Help with Resmed aircurve 10 v auto settings - too many events

[nixynic]

Hi all ,   


We are brand new to the bipap machine.  My husband is really struggling - he is getting a higher number of events by wearing the machine.  We downloaded the OSCAR program and have uploaded his results for the past three weeks.  For some reason the machine is not correcting his apnea events.  As I watch him at night, he will stop breathing and the machine does not kick in to restart him until past 10 seconds at least.    His settings and stats are attached.   Thank you so much!

[attachment=12484]

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I am not sure if I need to attach more detailed overviews - If I do - just let me know

[Sleeprider]

Nixynic, a bilevel machine is often prescribed for individuals that have not been able to be effectively treated with CPAP or that have central events in their sleep study. In this case, we don't know why bilevel was prescribed, but clearly it is not working. It appears your husband has complex apnea, which is a mix of central and obstructive events. Ultimately, the best treatment for this is ASV (adaptive servo ventilator), which is a bilevel positive pressure machine that treats obstructive apnea with enough base pressure to keep the airway stable, and that treats central and hypopnea events with pressure support to ensure breathing occurs, even without spontaneous effort by the patient. People with complex apnea are always prescribed a CPAP or BiPAP to determine if they respond to that lower cost therapy. They must "fail" CPAP or BiPAP before insurance will pay the cost of the ASV device they need. Your husband meets all the criteria for ASV approval with this high AHI and large numbers of central events.

We would like to take a closer look at the daily details chart rather than the Statistics. This lets us see how and when the events occur and if there is periodic breathing or other issues to consider. One thing we can tell from the Statistics is that the higher the pressure settings, and the more pressure support that is used, the worse his results are. This is typical. We can suggest settings that will result in fewer events, but it will not resolve the complex apnea. You need to start calling the doctor's office on a regular basis and complaining about these terrible results and how it is making his life dysfunctional. You need to get an expedited authorization for ASV prescription or sleep study. Don't leave the doctor's office in peace until they finally concede to this need.

[nixynic]

Thank you so much Sleeprider!!! We have been so frustrated.  It feels like the doctor could care less.  We will call and investigate getting an ASV.  I will attach screen shots of his

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more results

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more results

[Michaely6]

I definitely see ASV in his future especially if he is having all of these centrals and Obstructive apneas with a PS of 4 and EPAP at 4.

[Sleeprider]

I'm going to drop some useful reading from our wiki on you about the process for getting ASV and how users have interacted with doctors and the DME to get the equipment they need. The first thread is the process to justify and obtain ASV. This is the process and we are stuck with it. The second thread discussed some member's interactions with DMEs to obtain machines and how they got what they needed.
http://www.apneaboard.com/wiki/index.php...P_Machines
http://www.apneaboard.com/wiki/index.php...teractions

[idlewire]

From what you posted, your machine is in "S" mode, as it shows in the bottom left. This is why the pressure is never changing in response to the obstructives and why it has been pretty useless for him. You need to put it in Auto mode, so that it can increase pressure dynamically. He will get much better results that way.

[Sleeprider]

Good call Idlewire. The first logical step is to try to resolve obstructive apnea, and that can't happen when EPAP is stuck at 4.0 cm. Nixnynic, let's turn this machine free, and try changing to Vauto mode with max IPAP 18, min EPAP 6.0, PS 4.0. I can't believe I missed this!

[nixynic]

Ok we will try that  Thank you!

[nixynic]

Hi Sleeprider : Thank you again for all of your help.   He tried those settings here this morning for a few minutes and they were pretty tolerable, however it did give him ear pressure and a bit of a headache.   Is there a way to combat this?

[Sleeprider]

How high did the pressure go when he felt discomfort? The solution is just to reduce the maximum pressure to a comfortable level, and ease back to higher pressures as he adapts. If the machine is going to higher pressures, he probably needs it.