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My Wife Keep Waking up at Night!
RE: My Wife Keep Waking up at Night!
Finally, my wife had a lung function and respiratory muscle tests today, and the results is at the lower part of the normal range, as I was told by the sleep doctor!

Now I know that she has no hypercapnea and COPD or other lung diseases, but she still suffering from central apnea and obstructive apnea as detected by the machine! So I requested a bilevel titration for her, to determine whether she needed a machine with backup breathing support!

Meantime, I have adjusted the PS of the machine to 3, and the result indicated that there are less central apnea and obstructive apnea , but the tidal volume reduced to 320mL/kg. For a normal person, that should be 7mL/kg, so for my wife should be 7 x 39kg = 273mL/kg. But there are more fluctuation in pressure as indicate in the report.

I wonder, is the Resmed Aircurve ASV machine worth a try?

I have attached the lung function test and SleepyHead reports with PS=3 and PS=4 for your further comments.
[attachment=12284]
[attachment=12285][attachment=12286]
       


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RE: My Wife Keep Waking up at Night!
If it were me. Having 12 the other night, with a batch of OA and no CA. Showed that they are pressure CA and will probaby settle down. I would go back to basics and start again. Continually swapping pressure isn't working that well for you.

I would raise the min epap 1cm at a time till the OA resolve to a level you are happy with and then review. treat the H with more PS. Pressure CA don't normally have an o2 desat of any significance, you can confirm this with your spo2. The OA and H will have o2 drops and need sorting.

Have you see the titration guide? You could stay in auto and titrate, or you could go back and work in S mode.
https://www.resmed.com/us/dam/documents/...er_eng.pdf

Depending on copay, you could get a lab titration, they will most likely set it in S mode with fixed epap and PS/ipap. With 3 machine CA an hour, even if confirmed. I doubt they will suggest an ASV
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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RE: My Wife Keep Waking up at Night!
Thanks you "ajack" for your response!

When I took my wife to see the sleep doctor, he been very honest and telling us take bilevel sleep therapy and 
titration are out off his depth and will talk to his colleague and come back to us later. I was warned that a good 
bilevel titration is not an easy thing in Sydney, Australia, maybe due to Medicare copayment as you said!

Basically, after my wife been on the cpap/bilevel machines for nearly over 2 years, my conclusion is it is worth it 
for following reasons:
1. She stop snoring;
2. Her blood oxygen level is closed to 93-94% at night;
3. She feel less breathless when talking;
But the last piece of the puzzle still need to resolve is arousal at night, maybe due to CA and OA?

Last night, she had a surprising result by keeping the PS=3. The AHI is 1.79, CA and OA split into 50/50!
A good AHI for a "long time between drinks"! 
Big Grin Big Grin Big Grin

[attachment=12308]    
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RE: My Wife Keep Waking up at Night!
Oh, you're aussie. I missed that. You don't need to do it unless you want to. It's free at the public hospitals, but there is a wait, unless prioritised. Have you got private health, there isn't a gap at the private labs. With HCC, some labs will also just take the medicare payment. I know someone in Bris who had no ins but had free private studies and doctor. Then to be given a free cpap by the hospital system. If your wife needs an ASV, ST or VAPS, it is also free on a HCC.

While I'll agree that the techs that are training up, can be clueless and I have a story to tell there. In general, the guys running the labs are skilled.
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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RE: My Wife Keep Waking up at Night!
Yes! I am an Aussie!
We are not in HCC but with private health insurance and entitle for a rebate of $500 every 3 years for a new cpap 
machine! That is another 2 years wait before I can claim the rebate again!
Lets wait until next week and see what the sleep doctor have done with my request for a bilevel titration for my 
wife!
Any comments on the SleepyHead reports I posted earlier?
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RE: My Wife Keep Waking up at Night!
Self funded retiree, without a part gov pension and health care card..You show off. Smile
Going private is easier. I'd choose one of the teaching, respiratory professors, who also does a large public hospital. See him in his private practice. He would know of a good lab tech and be able to properly follow up. There are no restrictions. You can have a sleep titration study done every week and at no cost. If there's a medical need, to sort out the issues.
The charts fine, I don't think those are the settings the lab will do though. If by chance you didn't think I meand health care card, HCC. You should get a free ASV through the public hospital system, if needed.
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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RE: My Wife Keep Waking up at Night!
Mr "ajack", I am still working like a slave to pay my bills! But not very far from semi retirement!
I didn't know you can get a free ASV from the public health system! 
Obviously, you need to be a pension before you can enjoy this privileges!
It is good to know thou!
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RE: My Wife Keep Waking up at Night!
Can you post a screen shot of the graph of the inspiration and expiration times throughout a night of sleep? I wonder if her inspiration is getting cut off at the Ti max 2.0 seconds.

Your wife's tidal volume is completely normal based on her height and gender. Even the reduced tidal volume at PS 3 is completely normal. For her, I would not bat an eye at any Vt between 3-400 mL. The fact that she can generate normal volumes while asleep at a PS of 3 or 4 is a good sign.

The reduced respiratory rate is somewhat interesting but I'd say that the ABG helps confirm that it's causing no metabolic issue at this time. One possibility is that she breathes more shallow while asleep. But she is breathing at a rate which produces normal carbon dioxide levels, which shows that adequate gas exchange is taking place.

I suppose one experiment would be to switch from the VAuto mode to the Spontaneous "S" mode. The logic in this is that in VAuto mode there is the "easy breathe" algorithm which is essentially an automatic rise time. This tends to soften the rise to the full prescribed IPAP, causing the person to breath slowly and more deeply. You can see this live on the therapy treatment screen as well. If you flip to "S" mode and slowly increase the rise time over time, you will probably see a reduction in the respiratory rate. You of course don't want to artificially cause an increase in RR by making the rise time very fast, as that would be uncomfortable, but you may find one that matches her drive to breathe well.
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RE: My Wife Keep Waking up at Night!
Thanks you Matt00926 for yours response!

In the last few days, I set the machine to PS=3 and the AHI is consistently below 3, and last night went down 
to 1.11! Surprised!

But as Sleeprider pointed out previously, her Inspiration and Expiration time is reversed when using the 
Resmed Aircurve 10 vAuto. I pointed this out to the sleep doctor, he doesn't seem to be too concerned.
When my wife started off 18 months ago with the Resmed Airsense 10 AutoSet Min 4 and Max 20, the results 
was Inspiration higher than Expiration??? 

I will try the Spontaneous "S' mode on the machine later as suggested and keep you posted!

Attached SleepyHead report of last night, including inspiration and expiration times for your perusal:

[attachment=12376][attachment=12377][attachment=12378][attachment=12379]
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RE: My Wife Keep Waking up at Night!
FWIW, the I:E times have corrected here with 1.60 to 4.64 The I:E is 1 to 2.9. This is in the normal range, and while I don't recall the inverse I:E ratio, is a complete turn-around. With an AHI of 1.1 and mainly a few sleep-disruption centrals, this is excellent, and nothing to worry about.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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