Need help with wife's therapy

[GuyScharf]

My wife has been using an Autoset for more than three years now. AHI has been slowing increasing from an average of about 1.5 now closing in on 3.

Her machine is set for fixed pressure because allowing the Autoset to increase pressure usually results in a runaway to the upper limit, Accompanied by such discomfort that she takes her mask off. Overall, results seem better with fixed pressure.

She has tried a Valpeau SCC with little effect.

Attached is screen shot from last night and details from the flow graph. The events recorded in the flow graph are typical of other days. It looks to me like she is having a sleep disturbance, which terminates in an apnea, rather than an apnea starting the disturbance. As I look through the night, I see only about two events where the event immediately follows normal breathing and then the disturbed breathing follows.

I have tried EPR 3 and event VAuto with PS 4 and no significant difference in results. 

We would appreciate any suggestions!

            

[Sleeprider]

Guy, I think taking pressure to 11.0 and increasing EPR to 3 might be helpful here.

[GuyScharf]

She used a pressure of 11 and EPR of 3 last night. The result mirrors what I have seen in previous pressure testing: AHI increased to 4.63, almost all of which can be ascribed to an increase in CA's.

For almost the first year, her pressure was at 9.0, EPR=3 per the Rx (but using a brick, so data is absent). Her AHI was climbing and she was not feeling rested, so we tried titrating the pressure uip, but that approach has not been successful. I'm thinking of starting over at 9 to see if I have just mal-adjusted the settings or whether her needs have changed.

   

[Sleeprider]

I think you're on the right track. So much of this is trial and error. Like you, I make cautious changes in my wife's settings, but mostly I leave things alone. She is not interested in the data, and I think we're in a good place for her settings. She tends to have a low-level leak through the night, and I sometimes awaken and hear it. AHI around 1.0, so good enough. I rarely see CA events, so my job is a bit easier.

[GuyScharf]

Interesting development today: we were seeing wife's neurologist for her regular 6-month visit. Sleep quality came up and neurologist mentioned that AVAPS is usually more successful for the conditions my wife has. So we'll be seeing a pulmonologist at the hospital to evaluate current therapy and what we might do. We'll also be getting her wheelchair reconfigured slightly and a few other things probably not related to sleep.

[Sleeprider]

You know my bias to Resmed machines, and the one I think has the most intelligent volume assured positive pressure algorithm is the Resmed Aircurve 10 ST-A with iVAPS. When you get down to choices, maybe I can point you to some references to research the differences. If this looks like something you will be considering, request the provider manuals from Supersleeper for the Philips AVAPS and the Resmed ST-A. The clinical manuals are probably the best insight to how they work and differ from each other.

[SarcasticDave94]

Just chiming in. You know I'm biased towards ResMed as well, and with my diagnostic sleep study done this past Friday to Saturday, I may be about to get the ST-A iVAPS. Specifically in iVAPS it's nearly identical to the Astral NIV excepting in the box it's in and overall IPAP Max pressure, at 30 vs 50, and the NIV had built-in battery backup. Non-issue likely but there it is.

The ST-A has built-in black alarm box on top of the normal AirCurve machine and can be as low EPAP as 3. The power cord locks onto the back in the normal place, just that there's a lock button. Hoses, filter, and humidifier tubs should be same. FWIW.