Answer Question Pls

[golfgame]

Can you tell me if the "CA" in the attached expanded Sleepyhead Rpt indicates Central Obstructions?

Thanks in advance

[Sleeprider]

Golfgame, use the first link in my signature to learn what kind of chart would be more useful. Also, what are your exact settings? Your profile shows 13/7; is that fixed bilevel, or are you in APAP mode with a pressure support setting? It appears you are in fixed bilevel mode with an effective pressure support of 6. Yes, that can cause CA. I would suggest you try Auto mode with EPAP min of 7, IPAP max of 14 and PS 4. I bet it clears right up.

[golfgame]

They pre-set the machine before giving it to me so I can't specifically answer your questions. I have only been on the machine since Jan 1.  I was back to the Dr for the first follow-up visit and what I am told is that he feels that the majority of my apneas are Central. He has not been able to get the data he requires to determine that because of the way the machine is set-up.  He has been in contact with the DME (?) to get further data and has more or less been rebuffed so I was trying to send him something to help.

If in fact, the majority are Central then he will make application for a machine that gives a constant pressure based on my breathing sequence.  Because those machines are much more expensive Medicare make you jump thru hoops by trying the cheaper machine first.  He can't write the Rx for that machine without the evidence to back up his request.

[Sleeprider]

Golfgame, I can see what is happening. You have a 6 -cm pressure difference between IPAP and EPAP. The machine is setup in VPAP-S mode so the pressure is not automatic. The pressure difference (pressure support) is what is causing your CA events. You need to reduce that, and you might as well also reduce the residual OA and H events. You can do that easily in Vauto mode.

To make the change, just push the control knob and home button at the same time, enter clinician settings, and the first item on top of the list is mode. Change VPAP-S to Vauto (Mode S to mode Vauto). Change IPAP max to 15. Make sure EPAP min stays at 7.0, and set PS (pressure support) to 4.0. Problem solved.

It is the excess pressure support that is causing your centrals. This is easy to resolve with the instructions above. Your doctor seems to be a bit uninformed about your machine. It's simply setup wrong in S mode rather than Vauto.

[golfgame]

Thanks, I will attempt to make those changes and report back to you after I generate another report.

[golfgame]

Yes, you are correct about the Dr and the machine. He commented to me that he leaves the set-up and all to the DME company.  I don't know if that is how most Doc's do that, but at least he was up front about that. He said that all he wants is the results presented to him.

[Sleeprider]

You will probably cut about 75% of the events with these changes. Once you have a bit more data, we can look if there is any more fine-tuning needed. Also, once you have a week of these settings under your belt, leave a message with your doctor's office advising of the new settings of "Vauto at 15.0/7.0 over PS 4". They can update your records.

As you can see, we have the same machine, and I can guarantee that if I use PS 6, I would have just as many central events as you. I think what happened is that you were issued an auto machine, and somehow the prescription got messed up. Anyway, you have a great VPAP machine and it's going to give you very good results. I think you will find these changes a lot more comfortable. Just so you understand, the high pressure support caused too much CO2 to be blown off causing your respiratory drive to be messed up. It's not that harmful, and easily fixed. When we set bilevel pressure, we use the EPAP pressure to control OA (obstructive), and pressure support to reduce hypopnea and flow limitations, reduce breathing effort and increase ventilation volume. Too much pressure support results in CA, and too little can cause an increase in hypopnea. Your new settings will start at an EPAP of 7.0, but that can increase automatically if obstructed breathing is detected. The highest it can go is 15/11. Hope this is more clear.

[golfgame]

Sleeprider pid='194844' dateline='1488898736']Golfgame, use the first link in my signature to learn what kind of chart would be more useful.  Also, what are your exact settings?  Your profile shows 13/7; is that fixed bilevel, or are you in APAP mode with a pressure support setting?  It appears you are in fixed bilevel mode with an effective pressure support of 6. Yes, that can cause CA.  I would suggest you try Auto mode with EPAP min of 7, IPAP max of 14 and PS 4.  I bet it clears right up.

So what does this warning about VAuto mean?  Is VAuto something that a person turns on or off?  If so I didn't do that, could the DME have done that remotely?

[golfgame]

You will probably cut about 75% of the events with these changes.  Once you have a bit more data, we can look if there is any more fine-tuning needed.  Also, once you have a week of these settings under your belt, leave a message with your doctor's office advising of the new settings of "Vauto at 15.0/7.0 over PS 4".  They can update your records.  

As you can see, we have the same machine, and I can guarantee that if I use PS 6, I would have just as many central events as you.  I think what happened is that you were issued an auto machine, and somehow the prescription got messed up.  Anyway, you have a great VPAP machine and it's going to give you very good results.  I think you will find these changes a lot more comfortable.   Just so you understand, the high pressure support caused too much CO2 to be blown off causing your respiratory drive to be messed up.  It's not that harmful, and easily fixed.  When we set bilevel pressure, we use the EPAP pressure to control OA (obstructive), and pressure support to reduce hypopnea and flow limitations, reduce breathing effort and increase ventilation volume.   Too much pressure support results in CA, and too little can cause an increase in hypopnea.  Your new settings will start at an EPAP of 7.0, but that can increase automatically if obstructed breathing is detected.  The highest it can go is 15/11.  Hope this is more clear.

You have indicated that you and I have the same machine, however, I don't see the same nomenclature on my machine. I am not seeing the PRS1 760 Auto BiPAP part. 

" Machine: Resmed Aircurve 10 VAuto and PRS1 760 Auto BiPAP"

How do I determine the Humidifier name?

An unrelated question. Last night and one other time I awoke during the night and was hearing a cracking sound in the mask, kind of like the sound you hear in a garden hose sometimes when there is a very slow flow.  Could this be H2o in the tube?  A couple of months ago I changed from an Airfit P10 mask which I liked to a Swift FX simply because I had to tighten the strapping on the Airfit too much to stop the leaks that created a pain in one of the nostrils. I don't recall hearing this noise with the Airfit P10.

I have reduced the Humidity level once and turned the temp down at the same time.

[Sleeprider]

I have two auto bilevel machines; a Resmed Aircurve 10 Vauto and a Philips Respironics BiPAP Auto. The machines are similar, with some differences in how they deliver pressure support. My instructions were accurate for your use, and you should get the setup manual by following the link at the top of this page for CPAP Setup manuals.

You need to push the control knob and home button (lower front) at the same time. The machine will enter clinician mode. Scroll up to clinical settings and enter by pushing the control knob. The first entry is mode which is currently set to S on your machine, and needs to be set to Vauto. The second entry is IPAP max which should be set to 15.0, The third item is EPAP min which needs to be set to 7.0. The fourth is PS or pressure support which needs to be set to 4. This is what will reduce your central events. Finally the IPA. Once you have made these setting changes, scroll to the top of the list and select exit clinical settings...you're done.

If you want to post something useful from Sleepyhead, go to the Daily tab on that startup screen and take a screenshot of the information there as described in the first link in my signature. I assume you want to solve your poor treatment. Follow my instructions, and once we get this worked out, you will understand how your doctor or clinic screwed up.