My Wife Keep Waking up at Night!

[gumleafau]

I set the minimum pressure to 8 cmH2O last night and the result as attached!
When I get the Resmed Aircurve 10 vauto, what setting should I try first?
[attachment=6464]

[Sleeprider]

I'm glad you're getting the Aircurve 10. I really think she needs pressure support, and my thoughts are to set Vauto mode at EPAP min of 6, EPAP Max of 11 and PS 4.0.  It's really hard to predict her results based on the Philips APAP. It's a very different machine.  Once we have a base line with the Vauto, we can look at some details of the flow rate and try to resolve an issues.  Lots of flow limitation in the last trial ad a slightly higher AHI than the 4-20 settings.  I didn't expect that, but it's not the first time my expectations went unfulfilled. 

[gumleafau]

Thanks you for your quick response!
Being a new member, I need some help in delete duplicate posts and edit my own post (deleting attachments and add new one) after being posted.
I can only see 'REPLY' at the bottom right hand but no 'EDIT'!

[gumleafau]

Hi SleepRider,
My wife rented a Resmed Airsense 10 Autoset CPAP in April and she was wearing a full mask with NO soft cervical collar and attached a copy of the result for your perusal!
From the attachment, do you feel you need to make any adjustments to the recommended setting for the Aircurve 10 vauto machine which arriving next week!

[attachment=6468]

[Sleeprider]

This last graph was based on 4-20 with EPR 2, and the median pressure of 15/13 was remarkably ineffective.  My last suggestion was pretty conservative on pressure support, and you might want to start off with PS at 5 and allow max EPAP to go higher than the suggested 11.0.   I'd be lying if I said it was anything but a preliminary "guess" of what her needs might end up being.  Bilevel titration is nothing more than trial and error, even in a clinical setting.

The attachment below is the bilevel titration protocol.  I'm not taking for granted that she will require the same high CPAP pressure once she has the benefit of pressure support and using the positional therapy (collar).  It's reasonable to assume her EPAP needs are much higher than 6.0 cm, but I thought we could let the auto algorithm do the heavy lifting and figure that out for us.

[gumleafau]

Thanks you for your comments on the attachment and looking forward for your further assistance once we receive the new Resmed Aircurve 10 vauto next week!

[gumleafau]

Hi SleepRider!
Your recommendation for my wife to wear a soft cervical collar is getting some positive results.
She is still waiting for her new Resmed Aircurve 10 vauto and the results are from the Dreamstation auto CPAP machine set to fixed pressure of 10cmH2O.
The AHI is getting below 5 with full mask, and she never get to that low before and it is AMAZING!
However she still experiencing poor quality of sleep and getting woke up at night by OA and RERA, and need your further suggestions to minimize and/or eliminate these events!

[attachment=6558]
[attachment=6559]

[Sleeprider]

I think we can do a pretty good job with the next machine at addressing some of these remaining events. The unflagged periodic breathing after 23:30 on June 10 was a continuing hypopnea where the airway was very unstable, and eventually resulted in a full arousal and therapy break. If I was interested in cutting these events in hald, I would put that machine in Auto mode and use a minimum pressure of 10 and maximum of 14.

Glad the collar is getting us on the right path. Something that stands out to me is a very long expiratory time, that we often see with COPD. Bilevel will relieve the pressure during exhale and should make some very positive comfort changes. Your wife's tidal volume seems fine, but if you look at the respiratory time, it is very low at 9.6 breaths per minute. I think this points to the need to get her on a bilevel pressure and make this all easier for her.

I just want to say, her AHI is currently 1/10th of what you originally presented. That is fantastic progress!

[gumleafau]

It is an AMAZING reduction of AHI since using the soft cervical collar as suggested!
There is one thing I like to know is WHY when she wearing the pillow mask with large amount of mouth leaks she felt LESS tired than when wearing a full mask????
The AHI is very similar in both cases!

[attachment=6575]
[attachment=6574]

[Sleeprider]

Why not give the pillows another shot? Now that she is using the collar I think you will find leaks are much lower.