Bi-Level, S, ST, ASV??

[jtech1]

If I am correct:
   If these are obstructive, increasing epap will help.
   If these are central, reducing pressure support should help.

So changing 16/7 to 15/8 should show some improvement if this is correct, right?

During titration study they did not follow resmed guidelines, jumped to pressures haphazardly and spent less than a minute at some settings.

These seem to occur after exhale. Is that typical of all apnea’s, central and obstructive?  Without timed mode, the st will not transition to ipap unless it senses SOME inspiration right?

[Sleeprider]

I have a high level of confidence these are central apnea, and I would have the same with a PS of 9.0 cm and no backup rate. I think you should turn on the ST mode and set the BPM to your normal respiration rate minus 2 BPM. As serious as the apnea is, You might want to just call the doctor and get this worked out. You did far better on CPAP, and perhaps you should just set the pressure back to what worked best in CPAP until you can talk to the doctor.

[jaswilliams]

These seem to occur after exhale. Is that typical of all apnea’s, central and obstructive?  Without timed mode, the st will not transition to ipap unless it senses SOME inspiration right?

Correct the Resmed does not transition to Ipap  without an attempt to breath when not in timed mode

[jtech1]

This is not my treatment. It is my fathers. He was not on Cpap at all prior to this. His untreated ahi from sleep study was 67.  I can never get to the dr on a business day let alone weekend. But I am going to contact them Monday or go to office since I am sure they will not look at numbers for 30 days until follow up appt. Resmed MyView is ridiculous!  It is weighted towards hours used and not successful treatment.  This Aircurve should function as a regular cpAp with EPR if pressures are set with gap of 2-3 between iPAP and EPAP right?

[jaswilliams]

This is not my treatment. It is my fathers. He was not on Cpap at all prior to this. His untreated ahi from sleep study was 67.  I can never get to the dr on a business day let alone weekend. But I am going to contact them Monday or go to office since I am sure they will not look at numbers for 30 days until follow up appt. Resmed MyView is ridiculous!  It is weighted towards hours used and not successful treatment.  This Aircurve should function as a regular cpAp with EPR if pressures are set with gap of 2-3 between iPAP and EPAP right?

Absolutely.


Let’s start with more normal settings

Keep the epap at 7 and set ipap at 10 and that is an equivalent setting of a fixed pressure machine with a fixed pressure of 10 and an EPR of 3, if that’s what your attempting.

I don’t know what that will do to the numbers and with this machine it’s a shame we cant see the type of Apnoea as that would allow us to understand if more EPAP was required or other things.


Did you post the sleep study here ?

[Sleeprider]

If you want to simulate a CPAP with EPR, than an EPAP of 7.0 and IPAP of 9.0 or 10.0 would be equivalent to CPAP at 9 or 10 with EPR 2 or 3. I think your dad need the ST mode on. If you just leave the settings at 16/7.0 in ST mode with BPM set to 12, he will get timed IPAP trigger. The safest bet is to move back to CPAP until you can discuss with the doctor. It's safe to say 16/7 without backup is non-functional to dangerous.

[jaswilliams]

I just found the sleep study’s and the results last night are not a surprise based on the first titration study there is no answer without a backup rate, if the numbers in the first titration study are correct your dad did very well having an AHI as low as 34 !!!!


The backup rate is required and will have no effect without the PS of 9.


I am really reluctant to make any recommendations other than enabling the backup rate, your Dad’s numbers are a challenge and I wish an ASV had been prescribed, but I can understand why it was not.

For others the sleep study results can be found here http://www.apneaboard.com/forums/Thread-...#pid318678

[Sleeprider]

Jaswilliams, I just can't comprehend why any doctor would prescribe 16/7 without a backup rate. This was predictable and inevitable, and I can't help but think that someone transcribed the prescription incorrectly to leave off the backup. Once thing is certain, crap like this is far more hazardous to health than using a modern ASV at default settings.

[jtech1]

The backup rate is required and will have no effect without the PS of 9.

Are you saying that when backup rate is used it is standard to also use the higher pressure support levels?
I am inclined to just have him stop use today and tomorrow and be at the Dr office Monday morning with the SD card and OSCAR print outs.  As I said, the O2 levels seem to be better, even with the treatment at 37 UA/hr... but, I am concerned about the length of some of the apneas... out of 295 the first night I count:
     129 >= 30 sec
     15 >= 60 sec
     1 >= 90 sec
Second night, 220 events:
     116 >= 30 sec
     10 >= 60 sec
     4 >= 90 sec
Although, this may be his normal duration even off treatment... not sure, since the sleep study printout is crap and does not give that detail.
Do most people usually not have apneas of any type longer than 1 minute?  Or is it something most people have?

[Sleeprider]

He needs the backup rate. I do not know of any individual using PS 9.0 without a backup rate. This level of pressure support always will cause hypocapnea and the resultant central apnea. If you setup the machine in ST mode and let him do a short test of it with 12 BPM, you should see a significant difference. This prescription was an error. The CPAP and BiPAP titration do not show a useful result at any pressure, and the 16/7 over 227 minutes was a fluke. I would honestly make this an emergency call and try to get the doctor to look at it over the weekend. This is a lot of stress for someone with CHF.