New BiPAP ST user Vet with complex apnea

[Crimson Nape]

After reading that some users are having a problem zooming in on a certain span in OSCAR, I thought I'd provide another option for getting the time span needed.

At the bottom of the Events tab on the Daily Screen is a View Size slider option.  To its right is a numerical value, representing the number of minutes of the zoom.  To use this feature, either select an event above the slider, click and drag an area on a graph, or just click anywhere in a graph. Once you have done one of the previous, move the slider to the desired zoom level.  

[SHatfield]

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.

Here is what they diagnosed regarding movement.  

"IMPRESSION: - Sleep Apnea for PAP Titration. - Sinus rhythm with occasional PVCs. - PLMS; PLMI: 20 & PLMAI: 3." 

I mentioned above that I sleep in a recliner and have been a restless sleeper going from side to side and moving my legs.

[sheepless]

judging by that screenshot & your report, I would say your 20/hr plm is disrupting your sleep at least 3 times/hr, probably more. also causing flow limitations between movements, that like chin tucking, aren't likely to respond to pressure or pressure support.

edit: this is the clearest example of respiratory response to plm I've seen in anyone else, meaning it's most like my own.

[SHatfield]

judging by that screenshot & your report, I would say your 20/hr plm is disrupting your sleep at least 3 times/hr, probably more. also causing flow limitations between movements, that like chin tucking, aren't likely to respond to pressure or pressure support.

I hadn't thought too hard about that, but it makes sense.

[Gideon]

SHatfield, you should be good hor Beta-2

[SHatfield]

   





Here's last nights data.  It was a rough night in the sense that I coughed some and had to take the mask off twice.  Didn't zoom anything yet. But my total API numbers took a significant drop.  Gonna try this on the BETA version as well to see how it looks.

[SHatfield]

I basically asked them why I had a BiPap machine if I only had OSA per the titiration study diagnosis. Here's their response and suggested direction.

"It's ok. We are here to help guide you.
Your sleep apnea diagnosis would not be too worrisome at your age and with the current medical conditions that are noted in your chart. But it is a good tool to use to help your health while you are sleeping.
In your research, we would be able to prescribe the patient a CPAP (single pressure of air) or a BiPAP (dual pressure of air). For the mixed apneas that you have, the BiPAP is a good start.
In the actual needs of a patient's air pressure once they start PAP therapy, as in your case, this is where I start tweaking your pressures to see if we can find something better.
As for your feelings of fatigue, your provider would not be able to dial in on this yet since your sleep apnea is not being treated. Once we can get this situated, then it can sometimes take patients a month or two, sometimes more for their bodies to acclimate to getting rest.
Now, for your pressure, as in your readings about the CPAP. I can set your current machine to a single pressure of air (CPAP mode) and I would like to try that. I would set it at the pressure of 10 cmH20 and ask that you try that for a couple of nights.
Please keep in mind, we would now be starting the "tweaking processes" which we unfortunately do on some of our patients. I liken it to adjusting medications until a dose is found to benefit the patient the most, be able to tolerate, etc.
Let me know."

It looks like she said I have "mixed." I responded to this by asking which is it? 

This is Sleepriders comments, with permission.  

"That is a more honest answer. Setting the machine to CPAP mode means they think the bilevel pressure is not treating your apnea, and that they acknowledge the events are central. Central apnea will respond better to low, fixed CPAP pressure than bilevel. This is the first step in moving the right direction. At least we know you are on the radar scope now to try to resolve the events through pressure changes, and if that does not work, you will likely be provided ASV titration to see if that works. This is good news."

[Sleeprider]

MuzicCity was unable to tolerate the ST mode and went to CPAP mode. If you look at his chart, his AHI is actually pretty good. I don't know if that is a long-term solution, and he has an ASV titration coming up, but CPAP pressure rather than ST BiPAP was much better. http://www.apneaboard.com/forums/Thread-...#pid339234

I think it would be great if you two continue to support each other as individuals in a similar situation.

[muziccity]

Yes, they started me on ST mode and I struggled through it until I just couldn't take it anymore. My AHI was 20 - 30 that first week. I just didnt feel right so I switched it from ST to CPAP myself and adjusted the pressure in small increments daily to find the best setting. When I went back to my doctor he was upset that I changed modes but he concurred we should leave it on CPAP. My AHI has dropped from those crazy high numbers down to as low as 3. I'm still experiencing excessive tiredness but I think I'm feeling slightly better? I'm not sure but I'm desperately hoping that's something ASV might help with.

I'm very interested to see how CPAP works for you and compare it to your ST. If the pressure is too much at first to exhale against, you can adjust the ramp to a lower number like 5 or 6 and increase the ramp time as well. You'll get used to it pretty fast though.

[SHatfield]

   




Last nights results.  They still haven't remote adjusted my machine to CPAP yet.

---

Yes, they started me on ST mode and I struggled through it until I just couldn't take it anymore. My AHI was 20 - 30 that first week. I just didnt feel right so I switched it from ST to CPAP myself and adjusted the pressure in small increments daily to find the best setting. When I went back to my doctor he was upset that I changed modes but he concurred we should leave it on CPAP. My AHI has dropped from those crazy high numbers down to as low as 3. I'm still experiencing excessive tiredness but I think I'm feeling slightly better? I'm not sure but I'm desperately hoping that's something ASV might help with.

I'm very interested to see how CPAP works for you and compare it to your ST. If the pressure is too much at first to exhale against, you can adjust the ramp to a lower number like 5 or 6 and increase the ramp time as well. You'll get used to it pretty fast though.

Thanks muz.  I can see that my AHI has dropped a few points when they went from 15/10 to 16/12.  They should be changing my machine to a straight CPAP today.   I have asked them to tell me when they change the machine and how much.  I'm gonna start keeping track.  I'm down to about an 8.9 AHI right now which is better on paper than the higher readings.  Let's keep in touch. I'll probably follow you down this path.