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BIPAP machine stops blowing when I stop breathing
#11
RE: BIPAP machine stops blowing when I stop breathing
Thank you.
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#12
RE: BIPAP machine stops blowing when I stop breathing
It appears that your machine stopped when the leak rate went to maximum and no breathing circuit was detected. You removed the mask. I think we can help you get to the bottom of this.

I would like you to send me the link where you were trying to download Oscar but were asked for sensitive personal information. I will pass the information on to the Oscar development team to hopefully warn others or have the phishing site removed. Click on my user name to send a message.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#13
RE: BIPAP machine stops blowing when I stop breathing
Thank you for your reply.

Last night, there was little or no leak detected. (smiley emoticon) and the same thing happened. I recorded 37 events in just one hour. That's more than I have even without the machine because I must stop breathing a lot and then start up which, apparently, causes the machine to pause blowing air until I actively exert effort to get it blowing again.  I never removed the mask until I finally gave up. Perhaps I'd do better with the CPAP which keeps blowing no matter what?

RE the Oscar situation, I finally got it figured out and registered. Thanks!
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#14
RE: BIPAP machine stops blowing when I stop breathing
I still want to know what site is distributing Oscar on the condition of revealing your SS number.

We need to get a better idea why things are shutting down, but you have significant clusters of CA events. Since there is no clinical sleep study, there is only limited information from your home sleep study. If you have the results, it might be helpful if you post the results with any personal information redacted.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#15
RE: BIPAP machine stops blowing when I stop breathing
I'll add that it is extremely important for us at both AB and OSCAR to know what link you were using that requested your personal info while you were attempting to DL OSCAR.
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#16
RE: BIPAP machine stops blowing when I stop breathing
1.) I have discovered that I was on Oscar Insurance's website which is an insurance provider. Later, I accessed the OSCAR we use here via this website.

2.) In answer to your question about a sleep study. I did have a sleep study performed about a month ago. Here are the results. I hope this isn't too much.

Thank you.

HT: 73 inches WT: 175 lbs. BMI: 23 kg/m2


Most recent polysomnogram dated 07/07/2018 revealed an AHI of 11.7/hr. and RDI of 11.7/hr. SPO2 Nadir: 82% Total Sleep Time (TST): 118 minutes Rx: 5-10 cwp CPAP intolerant.
DIAGNOSIS
- Obstructive Sleep Apnea (G47.33)
SUMMARY
- Moderate Obstructive Sleep Apnea (OSA).
- Diagnostic AHI: 25.9 events/hr. Diagnostic RDI: 27.5 events/hr. SpO2 Nadir: 83% Total Sleep Time (TST): 148.5 min.
- Soft snoring volume noted.
- Mild Central Sleep Apnea (CSA).
- Moderate periodic leg movements(PLMs) during sleep.
- ECG showed no cardiac abnormalities.
SUGGESTED RX
- BIPAP Rx = IPAP 12 / EPAP 4 cm H2O Easy Breathe or equivalent: On Please set up member to respective patient compliance management program.
- MASK: Medium Resmed Airfit P10 Nasal Pillow Mask Respironics Deluxe Wide Chin Strap: Yes Heated Humidifier: Yes
- NOTE: Sleep Center issued the mask listed above to the member after an in-laboratory PAP titration study. The member is instructed to take this mask to the Apria Health Care appointment to pick up the PAP machine. May fit mask to comfort if initial mask was not issued or effective.
- Date of Diagnostic Test: 07/23/2022 AHI: 25.9 events/hr. RDI: 27.5 events/hr.
- SpO2 Nadir: 83% Total Sleep Time (TST): 148.5 min.
- Indication for sleep study: Prior diagnosis of sleep disorder, AFIB, Insomnia, Mood Disorder, Lost 32 lbs. since last study. Other: Allergic Rhinitis, Atherosclerosis of Aorta.
OTHER RECOMMENDATIONS

- Follow up evaluation with referring provider within 31-90 days after PAP initiation. Consider full night PAP titration IF symptoms or PAP intolerance persist despite adequate trial of daily therapy (i.e. at least 1-3 months).
- Positional therapy (avoiding supine position during sleep, raising head of bed) may be helpful.
- Aggressive management of any nasal congestion or obstruction is recommended.
- Optimize sleep hygiene: 7-9 hours of sleep nightly, regular exercise, and avoidance of alcohol/sedatives/caffeine prior to bedtime.
- Counsel regarding the risks of drowsy driving.
- Consider CBC, TSH, FERRITIN if clinically indicated.
- Oral appliance or ENT consultation for surgical options alone are unlikely to be effective second-line therapy for this degree of OSA.
MEDICATIONS
Sleep medicine self-administered - AMBIEN 1/2 TAB (10MG) at 09:00:00 PM. Medications taken are self-administered by the patient.

SLEEP STUDY TECHNIQUE
The patient underwent an attended overnight level one polysomnography titration to assess the effects of PAP therapy. The following variables were monitored: EEG (C4-A1, C3-A2, O1-A2, O2-A1), EOG, submentalis and leg EMG, ECG, oxyhemoglobin saturation by continuous pulse oximetry, thoracic and abdominal respiratory effort belts, nasal/oral airflow by pressure sensor, body position sensor and snoring sensor. CPAP pressure was titrated to eliminate apneas, hypopneas and oxygen desaturation. All technical elements were performed according to American Association of Sleep Medicine (AASM) recommendations. Hypopneas were scored by the Medicare definition with at least 4% desaturation (AASM definition VII.4.A).


TECHNICAL COMMENTS
Comments added by Technician: Cheyne Stokes Respiration: No. Willingness to use treatment: Yes
Comments added by Scorer: Baseline respiratory rate was 10. CPAP was initiated and titrated to 8 cwp then switched to Bilevel due to central apnea. Upon awakening patient stated to tech that he preferred to use BiPAP.
SLEEP ARCHITECTURE
The recording time for the entire night was 513.8 minutes.



The diagnostic portion was initiated at 9:08:10 PM and terminated at 12:34:28 AM. The time in bed was 206.3 minutes. EEG confirmed total sleep time was 148.5 minutes yielding a sleep efficiency of 72.0%. Sleep onset after lights out was 31.0 minutes with a REM latency of 100.0 minutes. The patient spent 10.8% of the night in stage N1 sleep, 82.5% in stage N2 sleep, 0.0% in stage N3 and 6.7% in REM. The Arousal Index was 9.3/hr.



The titration portion was initiated at 12:34:28 AM and terminated at 5:29:10 AM. The time in bed was 294.7 minutes. EEG confirmed total sleep time was 233.0 minutes yielding a sleep efficiency of 79.1%. Sleep onset after CPAP initiation was 3.7 minutes with a REM latency of 65.0 minutes. The patient spent 21.9% of the night in stage N1 sleep, 63.9% in stage N2 sleep, 0.0% in stage N3 and 14.2% in REM. The Arousal Index was 9.5/hr.

RESPIRATORY DATA
During the diagnostic portion, there were a total of 68 respiratory disturbances recorded: 42 apneas ( 34 obstructive, 0 mixed, 8 central), 22 hypopneas and 4 RERAs. The apnea/hypopnea index (AHI) was 25.9 events/hr. and the respiratory disturbance index (RDI) was 27.5 events/hr. The central apnea index (CI) was 3.2 events/hr. The REM AHI was 36.0 events/hr. and NREM AHI was 25.1 events/hr. The REM RDI was 36.0 events/hr. and NREM RDI was 26.9 events/hr. The supine AHI was 25.9 events/hr, and the non-supine AHI was 0 events/hr; the patient was supine during 100% of sleep. The supine RDI was 27.5 events/hr, and the non-supine RDI was 1.21 events/hr. Respiratory disturbances were associated with an O2 nadir of 83% during sleep. The mean oxygen saturation during the study was 96%. The cumulative time under 88% oxygen saturation was 2 minutes.



During the titration portion, the AHI was 7.0 events/hr. and the RDI was 7.0 events/hr. The CI was 6.4 events/hr. The optimal setting of PAP is as noted in "Recommendations". At this setting, the sleep efficiency was 96.8%, and the patient was supine for 100.0%. The AHI was 3.9 events/hr, the RDI was 3.9 events/hr. with 2 central events. Oxygen nadir was 83%.



LEG MOVEMENT DATA
The total leg movements was 109 with a resulting leg movement index of 44.0 events/hr. Associated arousal with leg movement index was 0 events/hr.

CARDIAC DATA
The underlying cardiac rhythm was most consistent with sinus rhythm. Mean heart rate was 54.8 during diagnostic portion and 46.7 during titration portion of study. Additional rhythm abnormalities include: None.
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#17
RE: BIPAP machine stops blowing when I stop breathing
That is most of what we needed. Your primary diagnosis is "mild central apnea". Once you got pressure and pressure support, that turned into more severe central apnea. That is not an unexpected result. CPAP and BiPAP without a backup rate treat obstructive sleep apnea but often make CA worse, because it further reduces carbon dioxide and respiratory drive. You were improperly prescribed bilevel positive air pressure. You need adaptive servo ventilation (ASV). The medical system has once again demonstrated its incompetence. While some people manage to get therapy success with a central apnea issue using a machine without the backup rate, you are clearly not one of them. Let your doctor know this is not working out because the machine has no capability to treat central apnea. If you don't get a reasonable professional response, we will continue to support your needs, but based on diagnosis, you have the WRONG machine.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#18
RE: BIPAP machine stops blowing when I stop breathing
Thank you for looking at my Sleep Study data and for your analysis. I've done a lot of research after your message and see that BiPAP therapy can actually make Central Sleep Apnea worse which I think was happening to me. I messaged my doctor a copy of part of your message along with articles on adaptive servo ventilation therapy. 
Does this mean I have Complex Sleep Apnea? I see that, according to these articles, I fit the profile of starting and failing with CPAP, then with BiPAP, which leads to the SVT method. I have requested that my doctor switch out my new BiPAP machine for a SVT machine. I see these machines are much more expensive than CPAP and BIPAP. 
I also appreciate that you "got" that my problem was NOT a pressure issue but the machine not being able to "learn" and respond to my breathing/non breathing patterns.
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#19
RE: BIPAP machine stops blowing when I stop breathing
Complex sleep apnea is the presence of both obstructive sleep disordered breathing and central apnea. We see a lot of it here as people a placed on CPAP to treat OSA and hypopnea, only to reveal an underlying CSA. Most sleep studies actually diagnose OSA regardless of the presence or prevalence of CSA, and nearly all will interpret hypopnea as obstructive without the kind of analysis required to make that assumption. I think much of this is driven by insurance which simply refuses to treat CSA without first demonstrating failure of CPAP and BiPAP without backup, before finally allowing reimbursement for bilevel with a backup rate. Even then, it is extremely common to see BiPAP ST prescribed rather than the far more appropriate ASV.

Since you worked hard to read and understand more materials to fill-in what I omitted in the first reply, I'll offer a link to one you can really use. The Resmed Sleep Lab Titration Guide is an excellent resource for understand the manufacturer's intended use for each machine, and how to titrate appropriate settings, or move to a different type of machine when events are not resolved. You need to focus on bilevel (VPAP-S and Vauto), VPAP ST (spontaneous/timed), iVAPS (intelligent volume assured pressure support) and ASV (adaptive servo ventilation). Note especially that ST is not intended for treatment of central apnea and be prepared to argue this with your medical team. https://document.resmed.com/en-us/docume...er_eng.pdf
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#20
RE: BIPAP machine stops blowing when I stop breathing
Thank you for your response and for this information. Based on the alternatives you present here and in your previous message, are you saying that, practically-speaking, my doctor would need to notify Apria Healthcare which is the provider for these medical devices at Kaiser here, to switch out my Res Med BiPAP machine for a Res Med ASV machine? The pulmonologist there would have to determine the settings, etc.

Yes, your comment about insurances is apt. I see that the ASV machines are at least $1,000 more than the Res Med Aircurve 10 VAUTO I received about a month ago.
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