Yet another newbie - I'm clueless...

[Sleeprider]

Randy, did your diagnostic sleep study or titration study point to any central apnea? I kind of got ahead of myself and went with the conclusion you have complex apnea. I hope you'll forgive me, but I see so much of this, and it is just a process. Hopefullly your doctor also has done his research and picked out a Resmed Aircurve 10 ASV as your next step.

You should expect less than 5 AHI for efficacy, so you are still quite a way out from that, and like I said, if there was a clear path to get there I'd suggest it. The fact you had to titrate on CPAP before getting bilevel tells me that cutting pressure support isn't a likely path.

[trish6hundred]

Hi RandyR,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy, and also with getting the machine you really need.

[DeepBreathing]

Just following up from SleepRider's last post, there are two basic types of apnea: obstructive and central. Obstructive (as the name suggests) occurs when your upper airway is obstructed mechanically by the tongue or soft palate. Central apnea is more subtle and occurs when the "breathe now" message doesn't get sent from your brain to your lungs. (That's putting it rather crudely but it's close enough for this discussion).

Central apneas might be idiopathic, or they might be caused by the application of PAP therapy pressure. If they are endogenous then an ASV is usually the best way to treat them, but that is an expensive machine and you'll have to jump through hoops. If your centrals are pressure-induced, then it might be possible to fine tune your settings to reduce or eliminate them. Sometimes they just go away of their own accord after a week or three.

In your case it looks like the centrals are coming on at the pressure which is required to treat your obstructive apneas. To eliminate the obstructives your pressure needs to go higher, but that would cause more centrals - you're walking a fine line between the two. As SleepRider said, it would be useful to know if you had idiopathic central apneas - these would have shown up on your initial sleep test (not the titration test).

[RandyR]

I slept very poorly during my sleep study, however in my layman's attempt to read through the report, I found this

Apneas (index, #): 14.0 (24)
Obstructive Apneas (index, #): 12.9 (22)
Mixed Apneas (index, #): 0.6 (1)
Central Apneas (index, #): 0.6 (1)
Hypopneas (index, #): 56.2 (96)
RERAs (index, #): 0.0 (0)

Then I was fitted with a Dreamwear with medium nasal cushions; CPAP set to 5 to 14 during titration.

Apneas (index, #): 3.3 (11)
Obstructive Apneas (index, #): 0.0 (0)
Mixed Apneas (index, #): 0.0 (0)
Central Apneas (index, #): 3.3 (11)
Hypopneas (index, #): 9.2 (31)
RERAs (index, #): 0.6 (2)

I think this shows me that my CAs increased and OA's decreased (significantly) when CPAP was applied during my test. And when I compare this data to the data from the past 2 weeks, it looks to me like my CA's have increased, while my Bi-PAP is set to higher pressure setting than during the sleep test (which shows lower CAs).

I'm wondering if lowering the pressure might be the correct direction. If so, then how much? Which setting (EPAP, IPAP, PS)???

Thanks again and in advance to SleepRider and DeepBreathing for your advice!

[Sleeprider]

Normally when complex apnea is present, we try to find the lowest pressure that can be tolerated without causing obstructive apnea. Also, pressure support is not usually helpful. I have an idea for some settings that we can try, but I can't promise it will eliminate the CA. On your Aircurve 10 Vauto press the control knob and home button (lower front) to enter clinical settings and then enter settings.

Set mode to Vauto
Set IPAP max to 10
Set EPAP min to 5
Set PS to 2.0
exit

This is going to give you an auto bilevel with a range of 7/5 to 10/8. We want to see the AHI and distribution of events with these settings before suggesting any additional moves. The lower pressure may allow some obstructive events, but we hope the CA will be significantly improved. In about 50% of people I have seen on the forum with this problem, this approach can reduce events below the level that requires ASV treatment.

I think it is important to have a candid discussion with your doctor regarding his expectations for your complex apnea. You should inform him your results so far are unsatisfactory. He should tell you if he has a contingency plan if you fail bilevel PAP treatment.

[RandyR]

Thanks Sleeprider. I read the page on the forum about how to get into the Clinician's Setting, so I'm familiar with that. I'll make the changes you recommend and report back. I already have a call into my Dr. to set up the "initial" post-equipment delivery/setup follow up appointment.

Thanks again,
Randy...

[Ockrocket]

ajack, My Doc told me, "Don't waste your time researching which is the best Bi-PAP machine.  I've already done that for you."...

Good luck on your pursuit of quality sleep!

If someone said that to me (about anything I was looking to purchase) it would be an instant red flag that they had a vested interest in me purchasing what they are telling me to buy. 

ALWAYS do your own research in to anything, you will be all the better for it in financial/knowledge/appropriateness of whatever it is you are looking in to.

[RandyR]

Since adjusting both pressures down per Sleeprider's post above, I've adjusted them up a hair, as my OA's dropped but my CA's went up.  I set my machine as in the pic for the past 6 nights, and last night's sleep was pretty good!  Over these past 6 nights, my AHI has dropped to a max of 10.86 and a low of 7.19, with my Apneas split almost evenly between OA, CA and HA.  I'm not sure if my machine can be tweeked further for better results.

[Sleeprider]

Let's try min EPAP 8, Max IPAP 12 PS 0. This will basically mimic an auto CPAP with no EPR / pressure support.

[RandyR]

I'll give it a try...