Should I switch to Bi-PAP and is it worth it for me?

[pr560]

Bumping this thread to see if I can get any advice from the above data.

[pr560]

I have been on APAP therapy for about 5 months now. This was last night. Is there any way to reduce respiration rate and subsequently increase Tidal Volume so that Minute Ventilation still stays around 7-10?

Is Tv of 260 for a 70KG Male ok? 

I am feeling better than when my Minute Ventilation was between 4.5-5.5 but I still have a loooong ways to go in this therapy in terms of quality of sleep and how I feel the next day. I don't feel so good yet it is better than what I felt before.

See attached charts below for last night(18 Clear Airway Events and 19 Hypopneas. 21 Pressure pulse Events)

[Sleeprider]

You are using a Philips Respironics System One (PRS1) auto CPAP and experiencing a unusual respiratory pattern that we have seen here before, although I can't recall which members have had this. Following exhale, your inspiratory effort is detected by your machine in two parts. The machine detects a false inhale followed by a zero-flow, then the main inhale occurs. This may be severe inspiratory flow limitation that would benefit from pressure support and better timing available in a bilevel machine, specifically the Resmed Aircurve 10 Vauto. With the Vauto, we would increase the trigger sensitivity so that the start of inhale would result in triggering IPAP pressure, and we would adjust the time of inspiration settings to ensure that your inhale received support for the duration of your spontaneous effort. The pressure support would eliminate your hypopnea and treat the flow limitation so that you would be much more comfortable and able to resume a normal respiratory rhythm. The PRS1 machine is falsely counting each inspiratory peak as a new breath, resulting in the high bpm count.

Your PRS1 is at least 6 years old and due for replacement. You will do better with bilevel. There are two avenues you can pursue to get the treatment you need. The conventional way is to talk to your doctor, and perhaps submit to bilevel titration studies, and obtain a new machine through insurnace. Another alternative is to purchase a lightly used machine off a marketplace like Craigslist or Offer-up and just get on with life. That is how I got my first bilevel, and quite a few members have done the same (see this post http://www.apneaboard.com/forums/Thread-...#pid313279 ). I encourage you to talk to your doctor, but be aware that very few understand the condition you displayed here or how that responds to bilevel. You would probably pass a CPAP titration sleep test with low enough hypopnea that they would not try bilevel, even though you will clearly benefit from it because sleep testers are "bean-counters" that only count apnea and hypopnea and do not look qualitatively at respiration. YMMV. There is nothing I can suggest for your PRS1 other than higher pressure, and I don't think that is your best solution, however if you are using AFlex at 3, turn it down to 1 or 2.

[OpalRose]

Hi pr560,
Just an observation...
Turn on the CA flag in the event graph, so we can better see where the Clear Airways are.

Go to the bottom of the page (left side) under the last graph.  There is a drop down box, click on CA to turn on.  While your at it, turn off VS2 and BND.  This will clean up your graph a bit.

Also, it is sometimes better if you would keep your therapy questions in the same thread so folk can see what you’ve already tried.  Your other thread (copied here) discusses Bilevel.

http://www.apneaboard.com/forums/Thread-...-it-for-me

I agree with SleepRider on the suggestion for BiLevel, as more pressure Support would help with the Hypopneas and improve respiration.  The only thing is to be aware that a BiLevel won’t treat CA’s and could make that worse.

Good luck, I have the same machine, generally low AHI’s, but high respiration.  I’m looking at getting a BiLevel, and will probably have to buy out of pocket, as my doc doesn’t seem to think there is a “need”.

[alexp]

I am a 70kg dude so I'm not sure which number is best for me on the range.

It's your height that determines the size of your lungs not your weight. How tall are you?

[pr560]

@sleeprider thanks for the reply.

I am not in a country with affordable Sleep Apnea equipment so I have to take care of it myself. I don't think there's a sleep centre in the country.

I imported the PRS1 from Supplier #2  so I'll still have to do the same for the Bi-level.

You are right about the 'bean counters' . AHI seems to be the only thing considered. One has to research and tweak themselves.

Thanks for the VAUTO suggestion. There are different types of Bi-Levels. I don't want to get one and find out that maybe I needed an ST or an SV or the likes. Is there maybe any more data or previous charts I could share that could help inform the choice better?

Another thing is that with Nasal pillows, I have a better AHI(less than 2) less Centrals(about 4 events a night), but with a FFM, I have more Centrals(around 15), higher AHI but for some reason I feel better in the morning with a FFM. Minute Ventilation is higher though with FFM(around 7) compared to 5.5 with Nasal Pillow.

[pr560]

@opalrose thank you for the suggestions.

I was about to link my earlier thread. 

Attached is the event graph.

[pr560]

@alexp I'm about 5'8(172cm or 67.7 inches)

[Gideon]

The OP would likely benefit, in time after his body adjusted to the higher PS, to BiPAP. His CA went away without flex meaning his body needs to adjust from the additional washing of CO2 that occurs with the better breathing that occurs from the higher PS.

[alexp]

@alexp I'm about 5'8(172cm or 67.7 inches)

Normal would be between 400 and 480 ml but again it's an average. You may have smaller lungs or may not need at much. 

Just to give you an idea, I'm the same height as you and I went from 380 ml to 420 ml on average after switching to a bilevel because I had chronic flow limitations. I'm still having some flow limitations but waiting a bit before increasing my PS again so my numbers may go up a bit more.

Another question, did they diagnose any central apnea during your sleep study? Otherwise, when you look at your central apneas, is there a big increase in tidal volume right before the event or is it steady? I'm just trying to determine if these are true central apneas or arousals.

You should read the topics discussing flow limitations and UARS. There were a lot in the last month and would probably help you understand how to recognize and deal with flow limitations.

Can you set the scale to -50/50 on your flow charts and show us some samples?