[Treatment] Oscar data help bipap

[Moemah123]

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.

I will do that definitely, cannot express how grateful for your patience and kind help.

[Moemah123]

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.

Hi Sleeprider,

I forgot to put my sd card but i woke up half way through night and found it shocking. My AHI was 10!! I had put the SD card back and took hydroxyzine and melatonin to force myself to sleep 3 hours more and my AHI per oscar is 8! as unclassified apnea. That is shocking to me, is that suggesting i mostly had centrals? I uploaded part of data and can try to do it again tonight. I am curious what that means now? 

Appreciate your input on the data, because i am shocked and i see u likely expected it. Also added another screenshot with expanded view of events that seem too clustered together. Seems i do need a backup rate?

[Sleeprider]

Yep, get back to the backup rate in ST mode and things will return to normal. I think it's amazing how well you do with ST at fixed pressures with PS 5. I have usually seen centrals require a move to ASV, but you're doing fine. I should have told you, that if you arouse during the night with a high AHI to restore the ST mode.

If you find ST mode falls short in providing restorative sleep, you should continue to fight for the ASV. It is the most appropriate therapy for complex apnea. Take a look at the Resmed Titration Protocol and you will see the intended use for the ST, and ASV. That should give you some basis for arguing your case. https://document.resmed.com/documents/pr...er_eng.pdf

[Moemah123]

Yep, get back to the backup rate in ST mode and things will return to normal. I think it's amazing how well you do with ST at fixed pressures with PS 5.  I have usually seen centrals require a move to ASV, but you're doing fine.  I should have told you, that if you arouse during the night with a high AHI to restore the ST mode.

I had planned to go back to ST but was committed to getting you data at expense of good day

So my hopefully last questions are. 

Is it a matter, at this point finding the right pressure settings with ST that gives me good night sleep e.g. 14/9 noting when I was 11/6 had same ahi but was tired (any idea why even though events were the same ?)

Should I stick to fixed pressure  e.g. 14/9. As it seems you are praising ST and how long before I move on to different fixed pressure

If I could find such settings does Asv help better with same settings or if I sleep well no need?

Appreciate it all !

[Sleeprider]

I am not very inclined to "praise" ST. I have called it the BiPAP without a mission in that past, and it should be replaced with the ST-A that includes an iVAPS algorithm. ST was never intended for the treatment of central and complex apnea, but sometimes it works. I prefer to look at the design intent and research done by the manufacturer which clearly indicates your condition should be treated with ASV, and leave the ST for the COPD, obesity hypoventilation and other thoracic neuromuscular disorders. ST is what you have, and my suggestion was, it is not providing restorative sleep, to continue the fight for ASV. It will work better.

As far as what pressure to use, your success with ST already defies my logic, experience and is working in spite of the fact I would tell you it won't. You are doing great and I have no idea what to suggest, because you are far far outside my envelope of experience with ST and complex apnea. I don't know why it's working! If this is a frustrating response, welcome to the club. I'm just flummoxed.

[Moemah123]

I am not  very inclined to "praise" ST. I have called it the BiPAP without a mission in that past, and it should be replaced with the ST-A that includes an iVAPS algorithm.  ST was never intended for the treatment of central and complex apnea, but sometimes it works.  I prefer to look at the design intent and research done by the manufacturer which clearly indicates your condition should  be treated with ASV, and leave the ST for the COPD, obesity hypoventilation and other thoracic neuromuscular disorders.  ST is what you have, and my suggestion was, it is not providing restorative sleep, to continue the fight for ASV. It will work better.  

As far as what pressure to use, your success with ST already defies my logic, experience and is working in spite of the fact I would tell you it won't. You are doing great and I have no idea what to suggest, because you are far far outside my envelope of experience with ST and complex apnea. I don't know why it's working!  If this is a frustrating response, welcome to the club. I'm just flummoxed.

I don't know why going through this reply made me laugh, I think you are right the charts look good so i will keep trying to find setting that does work for me otherwise push for ASV. I will try to report back if there is more. Thanks Sleeprider!

[Moemah123]

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.

Hi SleepRider and all, 

Hope you are doing great. So, wanted to report back.

I got an resmed ASV device, set it to AutoASV and had settings as you instructed. I am attaching a sample night from yesterday. 

Your comment was that ST was doing great for me. Looking at Oscar data, I can see that there are times that ASV pushed much higher pressure than i would normally set on ST 14\9. From ASV can is it possible to induce what right settings for ST would be? For example i noticed that med is 11.72\7.74 which is 5cm pressure difference that you expressed sufficient. 95% case is 16.26, so not sure what's the difference between this and med? and which settings you recommend i test ST with?

From a personal feeling perspective. I would say i feel 80% better with ST than i used to with regular CPAP, then ASV would be close to 90% the difference is noticeable but marginal. Both i do seem to have some sort of aerophagia but so little, but found that with ST i have to mouth tape or i would drool, ASV was 50\50 nights.
 
So given this data
1. Is ASV then the right device for me, or given that they seem pretty close stick to ST or keep trying both for a while longer e.g. a week each back and forth?
2. What ST settings to change from 14/9 to test if i can do even better?
3. What ASV settings would you change now to fix aerophagia or overall given what it's doing?


My goal is to eventually get an ASV, but for now maybe use ASV to figure best settings for ST if that makes sense?

Thanks once again

[Moemah123]

Would like to add, that with AutoASV yesterday, i found machine woke me up and would keep increasing pressure to 17 - 18 even though i am up and trying to breath normally, it was all over place with pressure, is that normal?

Appreciate the help

[Sleeprider]

The results are excellent, and a very significant improvement over what you were able to get from the ST based on AHI. When you machine blows at you, the trick is to blow-back. That will stop the machine from increasing pressure support. It's going to take some time to fully adapt to ASV, but it's encouraging to hear you are feeling better and the results are spectacular. This appears to be better therapy, even though you tolerated ST (much to my surprise). The pressure range seems appropriate, and EPAP is varying in about a 1.5 cm range which is very good.

I'm impressed you managed to obtain an Aircurve 10 ASV, and suspect you paid out-of-pocket to accomplish this so quickly.

[Moemah123]

The results are excellent, and a very significant improvement over what you were able to get from the ST based on AHI. When you machine blows at you, the trick is to blow-back. That will stop the machine from increasing pressure support. It's going to take some time to fully adapt to ASV, but it's encouraging to hear you are feeling better and the results are spectacular. This appears to be better therapy, even though you tolerated ST (much to my surprise).  The pressure range seems appropriate, and EPAP is varying in about a 1.5 cm range which is very good.  

I'm impressed you managed to obtain an Aircurve 10 ASV, and suspect you paid out-of-pocket to accomplish this so quickly.

Thanks SleepRider,

I did pay out of pocket about 700, not much considering I would go through tons of appointment to obtain ASV so it felt like a good deal and hours were really low. One more thing, given the pressures above, what is really then the best pressure ST can be set to given ASV data, since i will still have to jump back to ST from time to time for compliance. Any thoughts?