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BIPAP making my CSA worse
#1
BIPAP making my CSA worse
I only have central sleep apnea, so this has been tough to get fixed or even talk to a doctor.
Apparently this is mild, but I'm always tired, and have been most of my life.
in testing without a bipap my o2 levels seemed pretty consistent but my heart rate spikes from 60 to 90 quite a bit
my poor sleep study said 8.8ahi csa
my titration ended on bipap 13/6 with 3ahi

I wear a muse eeg headband, so I can confirm the apneas happen during deep or REM sleep

Do I need an asv?

well guess I cant attach images..

Here's some oscar data
https://i.imgur.com/TUxXRYr.png
https://i.imgur.com/3RgPZn6.png


zooming in on some flow data, looks mostly like this, sometimes it looks/sounds like it's chugging, I read that's due to it not being level, so maybe that was the case, as it was on a cushion.
https://i.imgur.com/DtFo0OQ.png
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#2
RE: BIPAP making my CSA worse
We may help guide you to ASV as the Aircurve 10 Vauto does not specifically treat CSA. Have you had a sleep test that shows predominately central events? If there are any diagnostic or titration studies, it would be helpful to further understand those results.

I'm going to suggest some setting changes and we will want to look at your results and then further refine them.
EPAP min 6.0
Max pressure or IPAP 9.6
PS 3.6
Trigger Sensitivity High

We are fixing EPAP pressure at 6.0 based on no apparent obstructive events and reducing PS from 4.0 to 3.6. By changing trigger sensitivity to high we hope to see the machine switch from EPAP to IPAP with less spontaneous effort or flow. We don't have a backup rate on the Vauto, so this is a trick that sometimes works, and we will also try trigger at very-high after seeing these results.
Sleeprider
Apnea Board Moderator
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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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#3
RE: BIPAP making my CSA worse
This is what's so baffling to me, why I wasnt given an asv right away..

initial sleep study:
https://i.imgur.com/sVEnaJO.png

diagnosis was mild central sleep apnea

then a titration starting with cpap and ending with bipap
https://i.imgur.com/NDwxzTM.png
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#4
RE: BIPAP making my CSA worse
You can probably blame insurance for not allowing ASV. Because of the cost of ASV (which is actually less than the cost of a study and all the B.S.) is higher, most insurance requires that you trial CPAP or Bilevel without a backup rate before being approved for the respiratory assist device with backup rate. Here is our wiki on that subject: http://www.apneaboard.com/wiki/index.php...P_Machines

How long have you been using your Aircurve 10? Have you had a follow-up with the doctor or have one scheduled? Pretty obvious your diagnosis should be central apnea. The titration study moved from CPAP with numerous CA events and progressed to BiPAP from 10/5 to 13/6. That is a lot of PS and I would have expected many more events, similar to what you currently experience. The hypnogram showed a relatively low event rate with BiPAP pressure, so you were prescribed the bilevel. I think you are going to just have to make some noise to get the ASV, or if you are financially able to buy ASV ($1699 for a lightly used machine from Supplier #2) you can speed things up. Anyway, the solution is going to be to complain until you are provided the therapy appropriate to your condition.
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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#5
RE: BIPAP making my CSA worse
Squeak loud and often.
I suggest you make no changes to your settings. Why? Honestly we collectively are very, very good at optimizing therapy to the best capability of whatever machine you are using,. Should you choose to do that start with he changes Sleeprider suggested, he is among the best you will find anywhere at this. Any changes we suggest will likely, not for sure, improve the results to the point where you will not need nor qualify for an ASV. It has happened many, many times in The past.

Ask your doctor what is your official diagnosis? Is the answer is not CSA then ask why not? What can WE do to change that since the sleep test results obvious show CSA, and we need the diagnosis to be correct if WE expect to be able to get an ASV through the insurance process. State that you understand the need To prove CPAP didn't work, the titration study proved that, and the BiLevel doesn't work and these results prove that (provide him with OSCAR charts proving that) so what do WE need to do to get an ASV? Do WE need to schedule an ASV titration to prove it works or is this enough evidence to order one?
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#6
RE: BIPAP making my CSA worse
Excellent points by Gideon, and I should have also warned that optimization can make advancement to a more appropriate ASV difficult.
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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#7
RE: BIPAP making my CSA worse
I appreciate your input. Is it actually possible to use a bipap as CSA treatment?
I tried your settings last night, but kept waking up with a completely throat/mouth with the air blowing out my mouth.
Maybe I need to go back to a facemask or use tape?

I'm still well at the beginning of the 90 day insurance dance as well.

The respiratory therapist told me it would be a 6 month wait for an ASV when I asked upon getting the bipap
not really in a spot to buy an ASV, but as of right now, unless it improves me enough that my cognition and energy are good enough for intellectually demanding work.
I definitely sleep better without the bipap, if that means much.

I guess the biggest question is, will an asv actually improve my energy, sleep and cognition, or if my baseline fog is not sleep related.

Are there any ways to really diy monitor CSA AHI changes with lifestyle changes, will any make a difference for csa?
More consistent sleep schedule, more exercise, cutting soda, no night time electronics
I've done all those off and on, but dont think I've ever accomplished more than 2 nights in a row with a consistent sleep schedule.

https://i.imgur.com/Eeom2d4.png
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#8
RE: BIPAP making my CSA worse
Your leak rate was the biggest problem here, and is not related to pressure which stayed constant at a much lower pressure than your previous charts (Dec 7). Your jaw relaxes and air diverts through your mouth causing the leaks, but you controlled leaks in previous days at even higher pressure. I'm sure you can learn to suck your tongue back to the roof of your mouth and avoid the leak. This chart shows only 1:35 time in therapy, so you will need to go longer to satisfy compliance requirements. Deal with the leaks by learning to keep air out of your mouth, or get a full face device. These settings seem to have reduced AHI by about 50%, but we need more time in therapy to verify the efficacy. The take-away is that settings kept EPAP constant at 6.0 and IPAP at 9.6 and there were no obstructive events, and fewer central events. The one flagged OA is after a large spike in flow, or a sigh, so is probably a change in position rather than apnea. We can conclude from this that higher EPAP pressure may not be needed. You can go ahead and try trigger sensitivity at "very-high" and it will reduce apnea another increment. The bigger challenge is to jump back on the horse when you fall off, and put the mask back on and get some hours in.

ASV is the better therapy. Optimizing bilevel may demonstrate efficacy at a level that prevents getting the higher level machine. If we continue to optimize, we have two goals; one is to get an acceptably low AHI and the other is satisfying sleep quality.
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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#9
RE: BIPAP making my CSA worse
A competent and sympathetic respiratory therapist or sleep specialist should have a good idea of what ranges of pressure will/should work for your condition and with the machine model you were given.  What the other gentlemen are saying, if I may, is that such an RT should immediately see that you have modified your various therapy pressures in a way to hope to dial in effective treatment.  Once he/she sees the ranges, and the trials at those ranges, it should become quite apparent that what you have cannot treat you.  That's the simple logic of our approach.
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#10
RE: BIPAP making my CSA worse
well, the other days was with a full face mask, but it's extremely uncomfortable.

I think I have to find some tape, I cant seem to keep my mouth shut, and the nasal pillow woke me up with extreme nose pain,
I'll try my smaller mask from the titration, again

[Image: wsZXSYK.png]
the clinicians menu showed 8.8ahi, not sure why the difference, but that's what I was diagnosed at during my initial sleep study

interestingly, according to my muse eeg headband, during the period of no apneas I was in deep sleep, then light sleep when the apneas happened around 2am, not sure what happened to 12-1am data, usually try to sleep at midnight

ended up ripping everything off and just trying to sleep, as I had a horrible migraine after that, and still do, 14 hours later

my RT said it was weird I was prescribed this and not an ASV, but also that it'll take 6 months to even get an ASV,
I did my o2 test, lowest I was at was 88% for 3 minutes, that night I probably clocked 3-4 hours with the machine
My pulmonologist's nurse said the o2 was fine.


For reference, my o2 never dipped below 92% prior to machine use, using a wellue o2 ring
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