Help with settings to improve overly high AHI

[Jeffo1]

Hi!

I was diagnosed with OSA ten or twelve years ago when I had done a sleep study and I had been using a CPAPP consistently ever since. I did another sleep study in August 2015 and it was found that I had OSA, Complex SA, and CSA. I was prescribed a Respironics Bipap ST which brought my AHIs down from 78 to 20s+. It was better, but not great and I was still feeling tired in the mornings.

After another sleep study titration at the beginning of April 2016, it confirmed both OSA and CSA and my pulmonologist prescribed the PR System One Bipap Auto SV Advanced which I've been using since 5/11/16.

A short time, I know, but I was wondering if someone had any suggestions as to what I should tweak to try to improve the overly high AHIs. Attached are two screenshots from SH.

Thanks,

Jeffo1

(Overall)
(zoom)

[Sleeprider]

Start raising EPAP until OA is less than 3 of your AHI. At that point we can review, but right now your machine is not adequately preventing OA. I would leave PS and IPAP unchanged.

[tmoody]

Hey Jeffo, good to see you here.

As you know, I am using the same machine, for only a month or so longer than you. Looking at your data, I agree with Sleeprider. At this point, your OAs are not nearly well enough controlled to be thinking about centrals. Your EPAPmin of 5 seems very low. Your median EPAP value during the night is closer to 11. So bring that EPAPmin setting up gradually and see if the OAs go down first.

[Jeffo1]

Hi Sleeprider!

Thanks for the suggestion. I agree. I stopped by my pulmonologist/sleep doc today with the print out from SH, asking her if we could increase the EPAP.

Best,

jeffo1

[Jeffo1]

Hi tmoody!

Yes, I've been following in your footsteps and I remember earlier on that with your PR Bipap ASV Advanced you had wanted to change your pressures, as well.

As someone here at the AF recently said , Complex Sleep Apnea is challenging to treat. I get that - and an occasional 10 AHI is a lot better than 78!

How are you doing these days??

Best,

jeffo1

[tmoody]

Hi tmoody!

Yes, I've been following in your footsteps and I remember earlier on that with your PR Bipap ASV Advanced you had wanted to change your pressures, as well.

As someone here at the AF recently said , Complex Sleep Apnea is challenging to treat. I get that - and an occasional 10 AHI is a lot better than 78!

How are you doing these days??

Best,

jeffo1

I'm doing pretty well, thanks for asking. As I described on the other forum (and here), I'm more systematic in my approach than I was when I started out. I'm trying to maintain the discipline of changing one variable at a time and leaving it alone for at least a week before trying anything else. At the moment, my AHI is running around 2.8, usually with no centrals (but I had 3 of them last night!), and that's fine with me.

I also turned off Flex and went to Rise Time=1, which I seem to prefer. At some point I'll try other Rise Time settings, but again, I'm just doing one thing at a time. Even though Rise Time is a "comfort" setting, it's still a variable.

There's something else we need to keep in mind, however--especially those of us with complex apnea. The ASV really is a different kind of beast, compared to other PAP machines. It takes a while to get used to it, at any settings, I believe. Just like moving to a new location, with different ambient night noises, it takes a while for the brain to adapt to the machine's behavior. It could hardly be otherwise.

Since I've only been on ASV since March 22, I suspect I'm only now getting to the point of being adapted to it. Many improvements in AHI that I attribute to my tweaking of settings might have occurred anyway, just in the course of adaptation. I'll never know. On the other hand, some changes seemed to cause immediate and dramatic worsening of AHI, and I believe those were real effects.

But in your case, the OAs are the more immediate problem, and the first line of defense (or offense, if you like) should be to increase EPAPmin.

Since PS is essentially the "delta" of EPAP and IPAP, as you raise EPAPmin and leave PSmin alone, your IPAPmin will also increase. So you need to see what happens then. If your OAs go down and your CAs stay about the same, it's all good. If your OAs go down but your CAs go up, you might consider keeping EPAPmin at its new value but dropping PSmin.

There are many differences of opinion on this and other boards about how to set PSmin. I don't have any expertise, by a long shot. I only have some trial-and-error result of self-experimentation. In the long run, you'll need to do the same.

[vsheline]

Start raising EPAP until OA is less than 3 of your AHI. At that point we can review, but right now your machine is not adequately preventing OA. I would leave PS and IPAP unchanged.

Ditto.

I suggest not abandoning too early a strategy of gradually raising Min EPAP in order to reduce the number of OA and Hypopneas, even if it seems like the number of CA or OA or Hypopnea appears to have increased. The number of CA and OA and Hypopnea can vary a lot from night to night, for many reasons, and it is important to use weekly or biweekly averages when tracking the result of changes.

Continuing to raise the Min EPAP will always tend to reduce Obstructive apneas and obstructive hypopneas, but large short term fluctuations in our CAI, OAI and HI occur all the time and may fool us into prematurely abandoning the best strategy.

Take care,
--- Vaughn

[Jeffo1]

Hi!!

I spoke with my pulmonologist who recommended that I change my EPAP from 5 to 8 since my AHI was considerably high - 11 last night. My pulmonologist recommended that I go from 5 to 8 EPAP. Being quite anxious and following her direction, I adjusted it to 8 three nights ago and my AHI shot up to 14 the next day, so I tried going down to 6 the night after, and my AHI was 4.7. Better. Last night, I went up to 6.5 and my AHI was 11.

I've read hear that we should make changes slowly, like you had mentioned, so should I go back down to 6 or stay at 6.5 for the week?

Best,

jeffo1

For reference:

[tmoody]

I'd say leave it at six for a few days, since you did okay there. See if AHI stays low; give it at least five days. Then try 6.5. Try to commit to at least five days at a setting, unless it's a disaster. You need to give your brain time to adjust to the new setting.

[Jeffo1]

Thanks!