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Last night I tried 6.0 EPAP and 12.0 IPAP and turned off flex from 3. Yesterday I posted my redacted sleep study which I think you missed with all the comments on redaction. I've posted Oscar from last night. In my sleep study flex wasn't included and I titrated at 4 epap and 9 ipap. Flex isn't shown in Oscar that I can find for my machine and I know Oscar shows it for my son's ResMed machine.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
jwann, I went back and looked at the sleep study. You were titrated to bilevel with EPAP at 4.0. At 8/4 pressure events were mainly CA and during titration at 9/4 you had no events. What I'm seeing is that under bilevel therapy you are having central apnea events which were inconsistent during the study. It may be a coincidence that you had no events at 9/4 rather than a successful titration. We have seen these kinds of results before, but usually a test progresses through more pressure trials than the two you were tried on. I still think you need to let your doctor know that the therapy pressures you were prescribed are ineffective and result in numerous mixed and central apnea.
When you changed your pressure in the most recent chart to 12.0/6.0 you increased the pressure support, and predictably central apnea increased. We really need to cut that back! My recommendation of 9.0/6.0 will give you the same IPAP pressure that you titrated for, but a lower pressure support (higher EPAP) which should help with the events you are experiencing. Please reduce your IPAP to 9.0.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Sleeprider, thanks for the detailed explanation. I’ve let my doctor know what I’m experiencing. I’m changing the pressures to 9.0 IPAP and 6.0 EPAP. Could it be that flex lowered my pressures as wasn’t part of the sleep study and I need to go back to 9.0 and 4.0? I couldn’t find flex noted in my study. Thanks for the help.
Hello Jwann. I was going to reply to your post regarding specific machine brands. However, as Sleeprider and others have recommended ASV I'll step back and defer to their expert knowledge. Hopefully they can also guide you through the process of moving up from BiPAP to ASV.
Jwann, BiFlex on your machine works to smooth the transitions between EPAP and IPAP and can drop pressure slightly. I found a high BiFlex setting was not good to me, but I could tolerate 1 or 2 pretty well. I don't think that is what caused the large numbers of CA events. Your sleep study showed you had CA events at 8/4 pressure, and in the presence of CA events, I was surprised that the titration choice was to increase IPAP. Normally the presence of CA during titration should cause the technician to reduce IPAP (pressure support). The technician was not following normal titration protocols and the results do not appear valid or logical. I will attach a titration decision tree below and you can see for yourself what is supposed to happen. My suggestions for your pressure is based on these protocols from Philips and Resmed based on AASM Manual Titration Protocol.
Your results on BiPAP do not reflect the results obtained in the sleep study titration. Your central apnea event rate is very high and the appropriate response to this is to schedule a titration for ASV. This will be based on the same rationale used in your last sleep study where you did not tolerate CPAP and had "unresolved events". You need to discuss with the doctor that you have severe "treatment emergent central apnea". The next study will refer you back for titration on ASV. Aside from the process, when your next machine is dispensed, please express a preference for Resmed. We really do see better results as compared to the Philips Dreamstation series.
Note:
• Establish initial settings as indicated or as ordered by physician
• Initial BiPAP S settings may be adjusted to patient condition or severity
• Bi-Flex may be adjusted to patient comfort
• If central apneas are observed consider decreasing pressure for 20 minutes; if still present consider switching to BiPAP autoSV Advanced protocol
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
My API went to 3.5! I've attached Oscar from last night. Let me know if you recommend further changes. Once things have stabilized and we've decided between BiPAP and ASV then I'll request a new machine from my DME. Either the ResMed Aircurve 10 vauto or Aurcurve 10 ASV. My body is still getting used to the pressure but this seems much closer.
I would like you to hold at this pressure for now. The events at the end of the night can be discounted as sleep/wake junk, but the body of the night looks very good. In fact aside from that cluster and the one at the beginning of the night, your AHI is about 1.0.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
