[Treatment] Oscar data help bipap

[Moemah123]

Hi Everyone,

I would like some help and educating about my sleep apnea graphs. SleepRider and SarcasticDave i also appreciate your advice. Basically, i had done a cpap home test and i was diagnosed that i had equal OSA and CA and 30 AHI. I was given CPAP and it did not help. I did my sleep study and was given ST device. Both SleepRide and Dave advised ST is the wrong device. As i am moving in between doctors I am trying to make best of what device is offering and confirming if VAuto vs ASV is right for me based on below Oscar data. People asked to share flow limit but i have none showing in Oscar for ST device. 

I am sharing 2 nights of sleep which reflect majority of what i felt using device for past 2 months as data hasn't changed much. My AHI is 0.6 whether i have device on 11/6, 10/5, 14/9. I observed the following

10/5 and 11/6, 12/7 feel about same for me. I have now dreams, stopped drooling and waking up in middle of night etc but i wake up feeling lazy and not alert at all over all better feeling than cpap but not much

14/9 I sleep 6 hours and have to have to wake up once every 3 hours where i restart machine to ramp up again. Also drooling comes back. I mouth tape in both occasions and use nasal pillows mask My sleeping time goes from 8 hours to 6 hours 30 from above settings and i wake up once a night but feel slightly better than above settings.

I am not sure just from graphs what is different and what i am really suffering from as i cannot see CA in graph although i know i had them based on titration study and tests. Given the 19/Jan and 20/Jan data on 10/5 and 14/9 setting respectively, why did i feel better on second one but sleep less. Is this the right setting for me? and finally is VAuto or Asv the right device for me?

I really appreciate you all guiding me once again as i transition to a better specialist i hope and thankful to you all to no end. Please please let me know what more data i can share or do to help you all help me

[Sleeprider]

I'm impressed with the lack of events using ST, and it seems to keep you breathing at a fairly steady pace with good respiratory statistics. What backup rate are you using? It appears that the PS 5 you are using is sufficient to kick-start your spontaneous breathing because it would not normally be sufficient to cause a breath in the presence of a central apnea. ST is exceeding my expectations for efficacy for you, but if you don't feel rested, the other choice is ASV.

The Vauto is a great VPAP for obstructive apnea but has no backup rate. It's hard to imagine you would not have centrals with a Vauto.

[Moemah123]

Hi Sleeprider, my backup rate is 10. I am curious which data impressed you the 10/5 or 14/9. Your comment seems to indicate 10/5 is not enough?

I left my observations above but happy to follow advice on which pressure to stick to and for how long ans further data I can provide. I am glad ST impressed you so looking for guidance to maximize my treatment!

[Sleeprider]

Both are PS 5 and produce nearly identical results. The one I like best is not relevant from what can be seen, but rather what you feel works best.

[Moemah123]

I see, so in both cases if central kick in backup rate can fix it.

Some follow up questions is the 14/9 high enough to induce central? As I may stick with this for longer. Based on this data you see ST working fine right so I should give it a better chance? 

Trigger and cycle are med for me should I keep them as such or try high and very high. Just curious what are your suggestions for me for next steps

I really appreciate it sleeprider

[Sleeprider]

If you want to get a better look at how the machine works, look for places where the machine is pacing your respiration at 10 BPM and zoom in. I usually expect it takes at least 8 cm pressure support to cause a breath. Perhaps the machine PS at 5 is just enough to remind you. Is 14/9 enough to induce centrals? Try turning off the backup rate in S mode and see what happens. I would guess there will be centrals.

[Moemah123]

I am sorry again, I don't quite understand what you mean by 8 cm pressure to take a breath. Aren't I breathing normally its when I stop that backup rate locks in? If so what's difference between 8 and 5 in normally breathing scenario.

The second part about centrals. I was curious if 14/9 with backup rate 10 can induce central. I thought if you have high pressure that can happen even with backup rate and that's bad am I miss understanding? So when you suggest turning off backup rate to see if I get central with it, is it because you want me to find pressure that doesn't induce central

Apologies for many questions, summary of both is do you suggest I go up to 8 PS difference and use S mode to find ideal pressure ? Not even sure if machine can report central unless you know how to use charts to tell that I don't. Bear with me I feel we are very close thanks to you!

[Sleeprider]

You are using pressure support of 5.0, meaning your IPAP is set 5.0 cm higher than EPAP. Normally that is insufficient to treat CA events, and my experience is that it takes 8 cm, or at EPAP 9.0, it may take 18.0 to 25.0 cm of IPAP pressure to cause a breath, at least with ASV. There is no suggestion you are actually having any central apnea. Without a backup rate in S-mode, if you don't have central events, consider yourself cured.

The S mode experiment I was suggesting was to keep your settings exactly the same except use S mode at EPAP 9.0, IPAP 14.0. If there is no apnea in S-mode, you don't have any central apnea and the original diagnosis was wrong.

[Moemah123]

You are using pressure support of 5.0, meaning your IPAP is set 5.0 cm higher than EPAP.  Normally that is insufficient to treat CA events, and my experience is that it takes 8 cm, or at EPAP 9.0, it may take 18.0 to 25.0 cm of IPAP pressure to cause a breath, at least with ASV.  There is no suggestion you are actually having any central apnea.  Without a backup rate in S-mode, if you don't have central events, consider yourself cured.

The S mode experiment I was suggesting was to keep your settings exactly the same except use S mode at EPAP 9.0, IPAP 14.0.  If there is no apnea in S-mode, you don't have any central apnea and the original diagnosis was wrong.

Thanks Sleeprider,

I will switch to S mode today as i sleep and report results tomorrow. If it turns out i don't have CA in the chart, not sure if Oscar will report it but i will send it anyway. What are my next actions since as you said my diagnosis would be wrong. Does this mean i would use a VAuto or ASV mode or stay on S\ST mode with exactly same settings if things turn out exactly same as today and continue using device for foreseeable future couple more months and check back

I will still get data today, but appreciate your insight.

[Sleeprider]

Your ST may show an increase in apnea reported as UA events or "unknown apnea". We will assume that an increase in events is central, in the absence of a backup rate. If they do not appear, then you simply don't have central apnea and any CPAP or bilevel should work fine. I'd like you to check back tomorrow. I'm curious.