Philip Respironics Trilogy EVO

[annbower112597]

these are all my diagnosis, i have a lot of health issues, i weight 256 and i am 5fft7inches tall

[annbower112597]

Here is my sleep study

[annbower112597]

Last nights numbers. Don’t understand the leak rate

[Jay51]

Thank you for posting all of that information Ann.  I forgot to mention to redact your personal information on your sleep study.  Not a big deal since you are using your name as your username though.  

A couple of things jump out at me.  1st, your medical history:  COPD, restrictive lung disease, pulmonary fibrosis, sleep apnea, and allergic rhinitis.  All of those diagnoses combined are what got you the Evo ventilator.  You also have a tremor.  This could indicate that something neurological is contributing to your sleep apnea also.  

Sleep study:  You mainly suffer from OA's.  Just a few CA's compared to all the OA's.  That is a better than having both high OA's (obstructive sleep apnea) and CA's (Central sleep apnea).  Your EPAP range should take care of these.  The only other thing that might help you could be a soft cervical collar to wear at night.  It could keep you from chin tucking and increasing the severity of your OA's.  Or possibly trying a pillow that is less tall in height (if your neck can sustain it).

You had 5 minutes under 90 SPO2.  SPO2 is a fancy name for blood oxygen levels.  If it stayed below 88 for 5 minutes, then you qualify for supplemental oxygen per Medicare guidelines.  You may be just on the border of qualifying based on your sleep study.  

Your spontaneous breathing rate was 9.85   This is a little lower than normal.  The Evo has a rate of 14 set to pace you.  The PS range on the Evo looks sufficient to me to be able to treat this also IMO.  

Your % spontaneous trigger from your Evo stats was only 4%.  Your I:E ratio of 1:1.9 seems ok.   PIF is Peak Inspiratory Flow is 55.1 L/min.  I am not sure what this means. I will further research it.  9.7cmH2O not sure either.  The leak rate is 44.8 L/min.  Can you feel the mask leak when you go to sleep or when you wake up at night?  Anyone who knows what these numbers mean can post to clarify.  

IMO, your settings should be taking care of your disordered breathing at night during sleep.  The only way I could gauge my Evo settings to AHI was to purchase an oximeter (contec and wellue are 2 popular brands).  You can shop for one in your budget, or you don't have to purchase one if you don't want to do so.  According to the research that I did, every 3% or 4% drop in SPO2 correlated to a single AHI (over 90% correlation rate).  

What kind of mask do you use?  I am guessing a full face mask.  I tried my hardest to make a nasal pillow mask work, but I could not exhale fast enough against the pressure (which set off the low rate alarm).   Possibly getting a better seal on your current mask or maybe even trying another one could help.  

Any others question that you have, Ann, please post them and I (we) can try to answer them.  

This is my best analysis of your situation.  I encourage anyone who sees anything different or any errors in my interpretation above to post to clarify.

[annbower112597]

i use 2 liters of oxygen every night, so far i just need oxygen at night and not during the day thank goodness, thank you for all your fast responses, you are amazing

[Jay51]

You are most welcome, Ann.  With the 2 liters of supplemental oxygen at night, and your current settings, you should be treated adequately IMO.  You can always ask your RT at your DME about how they think your settings are performing; and how your therapy is going.  Most of what I know I have learned here at apneaboard.

[annbower112597]

these were my numbers from last night, How do they look? i dont understand the leak rate as there is none that i can feel

[Jay51]

MAP I think is the mean pressure during the night.  Your PIF (peak inspiratory flow) may be a little bit low, but not too bad.  I:E ratio looks ok.  % spontaneous trigger means the machine is breathing for you most of the time during the night (98%) of the time.  IMO, it is a good thing you have this machine because it is performing this important function for you (pacing your breathing and increasing your breathing rate).  Your leak rate may bit a bit high.  From the numbers I found in my research, around 22 or 24 or so is supposed to be normal, but with a ventilating type machine where the pressure support is much higher (bigger difference between EPAP and IPAP) more leaks can occur.  PIP is peak inspiratory pressure.  The maximum pressure used on an inhale.  VTE is the tidal volume on your exhale.  It should be close to your tidal volume on inhale.  Your RR (respiratory rate) 14 and minute vent of 7 look good.  The only one that stands out to me could be possible higher leaks than normal, but it seems like you are getting good therapy from these 9 indicators.  By reducing leaks further, it would just lower the pressures that the machine uses.