newbie with AHI~50 & a new dream station biPAP

[Gideon]

Your numbers look like totally untreated Apnea. You need to get the recommended pressure settings implemented. When will you be seeing your Doctor? It should be not later than tomorrow.

[Sleeprider]

I agree with you seeing your doctor. The breaths themselves, when you take them look fairly normal. The closeup you showed was classic central apena with a gradual reduction of breathing effort. I think your machine is mis-reporting your apnea and that you actually have complex or central apnea, and unfortunately the breathing pattern you displayed suggests Cheyne-Stokes respiration. I completely agree that you need to see your doctor on this, and should be scheduling this as soon as possible. I think he would be quite concerned if he saw these exact same images. You might want to drop off copies of this at his office to see if that might expedite your next evaluation.

Are you aware of any cardiac or pulmonary conditions that might be in play?
Do you have a copy of your sleep study? Any central events there?

With regard to my previous recommendations for increased pressure, they may be valid for obstructive apnea, however, your most recent post has me thinking you will be learning about an "adaptive servo ventilator" ASV very soon.

[dmeRT]

You may be headed towards a bipap asv, but I don't think your there yet. To switch to asv, >50% of the apneas need to be central. 90% of your issue right now is untreated obstructive apnea. Get that fixed first and if your still having central's and the Cheyne-Stokes then an asv titration should be considered.

Good to hear you used the cervical collar, we can now rule out any positional issues.

[rbookman]

Shared data and comments with my sleep doctor.
Here's what he told me to change on my DSX700: IPAP from 17 to 18, and pressure support from 5 to 4.

[Walla Walla]

You need a new Doctor. ASAP!

[dmeRT]

That change will allow for your EPAP to get to 14 cmH2O max. Which is better than the 12 cmH2O max at previous settings. But....I'll bet you'll still need a higher IPAP setting to allow a higher EPAP. good luck.

[Sleeprider]

I am more or less thinking out loud here. My observations have been that the apnea are being erroneously flagged as obstructive, but are central in nature, and we also see clear evidence of periodic breathing in the submitted charts. We know in certain individuals, that both of these event-types can be worse with pressure support.

rbookman, it would help us so much if you have copies of any titration study that was used to set your pressure, for you to share that information. If you don't already have a printed copy of your titration and sleep study, you should get that for you personal permanent records. You cannot be certain these important files will be available to you in the future if you do not keep them. They will be used for years to determine your eligibility for equipment and prescriptions. My specific interest is to see how CPAP therapy was rejected, and how pressure support and therapy pressures were determined. Particularly in light of your very high AHI, it is important to review what these studies found, or if the studies were conducted at all.

[rbookman]

From the report:

"RESPIRATORY (thorax & abdominal respiratory inductive
plethysmography, PAP derived flow):
Continuous positive airway pressure (CPAP) was applied from 4
cmH2O to 8 cmH2O via a medium Simplus full face mask. Failure of
CPAP prompted a change to bilevel PAP (BPAP) with sekngs from
inspiratory posiRve airway pressure/expiratory posiRve airway
pressure (IPAP/EPAP) of 13/8 cmH2O to 25/20 cmH2O. A chin strap
was added in an effort to reduce the amount of air leak. The mask
was eventually changed from the medium Simplus full face mask to
the medium Nuance nasal pillows per paRent request due to
reported discomfort. Patient had difficulty tolerating the higher
BPAP pressures, and requested for the pressures to be lowered as
well. Respiratory events persisted throughout the titration, with
combinaRon of obstrucRve apneas and hypopneas, in addiRon to
few central and mixed apneas."

And then:

"4. This was an unacceptable titration per American Academy of
Sleep Medicine criteria due to persistent respiratory events and
hypoxemia during this study, most significant during REM sleep. A
combinaRon of obstrucRve and central respiratory events with
significant hypoxemia were noted throughout most of the PAP
titration. A therapeuic pressure could not be determined. Mask
discomfort and BPAP intolerance at higher pressures were also
reported by the paRent. The patient’s head was propped up with
pillows during this study, and supine sleep was not recorded."