should be on the phone asking why ASV was not prescribed. Describe your atrocious AHI results...all central apnea, and while a titration test is not required, demand either Rx for ASV auto or a titration test for ASV. All the ideas above are great for an individual with therapy onset central apnea, but PandaZA needs to get back to ASV.

[PandaZA]

I still have my old machine and I was planning on using it again. I have the ResMed S9 VPAP Adapt ASV. Interestingly enough the DME respiratory therapist questioned the prescription too.