(04-16-2016 10:46 AM)robotman Wrote: Hey gang,
Months ago I posted here about the problems I was having with my loaner cpap machine. You guys told me to try to get a bipap one, and I listened. It took me until 3 days ago, with visits to a sleep clinic and specialist, but I finally am trialing one and have one ordered, the ResMed AirCurve10 Vauto.
But I just checked the sdcard in SleepyHead, and I'm really disappointed. I'm getting 30 AHI every night, mostly central apneas. I spoke with the respiratory therapist yesterday (before I looked at the results) and he said it looked good!
The sleep clinic bipap test said "The most satisfactory pressure was IPAP 12.0 cm of H20 EPAP 5.0 cm H20, which resulted in an apnea-hypopnea index of 6.0 events/hour and a total arousal index of 2.0 events/hour." So why isn't it working? The doctor gave me a sleeping pill (zopiclone, a hypnotic) to take when I went to the sleep clinic; I was literally almost falling over when I walked in; do you think this could have affected the test results?
The nurse at the sleep clinic also said that maybe my raspy-can't-hardly-talk throat problem was caused by using the nose pads type of mask, and suggested using a full face mask. This has been uncomfortable, with constant leaks around the eyes and chin, no matter how much I try to fix it. I end up breathing mostly through my nose anyway (even though it's hard sometimes) because when I breathe through my mouth it actually hurts my brain in a couple of spots, which scares me a lot.
Frankly, I'm about ready to give up. Even though I have felt way more rested the past few days. I also think I might have made a mistake by getting this respiratory therapist to purchase the machine through my insurance; maybe I should have done that through someone else - doesn't that basically mean I'm committed to using him now?
I don't know what to do. I'm getting very frustrated.
Here's the data .zip.
Until you are able to get a special type of bilevel machine called an Adaptive Servo Ventilator (ASV) bilevel, such as recommended by Sleeprider months ago in your early thread, your machine will not be able to prevent central apneas.
The AirCurve Auto is an excellent bilevel machine for optimal treatment of obstructive sleep apnea when not complicated by central apneas.
Standard bilevel therapy modes like S bilevel mode and Auto bilevel mode (which are what the AirCurve Auto can provide) usually increase the number of central apnea events, unless the pressure difference between EPAP and IPAP is small and/or the pressures are low, in which case treatment using a standard AutoSet would pretty much be the same as using the AirCurve Auto.
I suggest talking to your equipment provider about cancelling the order for the AirCurve Auto (it is unable to treat your central apneas) and asking your doctor to prescribe an ASV titration so you can get an ASV machine, which is very obviously what you will need. Or perhaps he would be able to prescribe an ASV machine without a special ASV titration, I don't know.
Meanwhile, either continue using the AirCurve Auto or use your AirSense AutoSet if you still have it.
If using the AutoSet, I suggest turning down EPR to 2 for a week or two and then 1 for a week or two and then Off for a week or two, and then deciding what EPR setting works best for you.
If using the AirCurve Auto, you will need to reduce Pressure Support (if you're using Auto therapy mode) or increase EPAP while keeping IPAP unchanged (if using S therapy mode). You may also need to lower IPAP or the max pressure.
If you set the AirCurve Auto to equivalent settings as the AutoSet it should provide equivalent treatment. For example, if the AutoSet had settings of AutoSet mode, Min Pressure 8, Max Pressure 12, EPR 2, then the equivalent settings for the AirCurve Auto would be Auto mode, Min EPAP = Min Pressure minus EPR = 8 - 2 = 6; Max Pressure = 12; PS = EPR = 2.
If in fixed-pressure CPAP mode, raising EPAP or reducing EPR tends to reduce obstructive events, and lowering IPAP or lowering PS tends to reduce central events.
And I encourage you to continue making sure you are never rolling onto your back in your sleep. Congratulations on that. Keeping off our back usually strongly reduces our pressure needs, such that we may be able to avoid most or all obstructive apneas without needing to use high pressures.
Central apneas, especially if short like less than 20 seconds, are usually far less stressful on the heart than obstructive apneas.
Good luck in continuing to avoid another stroke.