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Changed from Cpap to BipapASV and always tired
#1
I have been on Cpap for about 20 years for Complex/Obstructive Apnea, the last 7 or 8 years at a setting of 15. It was working well for me but I started to feel less rested about 7 months ago.
I am fairly new to Medicare so I had to have a new sleep study for Medicare in order to start getting my supplies. The study recommendation was to move to a Bipap.
I have also been suffering with severe sinus problems for many years and had seen about a dozen ENT's over the years and finally found a new ENT that knew what he was doing, he tested in many new ways that had never been done in the past.
He told me I had a deviated septum on both sides, 85% blockage in the left & 90% blockage in the right. He did surgery and I can now breath like I never knew was possible. I had to stop using CPAP for about 2 weeks after, I sat up in my recliner every night and actually slept without the Cpap, not great but was not miserable.
So the ENT ordered me a Respironics Bipap ASV (DS960) and changed me to a full face mask. I have felt extremely tired all of the time and take a nap almost every day but that does not help. My AHI is 18 or so and back on the Cpap it was 4.3, big change.
My settings according to the paperwork are:
IPAP Max 20 & min 13
EPAP Max 10 & min 5
PS 10
PS min 5
Backup rate Auto
------------------------------
14_cm H20 min IPAP 6_cm H20 min EPAP

Bipap is so new to me that I have not even tried to verify that the unit is set correct. I could really use some advice, it has been almost 3 months since I have had a good restful sleep.
I go back to see him in 2 weeks.
Thanks
David
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#2
are you using sleepyhead or encore to read the data? if not, you should, otherwise, you're just guessing at where the problems are coming from.
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#3
(07-16-2014, 02:46 PM)diamaunt Wrote: are you using sleepyhead or encore to read the data? if not, you should, otherwise, you're just guessing at where the problems are coming from.

Yes, I am using SleepyHead which just recently started to read the data correctly from the DS960, both Encore Basic & Pro2 as well as SleepMapper. I also Used Rescan for my S9 and still have it setup so that I can access the old data.
I do not understand most of the data in the reports and had always just checked the AHI for the most part.
I will try to post some of the reports later in the day after a Pain Dr. appointment. Just let me know what info you think I should post.
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#4
Hi dgalvin66,
WELCOME! to the forum.!
I'm not sure what graphs that you should post to help you but hang in there, I know someone will know how to guide you through all of this.
Hang in there for more answers to your questions and Best of luckk to you as you continue on your CPAP journey.
trish6hundred
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#5
(07-16-2014, 03:01 PM)dgalvin66 Wrote: Yes, I am using SleepyHead which just recently started to read the data correctly from the DS960, both Encore Basic & Pro2 as well as SleepMapper. I also Used Rescan for my S9 and still have it setup so that I can access the old data.
I do not understand most of the data in the reports and had always just checked the AHI for the most part.
I will try to post some of the reports later in the day after a Pain Dr. appointment. Just let me know what info you think I should post.

I suggest starting with robysue's new work in progress guide to sleepyhead:
http://www.apneaboard.com/forums/Thread-...2#pid73182
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#6
Thanks for the link. I bookmarked it and also created a PDF file of all of it so that I can read it on my tablet or laptop if I do not have internet where I am at the time.
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#7
(07-16-2014, 01:42 PM)dgalvin66 Wrote: I have been on Cpap for about 20 years for Complex/Obstructive Apnea, the last 7 or 8 years at a setting of 15. It was working well for me but I started to feel less rested about 7 months ago. ...
So the ENT ordered me a Respironics Bipap ASV (DS960) and changed me to a full face mask. I have felt extremely tired all of the time and take a nap almost every day but that does not help. My AHI is 18 or so and back on the Cpap it was 4.3, big change.
My settings according to the paperwork are:
IPAP Max 20 & min 13
EPAP Max 10 & min 5
PS 10
PS min 5
Backup rate Auto
------------------------------
14_cm H20 min IPAP 6_cm H20 min EPAP

There are two conflicting sets of settings. Above the dashed line it says EPAP min is 5 and PS min is 5, which would make IPAP min = 10. (EPAP min plus PS min equals IPAP min.) But below the dashed line it seems to say IPAP min is 14 and EPAP min is 6, which may mean PS min was 8 (which would be pretty high for PS min)?

Your AHI is large (18) and your EPAP min is a lot smaller than your old CPAP fixed pressure setting of 15 which had been working pretty well at preventing obstructive events.

I suggest you ask your doctor to look closely at the waveform Flow data on your SD card to see if there are signs that the EPAP Min pressure is inadequate for you and needs to be raised closer to 15 (such as 10 or higher). Your doctor would also raise the IPAP Max setting if he raised the EPAP Min setting.

If the waveform of the airflow out of your lungs during exhalation (which is the negative portions of the Flow waveform) shows jerky or "stop and go" shape instead of a smooth and monotonically changing waveform, this would indicate there is obstruction occurring at the low EPAP pressure. If the EPAP pressure is too low and is allowing obstructions to occur you would have problems exhaling freely, and this would lower at least partially the tidal volume (Vt), which is the volume of air you are inhaling or exhaling in each breath.

I suggest you look closely (meaning, "zoomed in" until 30 minutes or 10 minutes or 5 minutes fills the screen) at the Mask Pressure, Leak, Flow, Tidal Volume and Flow Limitation waveforms near the times of your AHI events, and ask questions from the forum about that the data may indicate.

Are your AHI events mostly obstructive apneas, clear airway apneas, or hypopneas?

I suggest you call the doctor's office to ask if you should drop off the SD card the day before your appointment, so your doctor would have time to study it before your appointment. May also help to drop off SleepyHead reports at the same time, with the waveforms zoomed in to show something interesting. If your doctor turns out to be unwilling or unable to look closely at your Flow waveforms and figure out what the problems may be, then I suggest you should consider changing doctors. There are good ones out there.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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