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Help needed please
#1
Question 
Help needed please
Hi,
    Two months ago diagnosed with severe sleep apnea AHI > 60.   Been using a ResMed Airsense 10 Autoset for about 6 weeks.  Just got results from titration test and doctor is recommending a bipap (ipap 20, epap 13) machine.  Going to pick up the test results tomorrow.  Based on the following Autoset results do you think a bipap is needed?  I feel so much better on the current machine, but the numbers are not great.  Thanks.

Craig


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#2
RE: Help needed please
First, Craig welcome to the forum!

The people here are excellent. They've helped me so much. I'm new to apap and their help made all the difference.

I don't have their skill, yet!
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#3
RE: Help needed please
A PS of 7, what you stated above is unusual. I'd like to see the sleep test. Did your doc say why a BiLevel?

The second chart has a lot of chin tucking which is driving your AHI up. Read the link on a Soft Cervical collar in my signature is seeing the clusters of OA events is common for you.

In addition, you have a lot of flow limits, Increase your EPR to 3 (EPR =3) to help resolve this.

You posted nothing about how you feel which would help to determine if you need a BiLevel. That said a BiLevel with PS above 3 could help with your flow limits.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#4
RE: Help needed please
Yes the aircurve will help. It has PS up to 25 at .2 increases. It will help with the hypopneas which you have a lot of.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: Help needed please
Just to clarify.  The first chart 11/16/20 with the lower AHI (3.71)had EPR set to 2.  The next night 11/17/20 I upped the EPR to 3, upped min by 1, max by 2, and added a cervical collar.  The result a far worse night of sleep and an AHI of 8.31  Yeah I know to many changes all at once.  I would justify it by saying I was trying to keep the min exhale rate constant at 9.  In general I would say that good nights with AHI of 3 to 5, I feel great the next day. Bad nights with AHI of 8 to 12.  I don't feel as good, but still better than pre CPAP.  Thanks.

Craig
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#6
RE: Help needed please
Given that you tend to run higher pressures, maybe that's why doc wants you on BPAP. As noted it would be good to see the sleep study report. If you find out which PAP exactly you're getting according to doc do let us know. Hope it's not an ST...
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Help needed please
Attached are the results from last night.  I went back to the settings from the 16th, and only changed EPR from 2 to 3.  Also no cervical collar last night.  I want to get a night or 2 of data without it before I try it again.  Thanks everyone.

Craig


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#8
RE: Help needed please
You have very high flow limitation even while using an EPR of 3.  The FL is driving your pressure to max.

If you were using a BiLevel, you could possibly enjoy a lower pressure while using a higher PS. This would likely clear up Flow Limitation.  If you have an opportunity to try a ResMed AirCurve VAuto, don't pass it up.  

As you are aware, the Obstructives are positional. Try a different size or style collar, and be sure your pillow isn't too high. That can cause your chin to tuck into your chest regardless if you sleep on your side or back.

Of course, how you feel in the morning is key.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Help needed please
I picked up my sleep study and titration report from my family doctor this morning.  I will attach them below.  It looks like they are just summaries.  I suspect that any detail reports were not passed from the sleep lab to my family doctor.  The whole process has been pretty weird.  Any questions I have had, I have to call the receptionist at my family doctor, who passes the info to the doctor's nurse.  Who may ask the doctor my question.  The nurse then calls me back.  If I miss the call, then I have to call the receptionist again, and leave a message for the nurse to call me back again.  I hope this is just a side affect of the current pandemic, and not how things are going to always be.  Thanks.

Craig


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#10
RE: Help needed please
You're correct on the assumption that these are summaries. Detailed versions have several pages. If at all possible request them for your records. FWIW the answer to the request you don't need them or we don't need to give you copies goes against HIPAA which says you may obtain these.

With clusters present, the collar is necessary. And as OpalRose mentions, the FL still being present indicate the BPAP and the higher PS settings found there sounds like it will be needed for proper treatment and comfort.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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