(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 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.