Please help....

[PeaceLoveAndPizza]

Don’t be so quick to change things. Going from 16+ to 1.32 is a great success for AHI. 

How did she sleep? It looks like she used it for 4.5 hours and had good results. As she gets more comfortable with it hopefully she can tolerate it longer. 

Given her medical situation too many changes can be disconcerting to her. Let her have some time to adjust and hopefully have a more comfortable night. 

The remaining events are mostly OA and  hypopnoea’s, so if you do decide to change anything start with a bit more pressure, something like 5-12 PS 3. You could also try 4-12 PS of 4. I would not try increasing pressure and PS at the same time for now. One change at a time.

[Gideon]

A question on the Parkinsons, ask if it is impacting her breathing, if so ASV would be contraindicated.
IVAPS may be a better choice because, ASV is based on a 90 second moving average of her minute vent and with neuromuscular issues that could mean her volume would diminish over time. IVAPS is based on an assigned target volume to maintain and is much more controllable than an ASV. Think of IVAPS as an ASV on Steroids. IVAPS can handle anything an ASV can plus a lot more. If it was my mom i'd get the IVAPS. BUT, I don't have the details.

[Sleeprider]

To add to Gideon's information, iVAPS is "intelligent volume assured pressure support" and is provided by the Resmed Aircurve 10 ST-A. This is a respiratory assist device that, in addition to supporting spontaneous respiration, will treat hypoventilation, and maintain a target vent rate. The ASV is mainly to treat complex and central apnea and is very effective at treating periodic breathing, CSR and similar conditions, provided respiratory volume does not need supplemented with pressure support. There are strong indications that your mom should be using ASV or iVAPS, to treat the episodes of periodic breathing. Her median tidal volume is 280 mL and minute vent a 5 L/min, but since it varies so widely, we can 't rely on that measure alone.

I'm going to provide a link to the Resmed Clinical Titration Guide because you need to get up to speed on how ASV and ST-A works and what they are intended to treat. Read the sections starting at page 27 for ASV and 33 for ST-A. https://document.resmed.com/en-us/docume...er_eng.pdf

[Lann]

When I saw your message it was late at night, I already adjusted the machine. My father was the one who monitored her during the night and he told me she was very resistant to wearing the mask last night. 

I'm so sorry, I should've considered it more carefully when I adjusted the machine.

The report from last night. AHI 7.02 and a lot of CA events, I don't know why.
I am going back to the settings you suggested. She seems more comfortable with those settings.

[Lann]

Thank you for the reply.

here's the result from last night, It seems her CA worsened yesterday compared to the previous night. and she's not feeling comfortable, so we have to go back to the previous settings

I'm not sure if her Parkinsons is impacting her breathing as the doctor didn't mention that while we were in the hospital. Nonetheless, we'll contact the seller and ask if they have IVAPS available.

thanks for the recommendation.

[Lann]

Thanks for the additional information, I will read the guide, it seems very helpful.

[Gideon]

Set PS=4 over 4-8

PS of 1 is not enough for her.
PS is what manages her flow limitations.
8 max IPAP to keep pressures low

She doesn't need high pressures, because she has no obstructive events

See the waxing waning pattern in the flow rate. In her case that is all CSR. If the gap between those groups was 10+ seconds that would be a textbook chart of CSR.

[PeaceLoveAndPizza]

Lann, please read the linked wiki article below on Cheyne-Stokes Respiration (CSR). Do not be overly alarmed as given your grandmothers medical situation it was not unexpected.

https://www.apneaboard.com/wiki/index.ph...espiration

It is something for you and others in the family to discuss with her medical team. We can help finding a comfortable setting for her to get her the best sleep we can whilst keeping her entire medical situation in mind. 

You are wonderful for doing this to help her. Thank you for giving us the chance to help.

[Lann]

Thank you so much, her AHI was 1 again, she even managed to wear it a bit longer this time, nearly 6 hours.

I can't thank you enough, we were completely clueless without your help, you people and this forum are lifesavers!
 
Here's the result, we will stick with these settings now until anything changes.

[Lann]

Thank you. Setting the PS higher helps, Her AHI was 1 yesterday. And she feels better as we lower the pressure.
This is the best result we have so far, so we'll stay with these settings for now.

Thanks for the suggestions, we really appreciate it