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High CA in PSG and with Bipap
#1
High CA in PSG and with Bipap
Hello All,

New Dreamstation/Brevida Bipap user.  Use Sleepyhead and Dreammapper.  Representative numbers are .68 OSA/hr, 4.10 Hyp/hr, 10.37 CA.   I had around 35 OSA and 35 CA in my PSG, so my doctor says that this is not bipap induced and he would not prescribe an ASV machine.  My pressure are about as low as you can go 8 in / 4 out.  I don't have pressure relief.  So, how to deal with CAs?  Hopefully, these will reduce with time.  It has only been one month.  The doctor says to ignore the CAs, which I find less than helpful.  I will share more data if I can figure out how.

Thanks,

Joe
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#2
RE: High CA in PSG and with Bipap
I would see another doctor, You had significant CA during the sleep study, you are failing the BPAP and may need a sleep study with the ASV or VAPS. Your doctor doesn't think these CA are pressure induced, This type can resolve within a few months. So I'm at a loss to why he is waiting.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: High CA in PSG and with Bipap
Certainly others can correct me, but isn't a central count equal or greater than obstructive indicative of at least investigating ASV? As for me, on my BiPAP PSG it was very heavy central of 124 to 24 obstructive.

Dave B.
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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#4
RE: High CA in PSG and with Bipap
Hi J Duffy,
WELCOME to the forum.!
Hang in there for more answers to your questions and good luck with CPAP therapy.
trish6hundred
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#5
RE: High CA in PSG and with Bipap
We have had members come to the forum and resolve central apnea to an acceptable level using relatively low pressures and avoiding bilevel pressure or EPR, and some have moved on to use an adaptive servo ventilator (ASV), which is meant to treat CA as well as periodic breathing, hypopnea and flow limitation.

In your post your said your pressure is going as low as it can go at 8 IPAP and 4 EPAP. That is bilevel pressure and is a pressure support (PS) of 4. That difference in pressure can be removed in settings, and in fact your machine is capable of CPAP pressure or auto CPAP pressures. The question is, why are you on BiPAP? Did your previously fail CPAP? Perhaps your doctor is still evaluating whether to move you to ASV. Anyway, if you want to resolve these CA event, I think we can help you find some settings with less pressure support, or no pressure support that may help.

Download #Sleepyhead and post a chart. The instructions are in the first two links in my signature. That will give us an ideal of what is going on as well as the settings you are using. The collective has been pretty good at helping new members to get better results, or move toward a more appropriate therapy.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#6
RE: High CA in PSG and with Bipap
(10-20-2017, 04:39 PM)SarcasticDave94 Wrote: Certainly others can correct me, but isn't a central count equal or greater than obstructive indicative of at least investigating ASV? As for me, on my BiPAP PSG it was very heavy central of 124 to 24 obstructive.

Dave B.

Come on Dave,  we are talking about the SYSTEM here,  you didn't actually expect something yo happen, did you?  After all it took you like forever to get thru that ASV battle.


That said J Duffy,  Post your daily charts from sleepyhead, and post your report from your sleep study.  That will give us something to advise you on.  See my sig nature for how to do this and pay attention to organization (which charts to post).  And 1 more change, Untill you reach "Member" status (after 3 posts)  add a space to your URL like this, 
"htt p://IMGUR.com/xxxxxx.png"
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#7
RE: High CA in PSG and with Bipap
Yeah I know bonjour. What makes sense to us commoners may not make sense to: politicians, doctors, DME offices, and maybe lawyers...

Do not disturb, Dave is disturbed already and he's not in the office but in the Dunkin Donuts drinking coffee...

Coffee And J Duffy best wishes on success with silly Duck Dr. Shenanigans.

Dave B
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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#8
RE: High CA in PSG and with Bipap
Apparently I need to post 4 stupid posts before I can post data...

Have I posted enough yet?
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#9
RE: High CA in PSG and with Bipap
http s://i.imgur.com/MaqmAvs.png
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#10
RE: High CA in PSG and with Bipap
You have reached full member status and can link and post images now.  Here is what you posted above.  With EPAP min 4.0 and PS 4.0-8.0, IPAP max 14 you are having mostly central apnea and hypopnea.  In my experience, the high level of centrals is a product of your PS being too high.  The PS range in this chart is mostly 4-5 cm and I think you would do much better with EPAP min 4.0 and PS 2-4 cm.   We may need to make some other adjustments if this is not comfortable or if OA and hypopnea persist.  The relatively low EPAP seems to be sufficient to prevent most OA events (you had only 2), and there is very little snoring.  We may end up increasing EPAP to 5 or 6, but I think you need much less pressure support on your minimum exhalation pressure. 

On future charts, it would help if you minimize the monthly calendar by clicking the triangle in the date line, and turn off pie charts in File/Preferences/Appearance.

[Image: MaqmAvs.png]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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