[Treatment] BIPAP Settings - ResMed AirCurve 11 Vauto

[dcbauman]

Hi All! Looking for some insight: I have been on CPAP for 8 years that successfully treated OSA. Have recently upgraded to BiPAP due daytime fatigue attributed to CA events.
I have a ResMed AirCurve 11 VAuto machine with pressure set at 9 and 5 for EPAP.
Trouble is that some nights are fine with AHI at 5 or 6, but some nights are high with AHI at 15, 20, or 30. Are there settings I can change to help with this?
Attaching recent night Oscar screenshots so you can see one of the poorer nights.
I have follow up appointment scheduled later this week and want to have some input to discuss with the sleep doc.
Thanks very much for you perspectives!

   

   

[staceyburke]

First thing is to make sure your mode is VAUTO - The top of the left column does not show it.  Next we have found that the trigger setting helps with centrals.  The 2 that helps is High and Very High.  Please set your trigger to High and we will see if that helps then try very high if we need more help.

[SarcasticDave94]

Another thing, do you have the detailed sleep study report? You might want to post the event table from that, regarding the Central Apnea aspect.

[dcbauman]

Thank you for the input - I wasn't sure about the VAuto vs. S mode since the Dr. simply recommended BiPAP with pressure of 9/5.
I will try the VAuto mode with high trigger tonight!

Also attaching sleep study report - there was not a complete sleep study: this one is the BiPAP titration study the Dr. ordered after reviewing the data from the AirSense 10 (previous CPAP machine). It seems this one shows the CA events as Arousals with a count of 62 or 10.3/hour.

[SarcasticDave94]

If they calculate AHI from actual hours slept, it appears it'll be 1.1667 during the diagnostic. 6 hours of sleep, 7 events of 2 Obstructive and 5 Hypopnea. Zero Central Apnea at all, until you get to OSCAR data. This is a high level of treatment emergent Central Apnea, and myself I'd be wondering if it's worth doing.

Unfortunately, I think your daytime fatigue isn't Apnea based. Get other things checked for cause, hormone, blood work, etc.

FWIW the VAuto vs S, the S is a static EPAP and IPAP, whereas the VAuto can vary the pressure, handling therapy better while feeling more comfortable.

If you want to continue VAuto, go to Trigger High or Very High to cut some CA. But again unless I'm missing something, this therapy is not helping.

[dcbauman]

This is a mystery to me as well:
It is true that the study did not report any CAs and OAs are being managed with CPAP, but it did flag 62 arousals. It is a similar pattern to what the OSCAR data flagged as CAs.
Another page is attached with the graph from the sleep study that shows the arousals at the top. To me this looks similar to the OSCAR graph with the CAs and what my previous CPAP  machine also indicated.

Of course this is not polysomnography so I don't know if they are real CAs or something else but I do think the VAuto setting with high trigger helped last night! I will monitor that for a few nights and see if it continues and talk to the doc at the end of the week.

PS: in the intervening years I think everything else has been checked - hormones, thyroid, blood work, etc. with no good cause found.

Thanks again for the input - hoping to make more progress!

[dcbauman]

Ok, three nights with the new settings: two with AHI in the sixes - felt pretty good. Last night AHI nearly 14 and not so good.
Screenshots are attached from two nights plus a zoom on a couple of the CAs. These look the same as they did before - any ideas?

[staceyburke]

It looks better with trigger at high, try very high and hopefully we will see more of a decrease.

[Sleeprider]

In addition to trigger at Very-High, also set your TiMax to 2.6 seconds. You're hitting the machine cycle pretty often.

[dcbauman]

Got it - will adjust to Very High trigger and TiMax 2.6 tonight.
Thanks very much!