Help analyzing OSCAR data - CA's?

[alemon]

Sorry for the double-post, I'm doing research now. If I can't get a machine from my doctor/insurance I'll be looking at funding it myself, but I'm a little confused on all the options for bilevel - I see the Aircurve Vauto, Aircurve S, and Aircurve ST. Is there a particular model I should be thinking about? Dave mentioned trigger settings to help with centrals, is that only available on the ST?

[SarcasticDave94]

A ResMed AirCurve 10 or 11 VAuto will also give you an S mode. ST is reserved for those with pulmonary disease like COPD. I've had a taste of ST and it's not a standard device in feel. You get static exhale and static inhale. ST will be Spontaneous Timed, with a breath backup rate, and is the old way to treat Central Apnea.

Get the VAuto if any. I don't recall if your diagnosis was discussed, but if there were CA on the diagnostic, then you'll want to consider ASV. If not applicable, back to VAuto.

And these ResMed VAuto will have the Trigger I mentioned, as well as Cycle and Ti Min and Max.

[alemon]

Thanks Dave, you've been an absolute lifesaver.

[SarcasticDave94]

You're welcome.

[alemon]

Hey folks, my bilevel should be arriving today or tomorrow. Wondering if I can get any advice/input on settings? 

Currently I've been doing 11cm EPR 3, last night attached, and I've felt moderately fine on these settings - not SUPER well rested, but not (knowingly, lol) waking up overnight! Still seeing lots of arousals though, thus the bilevel. I know Bi-level has IPAP/EPAP and pressure support as well as trigger settings, but I'm not quite sure how to translate them. I think pressure-support of 4, as it's one above my current EPR of 3?

   

[SarcasticDave94]

OK, which bilevel did you go with?

If the ResMed VAuto,

VAuto mode

EPAP Min you'll maybe not need to start at 11, despite setup to trial and error again, maybe try 8 or 9 EPAP Min

PS either 3 or 4 watch the CA though

IPAP Max maybe about 14

And yes Trigger High and if needed Very High for the CA control

Skip over Ti Min/Max for right now, leaving them default. No Ramp.

[alemon]

Thanks Dave. No updates on that front yet, I decided to spend some time giving the machine a thorough cleaning, it smells 'clean' but perfumed, like it was kept by dryer sheets. I slept awfully yesterday for unrelated reasons.

I did have another update though... made an appt with my sleep doctor to try to get a bi-level "over the table" rather than under, iykwim. Or at least a prescription for one. This did not go well - she was furious I had changed my settings, saying that clearly my machine should be set APAP 5-20, so it can "compensate for events", and that I was doing a disservice by going straight cpap. Did not listen at all when I told her the pressure changes were waking me up all night, and didn't listen when I presented evidence that by changing my settings my events had all dropped like a rock from the 'default' she gave to the machine, and she said that my centrals (in spite of being lower than they've ever been) were due to over-titration, which I strongly disagree with. 

Lesson learned, but what a bummer. I have another doctor I'm on the waiting list to see, but that won't be til November. Man.

[quiescence at last]

hmm. most docs are happy that their patient takes the active interest in studying and trying to get the best sleep. sorry you got hold of an authoritarian that didn't want to work with you on this.

my most predominant thought in viewing your charts is that the tidal volume is still low and respiration rate is consequently higher than norm but is still low enough not to boost your minute volume to a great level.

I don't know what would boost it, although having a pressure relief of 4cm versus top EPR of 3cm may boost that some.

Good luck.

QAL

[alemon]

Thanks QAL! Yes, it really was a bummer, I felt awful afterwards, but it does make me so appreciative of all the folks on this board.

Did my first night on bilevel! I woke up at 4A with horrible stomach pains and accidentally unhooked my hose - I don't know if it was aerophagia or something I ate, so perhaps it only got the 'steady' sleep of the night - I'm not 100% certain if this is due to the shortened time-of-sleep, but usually I'd have had at least a few CA's over 4 hours (not just the awake/sleeping ones) - all that said, literally my best chart ever haha

   

[SarcasticDave94]

The chart looks pretty good. I would consider lowing PS to 4, even 3 to see if this helps.

Sounds like doctor has a severe case of Egohurtitis. Fire and replace is typically the cure.