Bi-Level, S, ST, ASV??

[jtech1]

Here is a zoom in on a couple events.  S/T bilevel machine.

[jaswilliams]

Yuck. Classed as hypopnoea due to reduced flow but I would suggest reduced flow due to leaks not due to an apnoea.

[jtech1]

Thanks!  So, is it pretty certain that the leaks would NOT be causing loss of UA detection?  So, in this case, results are probably better than indicated if hypopneas are due to leaks... not the other way around, where missing UA detection due to leaks... right? In the case of an OA or CA I should still see flows go to zero in spite of leaks, correct?

[jtech1]

Really looking for some insight here... trying to decipher the difference between two masks... same exact settings on AirCurve ST.  EPAP 7, IPAP 12, BR 14.

The image with the almost constant leaks is the P30i nasal pillow.  The image with no leaks is the Amara View.

The nasal mask has constant leaks (although non-detectable by the user), and shows almost no apneas, just hypopneas.
The Amara View shows no leaks and lots of apneas (UA).

If this were a unit that uses the pressure pulse to determine type of apnea, then I could see where leaks might interfere with the classification of apneas... but, am I correct that leaks do not play a part in detecting the apnea itself.. but instead the overall flow rate is used to detect hypopnea vs apnea??  I want to understand if the leaks are playing a role in the significant difference in apneas and hypopneas between the two masks... OR, if it is more likely the nasal mask better controls apneas?  AND, if two different masks like this (nasal only vs mouth/nasal) may need different pressure settings to achieve best treatment?

Any advice on what to pursue here would be greatly appreciated.  Can't find any way to eliminate the nasal mask leaks... tried chin strap and liners... no difference.  But more importantly, why the significant difference in UA between masks?

Zoomed in images in next post.

[jtech1]

Here are zoomed in images.

The Amara View (no leaks, lots of UA) shows relatively longer apneas all night.

The P30i (tons of leaks), show very few UA (and the ones it shows are shorter than those with Amara view), and mostly hypopneas, where flow rate changes a bit but there is still clearly respiration.

Any insight would be greatly appreciated!

[jaswilliams]

Look in at the graphs these are things happening here. The leaks are affecting therapy. But more importantly the pressure support from the ST is insufficient to force/encourage a breath so the Apnoea is still occurring, it looks to me like more pressure support is needed. This is where the BiLevel treat meant falls down as apposed to ASV as on an ST machine pressure support is required at all times at a high level. But with an ASV it is only when required on a breath by breath basis

[jtech1]

Thanks for the reply... I would think that leaks would tend to flatten out the flow rate... no?  But the opposite is happening... with nasal mask and leaks, the flow rate is still there and seen as hypopneas... with the View mask and no leaks, the flow rate goes to zero and an apnea is logged.  Trying to understand why this is opposite what I would expect.

[SarcasticDave94]

IMO due to the high leak rate on the nasal mask chart, that throws out any hope of the machine giving useful therapy and accuracy in reporting is probably hindered to the point of not going to be helpful. Since you hide the OSCAR left panel details, I can't see some details of data or settings. Since you're dealing with a full face vs nasal, I'll make a guess you're probably mouth breathing or mouth leaking with a nasal mask, indicating if you don't use a full face, you'll need to add something to stop mouth breathing/leaks like taping, a chin strap like Knightsbridge, and/or a soft collar. Even so, you may find you must use full face. But again this is only a semi-educated guess.

[Sleeprider]

What a waste of time. ST machines are for people needing pressure support to overcome a respiratory insufficiency. Complex apnea is treated with ASV. Your results clearly show that PS 5 a 14 bpm rate is not working! Ask your doctor for the ASV titration. You have done your part to prove failure in the ST mode...now let's get something that has a reasonable prayer of working.

[vsheline]

... Complex apnea is treated with ASV.

In addition to being treated by ASV therapy mode, Complex Apneas can also be treated successfully by the AirCurve 10 ST-A machine in iVAPS mode.

The ResMed iVAPS therapy mode prevents CA in the same manner as the ResMed ASV therapy mode prevents CA:  the machine immediately (within a few seconds) increases Pressure Support as high as needed in order to maintain a target Minute Ventilation.

However, please note that the somewhat similar Philips DreamStation BiPAP AVAPS machines cannot treat CA, since the Philips AVAPS therapy mode reacts way too slowly, making only small adjustments to the Pressure Support every minute or so.