New member. Help with hypos

[SarcasticDave94]

OK, I'm going to suppose these will be treatment emergent Central Apnea that would show up regardless of machine. You had zero Central before pressure, then they appear during pressure being introduced.

Remind me, how long have you been on therapy? While treatment emergent CA shouldn't last much past the 3 month mark, some may linger further out.

The ASV would treat even these treatment emergent Central Apnea, however shouldn't be necessarily required. The ST-A still comes across as very overkill, with actually fewer options to give therapy that you need. Yes, the ST mode appears to treat the Central component, but that leaves you with Hypopnea in moderate sized clusters.

Let's see a recent sample of OSCAR with just these: Events, Flow Rate, Mask Pressure, Leaks, Flow Limit. A full night not zoomed and with left panel set on your summary.

I'm still not convinced there's any need for the ST-A for treatment emergent Central Apnea. It seems as I mentioned before, very overkill and lacking actual settings based on your needs.

[Hosemaster]

I think this is what you asked for. I started APAP in July with a max of 15 and was switched over to the ST-A in December set at 15/11. They originally wanted to give me a regular BIPAP but I was worried about centrals and this machine has the backup breath. Have you heard of treatment emergent CAs going away on their own after five months?

   

[SarcasticDave94]

Yes, for some to most, treatment emergent Central Apnea will resolve itself as your brain adjusts to the slightly additional pressures a CPAP causes typically in 3 months. What this does is flush out higher CO2 than the body calculated as your normal. Low CO2 tells your brain you don't need a breath yet, so there's a longer pause. And a 10 second breath hold like I just described is flagged as a Clear Airway/CA.

As I said, the medical team tried to help, but too much I still think. You asked for help with the CA and they jumped to ventilator ST-A running ST. They could have also given you old school CA therapy called ST with the same ST mode you've got now in a less expensive machine. Both ST and ASV have breath rate timing which is helpful in elimination of any type clear airway or Central Apnea.

If you're up to an experiment, I'd suggest a few minutes on your ST-A set to CPAP, which here will be static pressure. Try your current EPAP 11 or so. Endure it enough to record at least a few minutes. Then as needed, switch back to your full current ST setup. The goal is to see what happens when you run CPAP. Look to see if CA appear.

For the record, I think either VAuto which is a standard Auto bilevel, or if pressed because of a too high for you to accept the treatment emergent CA, ASV would be second choice. I still think ST-A is overkill for your need, mostly because there's the other 2 that'll deliver pressure ranges that will be more comfortable.

[Hosemaster]

For some reason my RT suggested a full-face mask to treat some of the hypos. Does that make sense to you? It took me long enough to get used to the nasal pillows and chin strap without strapping more silicone to my face

[SarcasticDave94]

I don't think switching to full face affects events much unless your current masks are leaking uncontrollably. In my opinion, probably more somewhat misguided suggestions from your medicals. They're just not coming off with vibes of being bright lightbulbs. No offense.

If you're after more Hypopnea control, the clinical guide would say add 1 cmH20 IPAP and view results, repeating the increase until they lower.