[Therapy Question] Helping Someone

[dracus]

My mom just got updated to a new Phillips Dream Station Auto BiBap from an ancient dumb brick of a cpap she's been using for years. I am working on getting a copy of her prescription and latest sleep study. I know she's got COPD and other health issues. Currently she's adding supplemental  O2 at the mask side.

Her sleep doctor is horribly hands off and I doubt he's looking at the data. I'd like to do everything I can to help optimize her therapy for the best. Subjectively, she says this is the first day she hasn't had to have a nap in years.

I know she has a dream station auto bipap machine. I have already got the clinical manual, set up sleepyhead, set up dream mapper for her, and turned on the AHI display which for some reason was turned off.

The machine is currently set up according to her prescription. I have not made any changes as I don't know enough about these settings and I only have one night of data. Here's what we've got so far.

Any thoughts, my only reference is myself and I'm used to seeing an AHI from 0 - .5 so this AHI was a bit alarming.

[Walla Walla]

I think a bump up on the minimum and maximum pressures would help with the obstructive events. But like you said it's only one chart so it might be wise to wait a few days. I wouldn't adjust the pressure support due to the fact of the COPD.

[dracus]

My initial question was to make sure nothing was crazy out of whack. 

I was going to get a week or so.

Sounds like her machine is setup reasonably to start. I advised her that her initial ramp from 5 was bit low and let me know of she's feeling starved for air at the beginning. 

This is roughly  twice her cpap pressure. 

Thanks Walla Walla

[Sleeprider]

Your mom is using fixed bilevel, and getting a lot of obstructive events. Since she has a BiPAP Auto, the machine could be doing the work of titration for you by changing settings from Mode BPAP-S To Bauto. Her current therapy is fixed at 21/15 (PS 6) To maintain her current therapy range, but allow some alternative pressures to be tried I would set mode to BAuto, EPAP min 15, EPAP max 18, PS min 5, PSmax 7, and IPAP max 25. The machine will adjust pressures within this range. These settings are not drastically different from her current setup, but may help her to cut some OA.

I suspect it has been a while since she was last titrated, and her COPD may have become worse. The suggested automatic settings will start close to her current pressure, but will allow EPAP to rise from 15 up to 18 cm. It is the EPAP that should help resolve OA. Your mom has a pretty low hypopnea index, so the suggested settings include her a pressure support 1-less than her current fixed setting. This may help with CA, but more PS is available in the settings if she needs more respiratory assist. She does not have flow limitations flagged, and her tidal and minute volumes look very good, so I think her current PS of 6 is working, and it is bracketed b the suggested range of 5-7. IPAP max is not really needed here. It is nothing more than a function of the EPAP max and PS max. You will need to monitor results to ensure changing settings has the desired result.

[Sleep2Snore]

I would get a couple more data readings at the value the machine is set for at the moment, then change it to how Sleeprider has suggested and see how it affects things.
I would have the machine do all the work as Sleeprider says and see how that affects her.
The fact she has not had to have a nap in the afternoon is an improvement.

Does not sound like the doctor is a very hands on doctor.
I hate it when doctors get mega bucks and do nothing to justify there money!

[dracus]

Thought I would give an update on this, now that I have some more data.

I have adjusted her settings to those suggested by Sleeprider. Her numbers are pretty consistently between 3-5 with half being OA.

Subjectively, her sleep has improved since the recent upgrade to the bipap. Her only complaint is she is occasionally bolting awake which I believe is consistent with the OA.

Here's a sampling of her charts in case anyone wants to add anything.

https://imgur.com/a/2xh37

Thanks, everyone for your awesome support..

[PaulaO2]

It looks like, from the leak graph, that she is opening her mouth while asleep. What mask does she use?

And she is still on single pressure bilevel? Not auto bilevel?

[Sleeprider]

My suggested settings were: "I would set mode to BAuto, EPAP min 15, EPAP max 18, PS min 5, PSmax 7, and IPAP max 25."

The graphs indicate you are using fixed BiPAP-S mode at EPAP 15, IPAP 21. I think you might find the higher pressure the auto mode would hit, might reduce some of those events.

[dracus]

These graphs  are based on her prescribed settings. I just changed it the automatic settings above.

I don't understand the leak data from these dream station machines. According to dream mapper her mask fit is perfect. She's using a Respironics ComfortGel Blue Nasal CPAP Mask.