9-10 AHI after a couple weeks

[hopefulsleeper]

I've been on the machine for a couple weeks and my AHI is hovering in the 9-10 range, which is much better than the 15-20 range I started with. I don't feel very well rested and I have to take naps every now and then though. In the night congestion makes it difficult to breathe through my nose and when I lie on my side it is even worse.

Interestingly, the AHI for my naps ranges from 1.67 to 6.38.

I'm not sure where to go from here. The Dr. says that this is a big improvement from the 45 AHI that I started with, but I think my concerns for having an AHI in 9-10 are well founded.

Any ideas? 

Last night:

h ttp://imgur.com/a/62onI

Zoom in:

h ttp://imgur.com/a/exlLM

Stats since start:

h ttp://imgur.com/a/C8b5S

[Sleeprider]

Based on what I'm seeing here, please raise EPAP min to 7.0. No other changes for now, and let's see what happens. A number of events are obstructive, and at least on the close-up initiate when EPAP is at its minimum. This is complex apnea, and you may need to discuss an ASV titration with your doctor. I think we might be able to improve the results, but this is not simple obstructive apnea, and we may need to also reduce pressure support to deal with centrals.

Do you have a summary of your diagnostic or titration sleep tests? Were central apnea noted? Why were you prescribed BiPAP?

[hopefulsleeper]

I'll raise my EPAP min to 7.0 and bring up ASV titration with my doctor.

The results of my sleep study are here: http://imgur.com/a/qERJ3. I didn't have any CA's without the machine on. I was prescribed BiPap because of "CPAP Intolerance" according to the third page. From the last page it looks like when they put me on Bi-level with 14/10/0 I had zero events. Could this be right?

[Sleeprider]

I'll raise my EPAP min to 7.0 and bring up ASV titration with my doctor.

The results of my sleep study are here: http://imgur.com/a/qERJ3. I didn't have any CA's without the machine on. I was prescribed BiPap because of "CPAP Intolerance" according to the third page. From the last page it looks like when they put me on Bi-level with 14/10/0 I had zero events. Could this be right?

You did not have central events in your diagnostic study, but when they put you on CPAP, it triggered "CPAP induced Complex Apnea".  The central and mixed AHI was 11.2. They can call this  "intolerance", but it is a well-known complex apnea syndrome caused by CPAP pressure.  Your bilevel titration at 14/10 lasted 96 minutes and showed no events.  This supports my previous observation that your EPAP pressure is too low, however for complex apnea, we often find bilevel with lower pressure support also produces better results.  So, anyway, the plan was to keep increasing EPAP to address obstructive events, and then modulate the pressure support (2-5) to deal with centrals.  We can still do this, but after seeing your test results, I think we go straight to 8 or 9 for EPAP min.

So tell me how you ended up with an EPAP min of 6, if your titration was 14/10?

[Sleeprider]

Let me just add, you failed CPAP due to presentation of complex apnea. You are now on a trial of BiPAP. If that is deemed a failure due to high AHI and complex apnea, which is the current situation, you would qualify under most insurance guidelines for a Bilevel ASV test. If you don't know what ASV is, then ask; but mainly it can overcome centrals with minimum EPAP pressure, and use pressure support to cause a breath during a central apnea or hypopnea to maintain a target rate or volume of respiration.

I'll get this out of the way now...I like the Resmed ASV a lot better than the Philips BiPAP S/V Advanced. This is based solely on the anecdotal comfort and effectiveness of the many people I have seen using these machines.

[hopefulsleeper]

I have no idea how I ended up with an EPAP min of 6, with a 14/10 titration. Maybe the technician setting up my machine made a mistake?

[Sleeprider]

I think so. I would say, either set your machine up to match that titration in BiPAP-S mode, or in BiPAP Auto mode, use EPAPmin 8.0 IPAPmax 14.0 with PS 2.0-4.0. Alternatively, call your doctor and ask WTF?

[hopefulsleeper]

I set EPAP min to 8, IPAP max to 14, PS min to 2, and PS max to 4. This got AHI to 6.64, my best night yet! Thanks sleeprider.



I've noticed in the graph that in a few instances I get several events after a pressure increase and then they stop happening mostly until the next pressure increase. I wonder what would happen if I change to BiPAP-S mode and stick with the same pressure the whole night.