New BiPAP ST user Vet with complex apnea

[SHatfield]

   

Here is the 2:40 zoom.

[Sleeprider]

Those are central apnea. The triggered breaths shows some response in the airway so it's not obstructive, but that should have been flagged as apnea. I do wish you'd give me a full 2 minutes.

[SHatfield]

Those are central apnea.  The triggered breaths shows some response in the airway so it's not obstructive, but that should have been flagged as apnea.  I do wish you'd give me a full 2 minutes.

I'm having a little difficulty getting a complete two minutes in my zoom window.  When I zoom in it shortens the amount of time.

[SHatfield]

   


think I got it.  Close to 2 minutes?

[Sleeprider]

That's it. What I wanted to see is how those hypopnea events are getting flagged. We can see the machine is delivering timed IPAP at 12 BPM and if not for the pressure support, this would likely be flagged as clusters of CA. There are spontaneous breaths with good amplitude and no suggestion of flow limitation or obstruction followed by several timed breaths that deflect the airway, but don't result in appreciable inspiratory flow. These are CA events that the machine is flagging as hypopnea because it senses enough movement not to flag as apnea. The flow is periodic with several breaths leading to the next few missed breaths. I can only assure you this is not a typical obstructive pattern. A bit more pressure support (higher IPAP) might cause enough airflow to avoid the hypopnea. It's not ideal but it's what we have. If this was ASV, the pressure support would back-off during the normal breaths and be much greater during the hypopnea and apnea. I think you know that's what's needed.

Have you considered elevating your complaint to the VA Patient Advocate? A strategy used by some others is to make daily complaints requesting the ASV titration based on the diagnostic test result of both obstructive and central apnea. If you cannot get an appointment for the titration within a reasonable time (30 days), the VA now allows for an independent medical opinion a.k.a. private second opinion. That might move the needle.

Would you mind if I add the word "veteran" or VA to the title of this thread? It might help to get the input of other vets on the board. Something like "Veteran With BiPAP ST and Complex Apnea"

[SHatfield]

Yes you can put Vet in the subject line.

[sheepless]

I'd like to see a 7 to 10 minute view of that same screenshot. could be periodic limb movement in roughly 10 second intervals. if so, ps won't help & may hinder.

[muziccity]

Hey SHatfield, I notice you were struggling a little bit with trying to get the proper amount of time. The same thing happened to me, I have a quick tip that will help you out. When you select an area, the duration of that area is highlighted in that yellow tooltip that floats above the graph. If you select too much and are zoomed in too far, you can just select a wider area in the "Event Flags" section above that. When you get a chance you should really install that beta version. The installation will be just like this one you already have. You dont need to uninstall this one to install the beta. 

   

[SHatfield]

   




Here's 2:35 to 2:44

***Let me throw this out there. I sleep in a recliner. I have always been a toss and turner. I wake up probably one to three times a night to go to the bathroom. Even the titiration study showed that I moved a lot. I'm usually aware that I'm switching back and forth, but there is probably arm and leg movement I'm not aware of.

[sheepless]

I haven't reread this thread so sorry if already covered. does your sleep study report periodic limb movement? strong indications of it in your flow rate.