New BiPAP ST user Vet with complex apnea

[SHatfield]

Hello from Western North Carolina.  Steve here.  Recently diagnosed with OSA and CSA combined.  VA set me up with a DreamStation at BiPAP at 15/10 cmH2O with a rate of 12.  It's interesting getting used to all of this.  

The only issues I've run into so far is, when I "inhale" and the machine increases pressure, occasionally the incoming airflow simply stops. Like someone putting their hand over my mouth halfway through my inhaling. Kind of random but happens probably 1-3 times a night that I'm aware of.  

Using a Resfit F20 that I'm pretty satisfied with. Didn't have much luck with nose pillows. 

Still working things out.  The VA says their a little concerned that my transmissions to them aren't showing any reduction in activity so waiting to talk that out with them.  Been on the machine two and a half weeks.  

Glad I found this board.

Steve

[Gideon]

Welcome to the Apnea Board.

Download OSCAR and post a daily chart per the Organize link in my signature.  
Also please post a redacted copy (full copy) of your sleep studies, the summaries tend to leave too much important stuff out.

1. you do not have a machine that is designed to treat CSA.  Do you have any other breathing issues?
I highlighted the machine I think you have below.  Do you have "COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions" I didn't think so.  At the bottom, green highlight is the one machine that treats both OSA and CSA.

On the feeling of "The only issues I've run into so far is, when I "inhale" and the machine increases pressure, occasionally the incoming airflow simply stops. Like someone putting their hand over my mouth halfway through my inhaling" That is a common complaint of the PR machines attempting to predict your inhales and exhales, ResMed machines do a much better job of following your breathing.

The OSCAR daily charts and your sleep studies are very important in us helping you through all this.



CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.
They should be chosen to treat the specific condition that the user has, Here are the various CPAP machines and what they are designed/intended to treat
This info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
  
  

[SHatfield]

   

Here is my machine's numbers.

[Gideon]

Now the question is what medical conditions do you have that got you an ST BiLevel? Is there any reason for this other than it is cheaper than the machine that will actually work?

[SHatfield]

bonjour this is all the information I have at the moment. It comes from my myhealth vet website. I have not been told that I have any other contributing condition. No COPD, etc.. I do see that they listed OSA and didn't say CSA on the later diagnosis. 

They did call me after a week and told me that they were concerned that there had been no diminishing in the events tracked and were going to get back to me in a week or so. This is all I have so far.  

I don’t have any of the full printouts of the reports.  Here is the information provided my VA healthvet site.  I’ll have to ask for full printouts.  I don’t have any other of the issues you listed. I’ll download the app you suggested.  Right now, I don’t have access to the full information on my DreamStation yet. I have never questioned them as to whether they gave me the correct machine yet. Thanks for the info.     

These are listed in order of occurrence.  

Home sleep study
LOCAL TITLE: MEDICINE SLEEP HST CONSULT OUTPT
STANDARD TITLE: SLEEP MEDICINE NOTE
DATE OF NOTE: DEC 26, 2019@10:08 ENTRY DATE: DEC 26, 2019@10:09:10
SLEEP STUDY REPORT FINDINGS Dates of Study: 12/15/2019 Location of Study: CHARLES GEORGE VA SLEEP DISORDERS CENTER "HOME" SLEEP TEST
Please see the scanned document in Vista Imaging for complete details Report's Impression: - Moderate Central & Obstructive Sleep Apnea/Hypopnea (AHI 17). Hypoxemia with SPO2
Results of home sleep study
I am writing to discuss the results of your Home Sleep Testing (HST) done at the Charles George VA Hospital. We have reviewed the results and the findings are consistent with central sleep apnea (CSA) and obstructive sleep apnea (OSA). CSA occurs when the brain does not send proper signals to the diaphragm to stimulate a breath. Because of the complexity of your apnea, I'm recommending a formal titration study to determine best treatment options. This requires an overnight stay in our sleep center to perform a formal evaluation. I feel this is the best approach based upon your symptoms and study findings. Our schedulers will be in contact with you regarding an appointment in our clinic for the titration study. I am hopeful that treatment of your apnea will improve your quality of life, help you feel better rested, and improve your daytime energy. We appreciate the opportunity to participate in your health care and look forward to continuing our relationship in sleep medicine.
 
Titiration study at VA findings.
SLEEP STUDY REPORT FINDINGS Date of Study: 01/27/2020 Location of Study: CHARLES GEORGE VA SLEEP DISORDERS CENTER Please see the scanned document in Vista Imaging for complete details PAP TITRATION STUDY IMPRESSION: - Sleep Apnea for PAP Titration. - Sinus rhythm with occasional PVCs. - PLMS; PLMI: 20 & PLMAI: 3. RECOMMENDATIONS: - BiPAP @ 15/10 cmH2O with BUR of 12 resulted in an AHI of 2 and a minimum oxyhemoglobin saturation of 90%

[Gideon]

Make sure you have an SD card in your DreamStation, any size fro 3-32GB (not bigger) will work. You may have one from a camera lying around. Cheap is fine.

"They did call me after a week and told me that they were concerned that there had been no diminishing in the events tracked" may mean the CSA levels haven't gone down which is not what they would have liked, but that is typical of CSA. A form of CSA called Treatment-Emergent often reduces over time. but your home study showed it without a CPAP which makes that form much less likely.

Navy here, SSBN 610, My mission was to drop a few dozen eggs on anyone that tried to do the same to us. Fortunately, we never had to execute that mission. And you?

[SHatfield]

There is an SD card in it.

Air Force here. Pope AFB/Ft Bragg. Sheet metal mechanic for C-130's. Met my wife who's a vet there in 76.

[Gideon]

Great, you have data, VERY detailed data down to a breath by breath if we need it. Now download and install OSCAR so you can post your most recent night's data and see what is actually going on.

[jaswilliams]

You may require our latest Beta version of Oscar with that machine but Bonjour can fix you up if needed. Good luck.

[SHatfield]

Well Bonjour.  I downloaded OSCAR and installed it.  Went to my machine and discovered that there is no SD card in it.  Just a blank slot.  I swear the tech told me there was one in there.  Oh well.  I've put in a call/email to them with some questions.  I'll add that to the list.  

Haven't been able to use the machine more than a few hours for the last two days because of a cold with a cough that I can't control.  


Steve