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BiPAP not working for CA
#1
BiPAP not working for CA
Hi - After going through a CPAP (Airsense 11) and BiPAP(Airwave 10) my CA is still not under control at 11 -20 events/hour. The BiPAP titration technician claimed to completely eliminate my CA with the BiPAP but this is not the case at home.  My CA events tend to cluster so his results may have been coincidental.  My sleep specialist wants me on an ASV but insurance won't cover because of the BiPAP titration result claim.  So I still awake with headaches and fatigue during the day.

Don't know if the doctor can override the titration results or order another titration test. Frustrating.

Settings 
IPAP 12
EPAP 8

Thanks!


Paul
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#2
RE: BiPAP not working for CA
Clarification please, what is Airwave 10? Brand and model.
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#3
RE: BiPAP not working for CA
Sorry - Its Resmed  Airsense 11 CPAP and  Resmed Aircurve 10 BiPAP
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#4
RE: BiPAP not working for CA
CA events tend to be difficult to diagnose with titration studies as they are often intermittent in some individuals. Clearly, we could help much more if you would grace us with a daily detail chart so we can see the pattern, frequency and types of events, as ell as pressure and settings. If the problem is mild to moderate, we may be able to resolve it with some machine tweaks that even most pros don't know about.he re

Your machine data is recording the events, and you should be able to discuss them with your doctor to over-ride the titration. A titration is simply a trial and error or observation of the results of different pressures and a successful titration is the absence or low-frequency of events over a relatively sort period of sleep time. It is not infallible. If you wish to post the results of your sleep study titration with personal information redacted, we can help you to interpret the results so you can better discuss them with your doctor. In many cases where titration appears to be successful in titrating CA events, the results are non-linear and nonsensical.
Sleeprider
Apnea Board Moderator
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#5
RE: BiPAP not working for CA
Thanks, will post images of the OSCAR data.  Yes my CA is intermittent throughout the night so when the sleep tech claimed he was able to resolve all CA events, I was very skeptical.  Trouble is, his conclusions may now prevent me from accessing the appropriate device. Hope your suggestions can help.

Paul
Thanks
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#6
RE: BiPAP not working for CA
I don't have my titration study yet but have attached a screenshot of OSCAR display using settings provided from the BiPAP titration sleep study.  I will contact my sleep specialist today and post titration study if he will provide.


Attached Files Thumbnail(s)
   
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#7
RE: BiPAP not working for CA
As I said before, results like this should be sufficient for your doctor to see the titration missed something. The detailed results and recommendations from your titration study, a.k.a. the complete study report is a medical record and must be provided to you upon request under HIPAA. Reasonable copying costs should be the only issue, but when a lab gets $4K for a study, that's just greed.

Leaks may be a factor in these results, however you have AHI over 16 which make me suspect you will need the ASV. I strongly suspect the OA events are actually centrals due to the complete lack of flow limitations. The shape of the leaks suggest you are losing air through your mouth rather than by a mask interface leak. What I want you to try for now is to reduce the pressure support to 3.0 and set the Trigger Sensitivity setting to high. I think this should cut events in half, but won't know until you try it. If we're going to use BiPAP S mode, that will be EPAP 8.0, IPAP 11.0, Trigger Sensitivity high. I'd like to see a 3-minute zoom of this data from 03:18 to 03:21 if you can do that, and instead of pressure use the mask pressure graph. This zoom will feature mostly your sleep respiration at a time of low-leaks and prior to the onset of a cluster of events, and gives us insight into your normal respiration wave.
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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#8
RE: BiPAP not working for CA
OK. Attached. I don't think it will be an issue with getting my report.  They really should post it on the portal.
The sleep test tech wanted me to use a full face mask as he used during the test.  I didn't see any improvement  when I did that at home and preferred the nasal pillows for comfort.


Attached Files Thumbnail(s)
   
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#9
RE: BiPAP not working for CA
Seems odd that when the leak rate jumps, the CA events seem to stop in many instances.
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#10
RE: BiPAP not working for CA
Zoomed shot shows a typical reduction of respiratory effort leading into a CA event followed by recovery breathing ahead of a second event. I think if we ere to look at the clusters, we would see that repeated in quick succession through the cluster. These apnea are long enough to build up a CO2 surplus and trigger a pretty good jolt of adrenaline. Two breaths at 3:18:15-20 show an extended exhale that almost tries to be apnea. The flow rate chart is easier if you right-click on the Y-axis near the chart title and add a dotted line at zero.
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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