Started Bilevel Therapy 1 Month Ago

[cchriss]

Hello, I've been doing bilevel therapy on a ResMed Aircurve 10 ST with AirFit f20 mask for chronic hypercapnic respiratory failure due to a neuromuscular condition for 1 month now. Doctor said I may also have sleep apnea so I might get tested for that in a couple months. Any way to tell w/ OSCAR data? Recently changed masks to the AirFit f20 and have been having fewer leaks than w/ the other mask (Ascend full face mask that the DME gave me) and a lower AHI. I'm mostly just curious if the settings look ok and if my numbers look okay.

Settings are:
Machine: Aircurve 10 ST
Mode: BiLevel-S/T
Pressure: EPAP 5 IPAP 12
Backup Breath Rate: 6


Here are some OSCAR shots.

[Jay51]

Usually a diagnosis like yours requires high PS (the difference between epap and ipap).  This helps both to inhale more oxygen and then exhale more Co2.  

Your 1st chart looks good.  A few H's in your other charts.  The way to stop H's are to increase pressure support even more.  Your pressure support is currently 7 (12 ipap minus 5 epap).  

If you ever get any O's, then raise your epap by 1 and keep doing so until O's disappear.  

You can try now raising ipap to 13 and see if that helps decrease your H's.  

If you want to, you might even try some positional apnea techniques to help as well:  lowering pillow height, side sleeping vs. back sleeping, and using a soft cervical collar.   Here is some reading on it from our wiki:     

• 5.3Positional Apnea                                                                                                                                                                                                                                                                                                                                                                                                                         Your back up rate of 6 is very interesting.  Apparently, it was set very low to stay out of the way.  Your median respiratory rate was 11 I think.  Your tidal volume is ok.   You can leave it here, but if you raised it, the machine may start triggering breaths for you.  Normal respiratory rate during the night is around 12 to 20.  Your 11 is not bad.  Go by comfort here if you want to.  You can experiment raising the back up rate if you want to and see how that works for you. 
  
  

[SarcasticDave94]

Yep backup breath of 6. Mine is low like 10, that's a real low rate it seems.

Unfortunate, your ST isn't very flexible. You get EPAP, PS, IPAP all in static form. No auto adjusting. It's just timed.

The ResMed AirCurve ST-A would probably best this if tuned correctly.

[cchriss]

Hey, thanks for your replies. I have 2 more OSCAR shots with higher AHI from before I changed masks. I'll pick up a soft cervical collar to try soon. I'll try raising ipap by one (ps 8) for a few nights to see if that helps. I'll leave breath to 6 for now, but might tweak it if my resp rate gets slower.
I'll ask my pulmonologist about the aircurve st-a next time.

[cchriss]

Tried EPAP 5 IPAP 13 for one night but pressure felt too high for me. My lungs felt overinflated but not painful. Switched back to IPAP 12 for now. I also lowered my pillow height and am sleeping more on my side now. AHI is usually under 1 now and I feel fine so not touching the settings for a while. Did some research into the ST-A and it seems better suited to me because the doctor wanted me on the ResMed Astral 150 at first but the insurance denied it. Not sure why I got the ST instead so I will ask doctor next appointment. Thanks again for looking over my charts. Just posting the one night with new settings.

[Jay51]

Better looking therapy here.  A lot less hypopneas (H's).  This came from using the positional apnea technique.  

Good plan to ask Dr. why you ended up with ST machine.