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rookie needs help [mixed apnea]
#1
rookie needs help [mixed apnea]
I had 2 sllep studies done in the last few months which led to the diagnosis of a complex apnea.  My AHI was 42 with slightly more centrals than obstructive.  I was prescribed a resmed 10 vauto bpap machine set at S therapy with pressures of 9/16.  The sleep study showed that at this pressure I had no apenas for 20 minutes.  I used the machine for 8 nights with no improvement.  The API increased to between 35-48 and I still woke up with headaches.  I have no heart problems.  My prescribing physician does not know much about changing the settings so I may be better off seeking help here.  After reading some posts I changed the settings to vauto and set the pressures to 9/17, ps=1.6.  This resulted in a api of 12.64, a big improvement but still terrible.  the clear airway apneas were almost twice as many as the obstructive.  I just guessed at those pressures but basically do not know what I am doing.  Any help would be greatly appreciated.
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#2
RE: rookie needs help
You are going to need a machine called an Adaptive Servo Ventilator (ASV). Don't screw around with this, your doctor already knows that Bilevel without backup will not work for you. Let him know this is not helping and you have a totally unacceptable level of AHI. Ask him to immediately schedule the ASV titration study. Hopefully your insurance is up to par. CPAP and BPAP will not work. You need a machine with a backup rate, and the best machine for the job is the Resmed Aircurve 10 ASV. Insist on it. It targets your background respiration rate and volume and helps you maintain it. Most members here with the Resmed ASV achieve less than 1.0 AHI. You will find a solution, but you must call your doctor daily and ask for the care you need.

Insurance requires that you have a trial on CPAP or BPAP before they will approve and pay for the ASV. It's B.S. but it is what it is. With a complex apnea diagnosis prior to therapy, the odds are very low that you will tolerate BPAP and achieve a therapy level that is effective. Even with the better result of 12.48 AHI, There is no pressure that can be shown to "work", and you had 78 events in only 6-1/2 hours. You probably know that is unacceptable.

How can we help?
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#3
RE: rookie needs help
Thanks for the help.  I have already asked the doctor to write a prescription for this machine. Problem as you know is insurance. It will take three weeks to get approved for an asv sleep study then at least another 4-6 weeks to get through all the paperwork and finally get the machine.  Is there anything I can do with this machine’s settings to help me out for the next couple of months?
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#4
RE: rookie needs help
Gary, that was the point, that you don't want to delay getting the ASV titration. Yes, the best approach to using your current machine, considering the central apnea component is to use low, steady pressure without pressure support. You are currently at 9-17 with PS 1.6. Let's try CPAP mode at 7.0 with no pressure support or EPR. Straight 7 will resolve all obstructive apnea, and not cause centrals It won't be a cure.
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#5
RE: rookie needs help
Hi Garym040,
WELCOME! to the forum.! Hopefully, you will be able to get your ASV Titration, soon.
You've come to the right place for guidance.
Hang in there for more responses to your post.
!
trish6hundred
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#6
RE: rookie needs help
As recommended I set up machine in cpap mode with pressure set to 7.  Big improvement as API was lowered to 5.3.  Only 1 obstructive apnea in 6.5 hours.  clear airway=2.59, hypopnea=1.38.  Awoke with no headache.  Any recommendations on tweaking this any further? Thanks
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#7
RE: rookie needs help
Post your Daily charts, they tell us far more than you do in words.
Always state how you feel, comfort issues are always important.

BTW no suggestions based on your description.  There may be after posting your charts.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#8
RE: rookie needs help
(03-04-2018, 10:31 AM)Garym040 Wrote: As recommended I set up machine in cpap mode with pressure set to 7.  Big improvement as API was lowered to 5.3.  Only 1 obstructive apnea in 6.5 hours.  clear airway=2.59, hypopnea=1.38.  Awoke with no headache.  Any recommendations on tweaking this any further? Thanks

That 10X improvement is better than I had expected.  I would stick with 7 or try 6.6 cm pressure.  Your problem is predominately central, so while CPAP is not the ideal answer, you're doing a whole lot better.   Be aware that if we improve your results too well, you will be considered responsive to this therapy and not qualify for ASV.  That may or may not be a downside to you, but at least you can get some relief with these low steady pressures.
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#9
RE: rookie needs help
I have been using my machine in cpap mode for the last few nights however the AHI is creeping back up and I am waking up tired and with a headache again.  
attached is last night's chart.  I woke up around 6:30 but had mask on and it recorded a lot of false apneas until i shut it off.  Any tweaking settings would be appreciated while I wait for an asv titration.  Thanks
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#10
RE: rookie needs help [mixed apnea]
I also see some obstructive events coming in, which might suggest using a slightly higher pressure. Bottom line is I think you end up with ASV.
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