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+--- Thread: Very high events per hour (/Thread-Very-high-events-per-hour)
Very high events per hour - Ron Poelstra - 09-02-2021
Hi all,
I started therapy with a ResMed AirSense 10 back on April 21 with very mixed results. One night very high events per hour and then for the next few down a lot. One night would be in the 30 to 50 range and then the next under 10. My pulmonologist does not seem to be interested in talking with me, they just refer me back to my family practice. I get the most satisfaction in talking with my DME rep. According to my sleep study I have mixed apneas with central apneas happening more than obstructive. For some reason the titration centered on cpap only and thus resulted in the AirSense 10.
It was believed from my GP and DME that I would do better on a bilevel machine and was moved to a ResMed AirCurve 10 vauto on August 26. During that time I came down with Covid which really messed with my lungs. I also have Asthma. My blood oxygen runs typically from 91 to 96 while sleeping. With those complications it has been difficult finding machine setting that work. Last night my events per/hr were over 86 with most being CA events. It seems if I allow the machine to gain too much pressure my CA events soar.
Any feedback would be appreciated, especially in the machine settings that may work for me. I could attach Oscar screenshots or copies of sleep/titration if desired.
Setting for last night are:Mode
VPAPauto
Min EPAP
5.00 cmH2O
Max IPAP
13.60 cmH2O
PS
7.80 cmH2O
Antibacterial Filter
No
Climate Control
Auto
Essentials
On
Humidifier Status
On
Humidity Level
4
Mask
Pillows
Ramp
On
RE: Very high events per hour - staceyburke - 09-02-2021
Please DO attach Oscar it is the only way we can see what is happening. Check out what CHARTS to include in my link to charts ( in my signature).
RE: Very high events per hour - Gideon - 09-02-2021
Please, Please, please post your OSCAR nightly charts.
Also, post full (redacted) copies of your sleep studies.
Why is your PS set to 7.8? Asthma? That is unusually high.
Tell us all you can about your asthma, This can significantly impact your machine choice, with a different BiLevel being better for you. I don't know which is why we need more info.
We NEED to understand the nature of your centrals, a 10 minute zoom of a couple of the clusters wl help us with that.
See the organize link in my signure for details of what to provide in the standard chart.
RE: Very high events per hour - Ron Poelstra - 09-02-2021
[attachment=35337][attachment=35336][attachment=35335]
Thanks for responding. As for the high PS setting, I am just trying to understand how to reduce my events, obviously going the wrong direction. I had asthma as a kid and just periodically since. When covid hit it has gotten a bit worse, controlled mostly with Flovent HFA.
[attachment=35339]
Part 2
RE: Very high events per hour - Gideon - 09-02-2021
Increased PS can be to manage your asthma, you have eliminated this reason.
The other is to possibly support difficulty breathing because of Covid. Is this the case? I suspect it is just you dial winging.
Assuming that you are not using your bilevel to support either your asthma or Covid, and it is very important to see your sleep studies, full copies, including tables and charts .
Try setting PS=1. PS is the most likely cause of your high centrals and the reason for a 10 minute view of your flow rate, yours was 39 minutes. This is because, if I'm right, you are flushing too much CO2 out of your system resulting in clusters of CA events. I am not confident in the reduction of PS working for you but your PS is way too high for you if you are not treating other pul.onary issues, asthma, Covid, with it. Your studies indicate that this may be ideopathic, unknown cause, and require an ASV for treatment.
RE: Very high events per hour - Ron Poelstra - 09-02-2021
I have tried to attach a pdf of sleep and titration, but the system says I can't.
Thank you again for the reply. I will adjust the PS to 1. Let me know how to proceed with the studies, so far no joy.
RE: Very high events per hour - cathyf - 09-02-2021
(09-02-2021, 01:44 PM)Ron Poelstra Wrote: I have tried to attach a pdf of sleep and titration, but the system says I can't.
Thank you again for the reply. I will adjust the PS to 1. Let me know how to proceed with the studies, so far no joy.
If you have the pdf open on your computer, you can take a screenshot of it and then attach the screenshot. (If you don't know how to do that, tell us whether you are using windows or mac and we can help you out.)
RE: Very high events per hour - Ron Poelstra - 09-02-2021
[attachment=35349][attachment=35350][attachment=35351]
Thanks again for all the replies and help!
RE: Very high events per hour - Ron Poelstra - 09-02-2021
I have evidently reached my attachment quota?
RE: Very high events per hour - Sleeprider - 09-02-2021
Ron, your apnea was predominately central when you did your sleep test, and it is completely off-the-chart bad with the pressure support you are using now. You need to go back to a basic CPAP approach and take the pressure support out of your therapy as suggested by Gideon. Pressure support increases ventilation and washes out CO2. This will always exacerbate central apnea. I'm going to suggest you set your Aircurve 10 Vauto to some very simple pressures. Mode Vauto, EPAP min 5.0, Max IPAP 10.0, PS 2.0, Trigger sensitivity very high. Normally, I would eliminate pressure support altogether, but we have found the trigger sensitivity on high or very-high can help trigger breaths.
You need to plan on contacting your doctor on your results, which are much worse than the baseline diagnostic test. Treatment is making your central apnea worse! You will need to be evaluated for Adaptive Servo Ventilation (ASV) which is the treatment of choice for central apnea and mixed central/obstructive apnea. Please discuss this with your doctor as soon as possible. Your response to therapy is such that you should discontinue the therapy until a more appropriate bilevel with backup is prescribed. ASV provides pressure support on a breath by breath basis to maintain your respiratory rate and volume. When you don't take a breath spontaneously, the machine increases pressure support to inflate your lungs. Your current therapy settings are disastrous, and you need to request a bilevel titration with ASV.