One Year Anniversary and Perplexed

[Spy Car]

I'm a few days past my one year anniversary using an APAP machine (ResMed AutoSence 10). I have not missed a day.

I've taken advice from the forum and used by own instincts to adjust pressures (and track with Sleepyhead), but where my numbers were OK, they have worsened lately (perhaps in part due to better sleep?).

From the beginning, I've had a mix of Central apneas and Obstructive (typically around 40% Centrals), but the past couple days have been over 50% Centrals with AHIs of 8.2 and 5.8. Typically I've been at half that AHI-wise. I've had recent nights as high as 12.5 and 14.5, but numbers are all over the place.

Current pressure is 7.2-10.8 with EPR of 3. In the past when I've cut the EPR I've slept more poorly, had worse numbers, and felt worse. Same overall when raising pressures, although generally over most of the year I've done better than currently.

I'm scheduled to borrow a bilevel AirCurve from my sleep clinic for 5 nights starting nine days from now as a trial.

I'm confused about the efficacy of bilevels. Can they help with Centrals? The Centrals seem to make me feel brain-fogged.

I'm perplexed. As recent numbers are bad, do I leave settings alone in case bilevel helps and "failing" helps justify new machine?

Not sure what to do.

Bill

[Crimson Nape]

Please post some Daily screenshots from SleepyHead for us to review. I have the steps listed below to help.

[Spy Car]

Here is last night's. Can post more later.

http://imgur.com/a/HP2xg

[Crimson Nape]

On behalf of Spy Car:

Code:

[url=http://imgur.com/tGb6q6P][img]http://i.imgur.com/tGb6q6Pl.png[/img][/url]

[Walla Walla]

BIPAP is not the answer. Try increasing your EPAP to 8 and reduce your EPR to 2 and see what happens.

[Spy Car]

As I explained in my OP, when I've reduced the EPR (or raised pressures) my sleep quality has gone down, my numbers have gone up, and I've felt worst.


Bill

[Gideon]

Based on your chart you need to increase your EPAP to support your obstructive and reduce your IPAP to reduce your CA.

To raise your EPAP we need to reduce your EPR. Autoset reduces the Expiry pressure by the EPR from the IPAP, the pressure you are setting.  
To lower your IPAP we need yo lower your range.  

Can we try this.  Min 7.2 (no change), Max 9.6
Now we need to raise the Min EPAP to support Obstructive so set EPR to 2.

This will put your EPAP at 5.2 to 7.6 and your IPAP 7.2 to 9.6
 You may need to tighten the range further but we can start here

EPAP = IPAP - EPR


Fred

[Spy Car]

So it took me a day to implement the suggested changes. I must admit a strong reluctance to decrease the EPR as previous attempts did not go well. Sorry to say, decreasing the EPR once again wasn't good. While the AHIs dropped, I had very disturbed sleep and felt like a zombie the next day. And, need it be said Fred, I appreciate the good faith suggestions (sincerely!).

Last night I kept the lowered maximum pressure (down to 9.6) and put the EPR back to 3. The AHIs were better, but more significantly I slept much better and didn't feel wrecked (as I had the previous night).

This 3.85 AHI is still significantly worse than average over the past year, but lately, my numbers have worsened. The CA events still seem to be making up a significant percentage of my apneas. I'm on course to borrow a Bi-level (AirCurve 10) next week for a trial, but I'm not sure what to expect.

I do know every time I'm reduced the EPR my sleep and my feelings of well-being have declined. My numbers are generally been worse as well.

I've been really diligent using my machine hoping for an improvement in my fatigue levels, but progress has been limited.

Does a bi-level offer any hope?

[Walla Walla]

The short answer is no on the BIPAP helping. The BIPAP is good for increasing pressure support. But increasing pressure support in your case will just increase CA events not lower them.

[Sleeprider]

Spy Car, if we were trying to resolve hypopnea, I'd be very supportive of the idea that a bilevel might help. If you want to resolve CA, the correct machine is an ASV. In your case you are probably marginal for getting insurance coverage of ASV due to low events, but i'm confident that if you had it, your events would be near zero.

The trial of the Aircurve 10 will be interesting, but I agree with Walla Walla that pressure support is more likely to increase central events. Anyway, the bilevel works to maintain your EPAP to prevent obstructive events, then can apply pressure support for hypopnea, flow limitations and other inspiratory obstructive events. I will be interested to see the difference (if any) in how it responds to your needs.