[Treatment] Change to BIPAP vauto in hope for better therapy

[Dave Water]

BIPAP vauto new therapy was bad on first night

I was on Airsense 10 APAP for the last 18 months but results were always kind of hit and missed. I also always wake up several times during the night. My Max/Min pressure is usually set at around 10/7 and EPR is full-time at 1. My AHI is usually under 5 but there were always a bit of mix of CA, OSA, hypopnea and RERA.

I decided on Aircurve 10 BIPAP vauto hoping that it will better my sleep/treatment and improve on CA. I finally received the new Aircurve 10 Bipap Vauto yesterday and was excited to try it out. I set up the IPAP - 10, EPAP - 6, PS - 4 and trigger - high. I thought that these setting maybe the best base on information I received and also base on my previous setting on my Airsense 10.

Last night, I woke up several times and around 5am, I changed the trigger to med as high seems to give me the push/pulse feel when it kicks in. Medium setting seems to soften the pulsing a bit but it seems to increase my CA. But overall the AHI is not good but I know there is also some leak as the tape came off a bit.

I would appreciate if I could receive advices on the setting of my VAUTO to improve the therapy. 
I hope I did not get a wrong machine that actually worsen my sleep apnea.

I am attaching the OSCAR diagram for you to review. 
Thanks in advance.

[Sleeprider]

Hi Dave. We'll be glad to help you. The Oscar attachment did not work, so try again. You need to upload the attachment, add it and insert it into the post. The tutorial for attachments is in my signature links. We can effect improvements on CA events with the Vauto, however the Vauto is not intended to treat central sleep apnea. Most likely we will want to reduce the PS to 3.0 and increase trigger to very-high.

[Dave Water]

    Thank you for the quick reply. 
I will change the trigger to very high and set the PS to 3 to tonight to see if I can get a better AHI.

I am trying to send the diagram again. I hope this time it works.

Thanks again for your advice.

[Gideon]

Dave your big problem is a positional apnea. Most likely you are tucking your chin in toward your chest. The tell are the clusters of obstructive events. It is very unlikely that any pressure will resolve this. Try a pillow modification, 1 vs 2 pillows, a less firm softer pillow. If that doesn't work you will need a properly fitted soft cervical collar, see the link min my signature. It can be totally eliminated overnight.

[Sleeprider]

I agree. Disregard my first "guess" based on no data. Read the article on Positional Apnea and focus your efforts or eliminating chin tucking. The clusters of obstructive apnea are really classic.
http://www.apneaboard.com/wiki/index.php...onal_Apnea
http://www.apneaboard.com/wiki/index.php...cal_Collar

[Dave Water]

I am so glad to hear that there is a solution and there is hope.


I have to sleep on my back because I have acid reflux and also I cannot sleep on my left because i do not want to press my heart.
So i have trained myself only to sleep on my back. But i though it is OK because I use a contour pillow with a soft front side to support
my neck. I guess it is just not enough support. I will shop for a SCC locally tomorrow so I can use it right the way.

At the meantime for tonight, I will set my PS to 3 and trigger to very high. I will try 2 pillow solution to better support my head to see if I can
lesser my chin tug to chest.

I am keeping my fingers cross for a better AHI. I will pose my OSCAR tomorrow.

Thank you so much for your help.

[Dave Water]

I agree. Disregard my first "guess" based on no data. Read the article on Positional Apnea and focus your efforts or eliminating chin tucking.  The clusters of obstructive apnea are really classic.

I must have missed your reply while i was typing.
OK, i will focus on eliminating chin tucking and leave the setting as is for now and see how things go. 

Thanks for your advice

[Dave Water]

I am attaching my OSCAR analysis for last night and my setting is as below.
IPAP-10
EPAP-6
PS-4
trigger-med

I used the soft pillow last night. 
A bit better AHI but I am surprised that I have so much CA, I was never told by my sleep doc that I have CA.
My CA stats on my Airsense 10 usually is below 1 or around 1. 

Also, i am not sure if i need to adjust for longer exhale time as I feel that the air pushes in a bit sooner and before i finish exhaling.
I am hoping OSCAR diagram will show this symptom but I don't know how to catch that sign from OSCAR.

I will shop for the SCC locally today. 
Do I need to change any of the setting or just start using the SCC tonight for the time being ?

Thanks for all your help.


   
   
   

[Sleeprider]

Leaks are pretty awful, and that can distort the number of CA events, so you definitely have some work to do in that regard. These look to be mostly air escaping your mouth rather than a seal leak at the interface. I think with continuing CA events, I'll go back to my original recommendation to reduce PS to 3.0 and trigger sensitivity very-high.

[Gideon]

Agree, now tackle the CAs as SR has indicated.