need help setting BiLevel

[PoolQ]

Only one OA all the rest are CA's and what looks to me like PB for a significant % of the time. Before I switched from APAP I could look at the plot and tell what kind of a night I had-PB around 20% was good, 30%'s decent, 80% not good at all.

Settings
IPAP max 15
min EPAP 5.8
PS 4.4
TiMax 2
TiMin 0.3
trigger/cycle med

CA's 48
Hypopnea 3
OA's 4
UF1 6
UF2 17

UF's set to SH default, 8 seconds

No idea what to change or to what setting

[archangle]

If you don't mind, upload a copy of your SD card.

One thing I notice is that your CA's tend to be short and have at least a few good breaths between. This is less worrisome than longer CA's or close together CA's.

The classical thing to do is reduce pressure and see if your CA's go down without increasing your total AHI.

[PoolQ]

https://www.dropbox.com/s/0p2nx0r9o9pl1h...5.zip?dl=0

[Sleeprider]

It appears the pressure chart only tracks IPAP, is that right?

How long have you been using the VPAP Auto? If you are just getting accustomed to the pressure support, then I suspect the CA and appearance of PB is more a matter of adjustment at this point and may not be a concern. You might try reducing PS to 4.0 and see if that helps a bit, but the results posted above are not that bad if you're just getting going with the new machine.

[PoolQ]

I was on APAP for 2+ months and had mostly centrals with periodic breathing. Dr. change me to BiLevel less than a week ago, centrals increased and PB stayed about the same lasting over an hour nonstop at times. I wake up 2-6 times a night and get up for 15 minutes to 2 hours before I can face going back to bed. I have adjusted all the comfort settings and seem to be doing fine on that front.

I just had a 2nd sleep study and had 253 arousals during the study

SLEEP SCORING DATA:
Lights Out / On (clock times): 21:31:20 / 07:00:51
Total Recording Time (TRT) (min): 570.5
Total Sleep Time (TST) (min): 178.0
Sleep Efficiency: 31.3%
Sleep Latency (min): 5.5
Stage REM Latency (min): 507.0
Wake after sleep onset (WASO) (min): 386.0

Stage N1 Sleep (min, % of TST): 44.5 (25.0%)
Stage N2 Sleep (min, % of TST): 50.0 (28.1%)
Stage N3 Sleep (min, % of TST): 61.0 (34.3%)
Stage R Sleep (min, % of TST): 22.5 (12.6%)
Supine Sleep (min): 43.5
Arousals (index, #): 85.3 (253)

RESPIRATORY ANALYSIS: (index = #/hr)
Apnea/Hypopnea Index (AHI): 40.1
NREM AHI: 45.9
REM AHI: 0.0
Non-Supine AHI: 26.3
Supine AHI: 82.8

Respiratory Disturbance Index (RDI): 40.4
NREM RDI: 46.3
REM RDI: 0.0

Apneas (index, #): 9.1 (27)
Obstructive Apneas (index, #): 1.0 (3)
Mixed Apneas (index, #): 0.0 (0)
Central Apneas (index, #): 8.1 (24)
Hypopneas (index, #): 31.0 (92)
RERAs (index, #): 0.3 (1)

Mean Awake SpO2: 95%
Mean Sleep SpO2: 93%
Minimum Sleep SpO2: 87%
Sleep Time with SpO2 < 88% (min, % of TST): 0.2 (0.1%)

[trish6hundred]

Hi PoolQ,
Good luck to you with getting your AirCurve set to work well for you.
By the way, WELCOME! to the forum.!

[justMongo]

It appears the pressure chart only tracks IPAP, is that right?

EPAP may be off scale since it's EPAP=IPAP - PS and PS=4.4
The pressure axis begins at 10 for that screenshot.

[archangle]

It appears the pressure chart only tracks IPAP, is that right?

That might be one of the things where SleepyHead doesn't support the AirCurve 10 models yet.

https://www.dropbox.com/s....

I don't see anything all that meaningful in your results. In particular, nothing all that seems all that "scary." You have periods of times when you have a number of pauses in breathing, but they're not that long, and have a few good breaths between.

I also notice your AHI isn't that high, and it varies quite a bit from night to night.

I was on APAP for 2+ months and had mostly centrals with periodic breathing. Dr. change me to BiLevel less than a week ago, centrals increased and PB stayed about the same lasting over an hour nonstop at times. I wake up 2-6 times a night and get up for 15 minutes to 2 hours before I can face going back to bed. I have adjusted all the comfort settings and seem to be doing fine on that front.

What kind of problems are you having that make it hard to face going back to bed?

Do you feel anything special when you wake up? Any indication as to why you woke up?

[jeffreyclay]

(I had to delete references in earlier post. Sorry, but I think you can follow the thread)

I'm very new in the learning curve. The term, "CA" is shown to be the abbreviation for "Clear Airway". I would think that is a good thing yet you mention a lower percentage being preferred.
Also, you discuss his "PB". I don't know what that refers to. I hope you don't mind a question from the back of the classroom.

[Sleeprider]

Hi Jefferyclay! CA is indeed a clear airway pause in breathing and is for all intents, synonymous with a central apnea. Since we can't say from the chart what the reason for breathing cessation was without EEG or respiratory effort data, "clear airway" is as good as anything. Normally a few CA events are nothing to be concerned about, but as the frequency increases it can lead to some oxygen desaturations or sleep disruptions that may need correction. The normal therapy for numerous CA events is adaptive servo ventilation (ASV), which is a non-invasive ventilator that maintains breathing rate and volume through pressure changes on a breath by breath basis.

PB refers to periodic or patterned breathing. There are many forms of patterned breathing, one of the more severe forms being Cheynes Stokes. The pattern shown in the graph at the top of this thread displays patterns of increased and decreased flow, however the nadir of expiration does not end with an apnea.

For PoolQ, I think someone with complex or central apnea is normally treated on ASV, but you are responding reasonably to the bilevel VPAP in terms of respiration rate, volume and even AHI. I think it would be nice if your machine had the ability to report RERA as that is part of your problem according to the sleep study. The bilevel still relies on you to initiate a breath and for that reason may not be the optimum therapy. If there is no effort, you tend to get stalled in a reduced volume patterm (PB) or a brief CA. You are kind of on the borderline whether that next level of therapy where the machine intervenes in breathing timing and volume is clinically necessary.

My personal experience with bilevel is that excess pressure support contributes to CA. My EPAP is sufficient to prevent OA as is yours. I use a range of PS to mainly prevent FL, H and RERA, and the machine automatically adjusts. Unlike you, I don't have a strong tendency for CA during untreated sleep, my problem is OA and H. Time will tell whether the VPAP auto can effectively treat your sleep disordered breathing. I think your tendency to central apnea suggests an ASV might be a better choice.