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+--- Thread: New patient. Have been having horrible nights. (/Thread-New-patient-Have-been-having-horrible-nights)
New patient. Have been having horrible nights. - Josephdfco - 11-17-2017
Hi! I was recently diagnosed with severe complex central/obstructive sleep apnea at the VA in West Haven, CT, and I started on a bipap machine on Monday. I've been using a nasal mask, which at first was working good, but then I started snoring again, so I got a chin strap. That helped initially, but last night was like the old days: snoring, sputtering, and waking up about 6-8 times per night. I talked to the sleep doctor today, and he scheduled me to get a full face mask fitted the week after next. Here's my data from last night: https://imgur.com/a/tA9u1
Do you think there's anything I can do in the meanwhile (I got the clinician's manual for the machine) to make the situation more tolerable? Thank you very much!
RE: New patient. Have been having horrible nights. - Walla Walla - 11-17-2017
First Welcome to the board. You came to the right place for advice. To tell the truth your condition is out of my league but I wonder if the Doctor is trying to get you to fail on the Bipap. He may be trying to set you up for a ASV machine which would the right one for you.
The reason I say this is the settings he gave you almost guarantees you to have more Clear Airway events. The Pressure Support which is the difference between the IPAP and EPAP is way too wide!
RE: New patient. Have been having horrible nights. - Sleeprider - 11-17-2017
If you hav>e good heart health (left ventricular ejection fraction >45%) then the machine you need is a Resmed Aircurve 10 ASV. ASV is an adaptive servo ventilator and provides breath by breath pressure support to cause a breath when you don't take one (central apnea. You are currently using IPAP 16, EPAP 16 which is a pressure support of 8 cm. In a machine with backup timing or intelligence like the ASV that would cause a breath, but your Vauto just stays at the EPAP pressure on every one of those apnea. You can zoom in on the graph and look at your flow rate and mask pressure to see this is true.
You have a diagnosis of complex sleep apnea, and these results and how you feel prove that is not the right solution. Contact your doctor immediately for titration to evaluate ASV. Don't take no for an answer. If you have congestive heart failure and LVEF% less than 45% you may need to try ST bilevel therapy. This is like your current machine with a timed backup to cause a breath when one is not taken spontaneously. The ASV is better, but requires the LVEF%>45%.
Tell the doctor your AHI is nearly 38 events per hour and all central apnea. You have no leaks. If he continues to think a mask is a solution, call him a moron.
![[Image: T7g1R8j.png?1]](https://i.imgur.com/T7g1R8j.png?1)
RE: New patient. Have been having horrible nights. - Spy Car - 11-17-2017
I'm with Walla Walla.
In any case, a Bi-level is not the answer. Monday you need to call the doctor's office.
I suspect you will need an ASV machine. Is the doctor trying to help you by guaranteeing a "fail"?
I'm sorry. I endured 5 days trying the same machine you are using to deal with less severe mixed apneas, and it was torture.
I'll let greater experts help you make it less bad.
Bill
RE: New patient. Have been having horrible nights. - Sleeprider - 11-17-2017
Adding to this post with something constructive, the best solution for a bilevel to treat your complex apnea is fixed pressure with very little pressure support or none. I would suggest that if you set your machine to CPAP mode at 9.0 cm, you will get the best results possible. It should cut back many of the central apnea, and you will have more hypopnea, but at least you'll be breathing.
Your complex/central event rate is serious business. If your doctor doesn't get it, get a referral to one that does.
RE: New patient. Have been having horrible nights. - Josephdfco - 11-17-2017
Thank you all! How many AHI events per hour? How do I set the machine to 9cm in CPAP mode? I know how to get into settings, and how to set it to CPAP, but I don't know how to find the 9cm setting. Also, would it help to take another screenshot of the other graphs visible?
Lovely! I'm in the middle of an epic battle with another doctor that apparently graduated at the bottom of his class. How do these people pass their USMLEs?
RE: New patient. Have been having horrible nights. - Josephdfco - 11-17-2017
My first wake-up, one hour later.
RE: New patient. Have been having horrible nights. - trish6hundred - 11-18-2017
Hi Josephdfco,
WELCOME! to the forum.!
Good luck with CPAP therapy and getting the machine you really need; you have come to the right place for guidance.
Hang in there for more responses to your post.
RE: New patient. Have been having horrible nights. - Walla Walla - 11-18-2017
To set (cm in CPAP mode do the following. Push the round knob at the same time you push the home button. (The one with a picture of a house on it). Hold for 3 seconds and the Clinical Menu will pop up. Go to Mode and change to CPAP. Than go to set pressure and change to 9.0. As far as telling the API tell them API of 38.0
RE: New patient. Have been having horrible nights. - Sleeprider - 11-18-2017
Josephfco, your complex apnea is one of the most clear-cut cases I have ever seen. I hope you will be very active in complaining and insisting on getting the ASV treatment you need. Please know that CPAP mode will not fix the problem, but it may improve results over the current 38 AHI (apnea hypopnea index), CAI (central apnea index), OAI obstructive apnea index.
Walla...API American Petroleum Institute?