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More help needed with BiPap centrals and obstructive apnea
#1
More help needed with BiPap centrals and obstructive apnea
                I have appreciated all the help I needed to reduce my centrals on a bipap.  My original settings were 11-25 with a PS of 3.  I am now at 8 -12 with a PS of 1.  I've done really well on that until the last couple of months or so.  Most nights I have an AHI under 5 with mostly centrals and a couple of hypopnea.  Then, a couple nights a week, I end up with back to back obstructive apneas that last anywhere from 30-75 seconds each.  This goes on for about 1/2 hour.  I am guessing I'm on my back at that time, which I try hard to lay on my side all the time, because it does make a difference.  My original sleep study was 2 centrals an hour, and 2 obstructive apneas an hour, but over 50 hypopneas an hour.  As soon as they started the bipap machine, they noticed an increase in centrals, and that was a real problem until I followed Sleeprider's suggestions, and reduced the settings.  

At one point I qualified for an ASV machine, but I no longer do, as the centrals have decreased most nights.  

So, I'd like some advice, here;  do I up my IPAP or EPAP to eliminate the Obstructive Apneas?  Do I call it "good" most nights, and just work at not sleeping on my back?  I have posted some good nights, and some not good nights.  I know they have the calendar and the other stuff I'm supposed to eliminate, but maybe you could give me some advice, here?

I guess I only got one bad night posted for May 12, the other nights are all a duplicate from September.  Very sorry!  I will try to post some good nights and bad nights later today. Oh-jeez
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#2
RE: More help needed with BiPap centrals and obstructive apnea
Larry
Have you tried a soft cervical collar to control the OA's? If you are tucking your chin it can cause the OA's and the collar will prevent chin tucking. You can get them at local pharmacy as well as amazon.
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#3
RE: More help needed with BiPap centrals and obstructive apnea
There was always the chance that centrals would return and that ASV would again need to be considered. You say you once qualified for ASV, and I don't think that has changed. The fact that lower, more stable pressures allowed you to achieve efficacy for a period of time is a strategy, not a cure.

It's always a question whether the events being recorded are correctly characterized. It's going to be a little bit like last time, where we tried lower pressure and it worked. You certainly don't need more pressure support, and I'm going to go with what worked last time; a gradual reduction of IPAP max. Your worst results are still when pressure rises above a threshold that triggers CA, and I'm not so certain that the big cluster of OA is actually OA. Take the maximum down to 11.0 and let's see where that takes us.
Sleeprider
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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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#4
RE: More help needed with BiPap centrals and obstructive apnea
[attachment=5845][attachment=5843][attachment=5843]I did try to lower the setting to 8/11 with PS of 1, and that worked well for the most part, but the "cluster" OA's kept coming up, so after looking at the data, I moved it back to 8/12.  I am wondering if I should raise it to 8/13 to see if that cuts down the OA, but without triggering more CA's.  Here's what the data looks like right now:    Dec. 1 to Jan. 27 (58 days)  OA = 15 days 1 or 2 events, 4 days cluster of 3 or more events
Jan. 28 to March 24th (52 days) 8/11 PS = 1  OA = 27 days OA clusters of 3 or more events = 16

so after looking at that, I decided to go back to 8/12 at PS=1  March 25th to May 12 (49 days)  OA = 19 days OA clusters of 3 or more = 10

I haven't looked carefully at the CA's, but sometimes they are definitely attached to a rise in pressure.  At other times, that isn't a factor.  I do look at the CA's , and sometimes they appear to be "roll-overs", while other times they look like they're part of pattern breathing.  I am attaching 3 screen shots.  One is a pretty typical night, while the other two are nights with the "clusters" and the seconds the machine thinks I wasn't breathing.  One of them, I've zeroed in on the "cluster", so you can see if it's really an OA, or just something else.  Could my machine be misinterpreting these?  I do have a sleep doctor, but she works one day / week as a sleep doctor, and the other days she's family practice in her hometown 80 miles away.  Plus, she had my pressure at 18 at one time, and I had over 20 CA's an hour, and I'm not certain I'll trust what she tells me, in any case.

I appreciate all the suggestions.  I'd like to get this figured out.
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#5
RE: More help needed with BiPap centrals and obstructive apnea
In general, we increase EPAP, and reduce pressure support for things like this, so I recommend 9 EPAP with 12 IPAP rather than 8/13.
Sleeprider
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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: More help needed with BiPap centrals and obstructive apnea
I will give that a try tonight.  Thanks!!  I do also have a cervical collar, which I can try this weekend, as it's at the lake cabin presently.  

 IAlso, as long as I'm asking for help, I seem to have a periodic breathing pattern which I am posting here.  My machine doesn't indicate that it is a problem, and it doesn't occur all night anymore, just now and then for about 20 minutes when centrals are occurring.  If someone knows the cause or if it's a concern, I'd appreciate it.   

Last night I went to bed with a terrible headache, and I have a lot of centrals that are just "roll-overs" that alternate with patterns like the one I'm posting.  Today, I'm feeling better, so hopefully tonight's report is better.
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#7
RE: More help needed with BiPap centrals and obstructive apnea
This periodic breathing pattern is common among people with CA event clusters, and it would disappear if you had ASV. That is really your answer, and all the rest of this is just a bridge over the greater number of events without therapy, until you get the ASV therapy you need.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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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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#8
RE: More help needed with BiPap centrals and obstructive apnea
Still having trouble with the centrals and clusters of OA right now.  I raised the EPAP to 9, and the hypopnias haven't changed except to go up a little bit, on average. 

 I am starting to get accustomed to the idea of the ASV machine, assuming I still qualify for one.  Sleeprider, you have been responsible for that.  I am planning to place a  call into the sleep doctor, and eventually, she will get back to me.  It's been, or seems like, a long road to get here. 

 When I first started this whole adventure (?) it was because of a heart attack, where they discovered I had sleep apnea.  My ejection fraction was on the borderline of "acceptable" when I was diagnosed, and I haven't had it rechecked.  It was 48%, and the cutoff for the ASV is 45%.  I know that several people pointed out that my ejection fraction is "fine" to have the ASV machine.  Maybe so, but 3% leeway doesn't seem like an abundance of clearance from my perspective.

Plus,   I had so much trouble adapting to the bipap machine, and from what I read, the ASV machine is even more difficult to adjust to, so I have no great desire to make my sleep even more difficult to achieve, if I can do ok with the bipap. 

I do think that the trouble I'm having right now could be related to my allergies and asthma.  Because I have asthma, it is concerning to have a mask on my face, and I still pull it off in the middle of the night in a panic now and then.  I get a monthly shot (Xolair), and when I get close to that and the night or do of the shot and after, my numbers are usually quite a bit higher.  This has been a rough spring for allergies for many, and I'm wondering if that affects my sleep apnea, as well.  Since I just started on the machine in the fall, I don't know how all these things affect sleep apnea.  It does seem that every night is different.  

Looking back at my Sleepyhead results from the fall, it turns out that even at 20, the machine couldn't stop the obstructive apneas I was having, while triggering over 20 centrals an hour, so I don't know if raising the EPAP would stop the obstructive apneas I'm having now.  

I will keep you posted as I keep working on the problem Thanks
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#9
RE: More help needed with BiPap centrals and obstructive apnea
cebeardie, good to have you back. The >45% LVEF incorporates a safety factor. The individuals in the SERVE-HF that were affected by the sudden cardiact death had less than 35% LVEF. Modern machines may not pose the same risks as the fixed EPAP with minimum PS machines these people were tested on. Many issues are under study that challenge that study. We can cover it in more detail, but you're not in the risk group.

It's getting late here, so if you post some more information, we can get to it tomorrow.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

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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