Guess which machine I will get...

[Cruiser]

Hi everyone,

I am new to the PAP world.  I am in Ontario, Canada and was given a referral by my family doctor as I was getting a lot of headaches in the afternoon.  It turns out I had high blood pressure which is being treated by medicine currently.  I am heavy at about 285lbs, 33yo and my sleep doctor said I have a narrow throat at my first appointment.

Thus far, this is the process I have gone through:
1) First overnight sleep study with nasal prongs (see report below)
2) Given a temporary APAP + Airfit F10 FFM for 3 weeks - I had to give it back last friday and I miss it
3) Second sleep study with the FFM to titrate

Next step:
4) Back to see the doctor on Aug 16th (cannot come soon enough)

After the temp APAP, I still feel tired.  It is better - but I still need a nap on one day during the weekend vs. used to taking two before the APAP.  Aug 16th cannot come soon enough.

Now, I believe that I am headed for a bilevel iVAPS, or ST.  During my titration study, I know I woke up to a bipap, and when I stopped breathing for a second, it forced a breath.  Prior to that, I couldn't sleep, so I suspect the bilevel allowed me to sleep well.  I asked at the end whether it was bilevel, and he confirmed it was.  I also asked whether it was common to do so, and he said that it wasn't.  Reading up on things, it sounds like I may have OHS.

My wife has insurance, so I can get $3500 towards a unit.  I am also wondering if it would be good to get an S or VAUTO as part of the government program as a backup for $280.

So...some questions:
1) Would it make sense for an iVAPS or ST in my situation?
2) I don't seem to have many centrals, but would an ASV provide any benefits?
3) Would the S or VAUTO be more beneficial as a backup machine?
4) Any questions I should ask the doc?

           

[Crimson Nape]

Hi Cruiser -

Based off your charts, I don't see a Bi-level in your future. Some tweaking of your setup should prove successful.

One question though; Based off your starting pressure, do you feel like you are suffocating when you first turn it on?

[Gideon]

Do you have any underlying medical conditions?
The ST and IVAPS have a forced backup rate, the VAuto does not.
ST  COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
IVAPS COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions

See the below info and see what they are intended to treat.  Unless you have some medical condition that I am unaware of, the VAuto would be the machine of choice.
your pre-treatment Central levels are low enough that you shouldn't need the ASV.  Your nightly charts don't show a significant increase in Central Apnea.
I do see some RERAs and thus Flow Limitations that could benefit with a bi-level, though your results on the autoset look fine.

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

[Cruiser]

One question though; Based off your starting pressure, do you feel like you are suffocating when you first turn it on

Yes, it feels like there is no where near enough pressure.
It just seems weird at my titration sleep study that they had bilevel with breath support turned on.  They must have seen something during that study and I certainly do not feel rested when getting up from APAP.

[Gideon]

Based on your comments up your min pressure to 6

[Cruiser]

Do you have any underlying medical conditions?
The ST and IVAPS have a forced backup rate, the VAuto does not.
ST  COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
IVAPS COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions

I believe I may have OHS - I have all of the symptoms, and I am obese.  As mentioned, during the second sleep study, I woke up to bilevel with forced backup, so I suspect that they agree.  Nothing diagnosed prior to the sleep study though and I do feel lousy still after using the APAP.

I suspect my main machine will probably be an ST or IVAPS, but I can get an S or VAUTO for ~$280 through the provincial program, so I thought one of them may be good for a backup/when I occassionally travel (once or twice a year for 2-3 nights).   Right now, I am certainly suffering without anything.

[Crimson Nape]

Most people report that feeling until they increase the starting pressure to at least 7cmH₂O.  You can request a Clinician's Manual, located in the Member's Private Area, to see how to enter the setup menu to adjust the pressure.

Link (you must be logged in):  http://www.apneaboard.com/forums/Thread-...P-Pressure

[Gideon]

For you, on your first chart include these (everything that impacts pressure increases)

Events
Flow Rate
Flow Limits
Pressure (not Mask Pressure)
Leak Rate
Snores

Because of the OHS post a second "Advanced"  chart as follows (make them fit)
Events
Flow Rate
Minute Vent
Tidal Volume
Respiration Rate
Insp Time
Exp Time

On the second chart post the full night to provide context, plus a couple of 2 min zoomed segments that are sleeping (not near a break)
Maybe we will see something there.

[SarcasticDave94]

Hi Cruiser, welcome to the Apnea Board.

The fatigue issues will reverse itself with time under CPAP therapy. Helping to remedy this will be getting your machine set to the best possible pressure settings and whenever you’re issued a machine to be certain to use it consistently.

Do some research if you haven’t done so already, decide on your mask and machine brand. I’m not selling you on one brand of machine over another, but quite a few prefer the therapy ResMed provides and I’ve got this brand myself.

Any medical conditions that require a higher level machine will need medical documentation so keep that in mind as well.

You probably already know this above info, but just felt like pointing this out as a reminder. Best wishes for quick success.

[Cruiser]

For you, on your first chart include these (everything that impacts pressure increases)

Events
Flow Rate
Flow Limits
Pressure (not Mask Pressure)
Leak Rate
Snores

Because of the OHS post a second "Advanced"  chart as follows (make them fit)
Events
Flow Rate
Minute Vent
Tidal Volume
Respiration Rate
Insp Time
Exp Time

On the second chart post the full night to provide context, plus a couple of 2 min zoomed segments that are sleeping (not near a break)
Maybe we will see something there.

Taken from a different night:
       

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I will note that each night here, I didn't go on my back because it felt like I had a hurricane on my face when I did.  At the sleep study, they forced me to go on my back for a portion.