BiPAP not working for CA

[PSlebow]

I will try the lower support 8-11 tonight. Will see if any change.  I switched back to my newer AirSense 11 which I actually already set to 8-11 since it has a pressure support up to 3. Not sure if that is the same as the AirCurve 10 biPAP response.  I put the dotted line in. Much easier to read.

[Sleeprider]

The Aircurve 10 Vauto and VPAP S have inspiratory timing and trigger/cycle controls. While I expect that lower PS will help, I want you to use the high trigger sensitivity which has worked to reduce CA events for many members. It is the one tool we have without a backup rate to really affect CA because it triggers IPAP with less inspiratory effort and often results in a spontaneous breath. Note on the last chart how events are preceeded by hyperventilation. ASV does ensure that you get a breath by triggeriing pressure support to cause a breath, provided your airway is open. While bilevel does not do the job of ASV, the higher trigger sensitivity can stimulate a breath in some individuals. You did a great job on the charts...you're a natural.

[PSlebow]

On the Resmed AirCurve 10 the sensitivity goes "Very low, low, medium, high ,very high". I assume I should start with "very high".

[Sleeprider]

I often advise people to step up the trigger sensitivity one increment at a time so we can observe the results of high, then very-high. If you are in a patient mood, that would be my advise. Changing to high is a pretty significant change in feel, but very-high is a big change in feel.

[PSlebow]

Got it.  Earlier posts claimed that very high can feel unstable by overcorrecting.  I'll start with high.

[Gideon]

FYI I am following and do support Sleeprider 's suggestions.

[PSlebow]

[PSlebow]

3 days with suggested BIPAP setting trigger sensitivity to "high". See significant improvement but is waning.
Night 1 CA=2.43/hr
Night 2 CA= 3.56
Night 3 CA= 6.44
Used Oxiring third night and O2 drops coincide with CA events.
I've seen this "adaptation" before where a change will make a significant improvement and slowly get worse. Probably need more data. Will see how things go after a week.

[Sleeprider]

Go ahead and move trigger to very high and see what we get. The Vauto is not really intended to treat central apnea, and trigger is the best tool we have.

[PSlebow]

So I waited a week using the suggested new settings from 8 - 12 change to  8 -  11 with Trigger changed from medium to high. Significant reduction in CA for the most part.  There are many high leak events but there are no CA's during them. CA's seem to cluster just after a high leak event resolves.

10-day Total/CA events

2.4/2.28, 3.56/2.77, 6.44/4.22, 4.4/3.9, 4.55/3.61, 6.63/4.93, 2.95/2.50, 4.75/3.08, 7.46/5.39, 3.32/3.00


Any more tweaks to suggest?

Thanks very much