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Dreamstation Auto BIPAP
#11
Leak rate is good. Philips machines calculate both total leak and excess leak, and your results are great.

For some reason, your doctor is moving towards ASV, and you may want to discuss any concerns with him to see if he disagrees with making some changes. That said, this is what I see. You have a mixture of OA and CA events. I would setup the machine a bit differently to deal with both issues. Your current settings are 16/11 (PS=5.0). If you want to try auto BiPAP, then I would set EPAPmin to 11.0, IPAP max to 18, PSmin 3.0, PSmax 5.0. And I might even reduce PSmin to 2.0.

Here's why: Your obstructive events are triggering with flow limitation and snores. So OSA is clearly a component of your sleep architecture. The solution to resolving OA is higher EPAP pressure. By setting the EPAPmin at your current fixed BiPAP level, you will start from the same place, but the machine will detect precursors of OA and increase EPAP pressure as needed. A lower PS may help reduce CA events. Pressure support helps reduce hypopnea and RERA, but it is not able to resolve CA in a non-ASV machine. That's because IPAP pressure has to be triggered by your initiation of an inhale, and the IPAP pressure support is not high enough to cause an involuntary breath anyway. So reducing PSmin to 2-3 may improve CA by limiting CO2 washout, and in any event, it won't make it worse. If you see an increase in H, then try more PS. The auto settings will allow EPAP to move up to as high as 16 if needed, but most likely, you just need a couple cm additional pressure during the OA episodes that may be sleep position or sleep stage related. That's my 2-cents, if you want to optimize the bilevel. From your graphs, I don't see a compelling argument for ASV yet.
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#12
Still waiting for response from Doctor

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