Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

BiPAP ST to ASV - Optimizing
#1
BiPAP ST to ASV - Optimizing
Hi - So after my sleep study showed though I was having central and obstructive apnea I was prescribed a BiPAP ST with a pressure of 20/16 - We have since adjusted it to 16/10. 

I have had a few really good nights showing AHI <1 but most nights I've been around 4-10.  Now I'm showing a lot of unclassified and hypopnea. My suspicion is they correlate with the mask leaks (nasal pillows with chin strap)

Can someone take a look at my Oscar chart and see if there are any recommendations you can make?  The difference in daytime drowsiness between getting a <1 and a 5 AHI is vast.


Attached Files Thumbnail(s)
   
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: BiPAP ST - almost there - please help
I saw your other thread with the ResMed ST, and if I'd have come across the other thread, I'd have mentioned you likely need ASV. First, you'll need an ASV titration, second you'll need to exchange the ST machine for the ResMed ASV.

A few questions about the ST machine and your path to therapy. Your diagnosic was posted on the other thread.

Was this a home study or a lab?
Did you wear a wide Velcro belt across your chest? This is referred to as an respiratory effort belt.
Do you have other medical conditions, like heart or lung disease?

Your answers help tell us if ASV will actually be a good choice.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#3
RE: BiPAP ST - almost there - please help
That thread is what prompted me to request an ASV titration. 

The pulmonologist basically said that the path insurance will approve is to do a regular titration. 

I did an in lab sleep study.  I had stuff strapped to my head and chest. 

The result was that I needed a BiPAP ST but they never actually tested me for an ASV.

Ive brought up the ASV to the respiratory therapist and they basically said in order to get one , I have to fail at using the BiPAP first, then do another study, then get an ASV.  

Anyways, we have gotten the BiPAP ST to get my AHI under 1.0 so I feel like this should work.
Post Reply Post Reply
#4
RE: BiPAP ST - almost there - please help
A 10 minute zoomed view of the UA please. I suspected CA but let's check for sure. I'm off to find your other thread. You should always keep your therapy posts together. Dave's comment makes me suspect CA even stronger. If so you have 3 paths

1. Decrease PS to avoid the CA/UA
2. Significantly increase the PS to treat the CA
3. Get an ASV to treat the CA. This machine is designed to treat CA/OA combos.

An ST is very appropriate if you have significant pulmonary conditions such as COPD, CHF, and others.
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: BiPAP ST - almost there - please help
here you go. 

I don't have any significant pulmonary issues.  My main issue is excessive daytime sleepiness, brain fog, etc. 

Originally I had an AHI of 20 at the at home test and was diagnosed with obstructive. 

did the APAP for 6 months and I was having centrals ...

Now Im on BiPAP - I have had a few nights where its been totally treated and my AHI was like. 7.  Other nights are like this one.


Attached Files Thumbnail(s)
   
Post Reply Post Reply
#6
RE: BiPAP ST - almost there - please help
Here is my old thread.

In the future, Ill keep this stuff all together.

http://www.apneaboard.com/forums/Thread-...a-included
Post Reply Post Reply
#7
RE: BiPAP ST - almost there - please help
Your mode is ST what is your backup rate?

Only after the last UA is there an indication of CO2 induced breathing resulting from excessive flushing of CO2 (typical of treatment emergent central Apnea. The rest look ideopathic, not obstructive because there is no larger recovery breath.
A 10 minute view toward the start of the UA showing the transition please
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: BiPAP ST - almost there - please help
backup rate is currently 9

here is the 10 min zoom where the UA starts


Attached Files Thumbnail(s)
   
Post Reply Post Reply
#9
RE: BiPAP ST - almost there - please help
My take on the UA is that they are ideopathic central Apneas

Look at 1:48:00 to 1:48:30 approximately.

See the taller breaths, those are the timed backup breaths, see the very much smaller breaths between them, those are you trying to take a breath without the machine's help. Show these two 10 minute segments to your doc, tell him this just isn't working for me. What can be done. Can we set up an ASV titration. Trial to see if that does a better job.

Note the plural pronoun to indicate you are in this with him.

I want your doc to correct this or attempt to and push a bit for the ASV.

I would try 2 changes
1. Set PS = 5, with intent to increase more.
2. Set backup rate = 10

An ASV sets an minute vent target to a 90 second average then adjusts PS on the current breath to hit that. Backup rate is again set automatically based on your recent history. It doesn't mis Apneas,especially central Apnea
Post Reply Post Reply
#10
RE: BiPAP ST - almost there - please help
Thanks for the help.  I will push the RT and the doctor for a trail on an ASV. 

In the meantime, I can change the backup rate to 10.   What do you mean by change the PS to 5?

Here is a screen shot of Saturday night where it worked really well and I got a 0.49.  This 6 hour stretch of sleep had me more refreshed than most other 8-10 hour nights.


Attached Files Thumbnail(s)
   
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
Question Philips Respironics BIPAP A30 vs A30-S roberts 0 62 09-26-2021, 01:14 PM
Last Post: roberts
  Help with optimizing PAP for 85-year-old QuestionableQuerant 21 453 09-22-2021, 01:20 PM
Last Post: QuestionableQuerant
Question [Equipment] Bipap with no ventilation advice dragonboyc 14 226 09-14-2021, 02:56 AM
Last Post: TassieDevil Tamar
  BiPAP pressures at maximum Chalkie 15 358 09-12-2021, 07:02 AM
Last Post: Chalkie
  Need help with asking for BiPAP from doctor. blancobonzo 11 217 09-08-2021, 07:40 AM
Last Post: Sleeprider
  Self Titration of a Bipap help? Zoltyzolt 1 117 08-30-2021, 07:52 AM
Last Post: Sleeprider
  Can I Make My Resmed ASV act like a Bipap? FormerSnoreGremlin 1 143 08-28-2021, 03:54 AM
Last Post: SarcasticDave94


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.