Please Help Me With My Settings.

[Expat31]

Hello, 

We really need some background information from you before being able to start to help.

Your graphs are not too much help at the moment, certainly no real evidence of leaking, and only a very short segment of apparent sleep. 

Can you post some details of your sleep study, ideally a redacted version of it, and your prescribed initial settings? 

Also can you explain what type of masks you may have tried, and any difficulties experienced. 

Thanks.

[shallbreathe]

Thank you, Expat. This was my inital sleep report:

Diagnosis
Obstructive Sleep Apnea (G47.33) - Severe based on pAHI=46.8 and O2 nadir of 79%
Central Sleep Apnea (G47.31) - Mild based on pAHIc=9.9

Recommendations
1) An in lab titration study and/or sleep specialist referral is recommended. Clinical correlation is
recommended to
determine if evaluation for cardio/neuro etiologies of central apnea is indicated.
2) If not feasible or refused, a trial of Auto-CPAP set 4-20 cm H2O with heated humidity and mask/in-
terface fitting.
Close follow up and monitoring is recommended in 4-6 weeks to adjust pressures if necessary. If central
apneas
worsen, an in lab titration and/or sleep specialist referral is recommended
[plus some other recommendations that I left out because they sound like some basic generic suggestions. Lose weight if necessary, etc.]

RDI 48.6 per hour
Snoring 10% of sleep time > 40dB
Oxygen Saturation 79% min o2, 92% average o2 saturation
True Sleep Time: 5 hours, 44 minutes
Sleep Stages: 78.59% light sleep, 14.79% deep sleep, 6.62% REM Sleep

AHI
Hourly Events 46.9
Total Events 269

RDI
Hourly Events 48.6
Total Events 279

Oxygen Desaturation
Number of Events
243 (4-9%)
7 (10-20%)
0 > 20%

Body Position Stats
Position       Back          Stomach         Right          Left
Sleep (mins) 187.0            0.0              127.5         40.5
Sleep %       52.7             0.0               35.9          11.4
RDI             48.1             N/A              45.5           60.5
AHI             46.1             N/A               43.6          60.5
ODI             43.1            N/A               39.8           57.4

Additional info that might be of interest:
I live in high elevation (over 5500 ft)
My choking-type obstructive apnea seems to have disappeared over the past few weeks. This was followed by a couple of weeks jerking awake quite startled at the onset of sleep. (Both with and without CPAP.) I eliminated all supplements and sleeping pills, and now I seem to be able to sleep with minimal jerking awake, but only for 2-3 hours at a time. (Again, both with and without CPAP).

I'll post my latest OSCAR info where I finally slept for more than a couple of hours with CPAP.

[shallbreathe]

So I finally was able to sleep with the cpap for more than 3 hours last night. (I only really started sleep after 2:45, the stuff prior to that is junk from me fiddling with settings.)

I seem to have no OAs, just all CAs now.

One thing I'm wondering is if these are "true" CAs due to my altitude, or a different type of CA that are treatment emergent. Is there any way to tell? Most of the CAs look like this:

   


Thank you for any insight or recommendations.

The OSCAR data:
   

   

[shallbreathe]

Second night on BIPAP and really struggling to figure out where to go with settings. Have switched from CPAP due to difficulty with breathing against pressure. 

Currently using nasal pillows and tape. Last night's chart shows a giant gap due to insomnia that typically occurs between midnight and 4pm. These days I'm getting about 3 hours of sleep daily. I hope you don't might the small amount of data...this is all I'm actually sleeping so it's all I have to work with.

About a month ago, I was orignally diagnosed with severe apnea (>40 ahi), most of it obstructive, with a small amount of central. I do live at altitude (over 5000 ft) but on the CPAP I was able to get that down certain nights to nothing on pressure 9.4, max 11.0, epr 3.

Starting BIPAP, the centrals have reared their head again.

Some details:


- The 30 minutes I had at the start of the night had fewer incidents but I felt terrible upon waking up after a 30 minutes or so:
    max IPAP 10     min EPAP 6.4     PS 2.0      TiMax 2.75      TiMin 0.25       Trigger Medium
- Remainder of the night post-insomnia gap is what is shown on Oscar (I guess Oscar will only show you the last settings you used)
    max IPAP 8.5    min EPAP 4.0     PS 2.0       TiMax 3.00      TiMin 0.2        Trigger Very High

I was able to sleep a bit in the latter half (maybe 1-2 hours total), but I kept getting chipmunk cheeks due to a small hole in the mouth tape.

   

Do I really need to tape shut the mouth as tightly as possible? And are the chipmunk cheeks/blowing through the mouth the possible reason for all the centrals? For some reason the "hole" wasn't a big issue with the CPAP. With BIPAP though it seems the seal needs to be as tight as possible or air starts accumulating in my mouth.

I'm working on getting a collar and possibly a chin strap to see if anything changes.

Thanks for any help!

[SarcasticDave94]

This should have been added to the therapy thread as a continuation. History is all over there.

Please go to your user profile and edit machine at least so we know what you're on at a glance, thanks.

1. Your settings aren't giving you any benefit of bilevel VAuto over AutoSet as it is now, except for Trigger that AutoSet's don't have.

Your pressure is too low to treat much at 4 - 8.4 and PS 2.

2. Your Ti timing probably needs to go back to default. I think it's 0.3-2.0 like mine. I certainly could be wrong though. I'm just now beginning to trial my new VAuto, and I'll have some to a lot of CA as well, probably anyway.

3. Trigger very high is correct for the CA flagged. Regardless your CA are too high to accept if they can't get resolved. I almost want to say you'd be better off on ASV to treat those CA.

4. I could be wrong but I think your mouth air issue is lacking a tongue seal. My ASV went to Max IPAP 25 on full face mask and didn't deal with the mouth filling with air, at least not aware of it. I wasn't taping either, which was why I did full face anyway.

[shallbreathe]

Thanks SarcasticDave! I've changed my profile and will ask the admin to append this to the last post. I'm just now realizing it is one therapy thread per person, apologies.

Can I ask why you're moving to VAuto from ASV?

In my case, Lofta says getting an ASV will be difficult...I guess there are numerous tests I'll need to go through before I'm cleared for that, apparently. I'm considering just buying one refurbished from one of the major CPAP sites if this Bipap doesn't work out. (I can probably get a prescription but the extensive tests I'm not sure if I can afford right now.) The issue is I won't be able to return it so I'll have to cross my fingers if it gets to that point.

In the meantime, I'll keep chipping away with the Bipap.

Your pressure is too low to treat much at 4 - 8.4 and PS 2.

Thank you. I thought the lack of obstructive apneas meant I was being treated...I guess I was confused. I'll try a step higher. I don't know if lowering the PS even further will help the CAs...but I'll give it that a shot.

I'll also bring down the TI back down.

Appreciate the feedback, thanks again.

[SarcasticDave94]

No worries on the thread issue. It's not a rule of one therapy thread per person, just for that continuity sake.

My change? I had ResMed AirCurve 10 ASV from 2017-19 for high predominant Central Apnea, like 124 CA vs 24 OA. I also have GOLD 3 COPD/Asthma. July 2019 I was hospitalized for pneumonia, September treated for bronchitis. After those 2 issues, ASV didn't sync with my breath patterns any longer. Although higher level than VAuto, ResMed ASV has only Auto timing controls like Trigger, Cycle, Ti anything. I might have been able to shape timing to help, if ASV had them. My DME RT at the time said I needed full ventilator failing ASV. Dopey doctors used between 2019 to 2023 disagreed, and pulmonary function test didn't prove need to go onto ventilator.

New neurology sleep medicine doctor at Johns Hopkins tested me once again in lab sleep study. Some CA but not as much as before. She's wanting to see where I'm at after being no PAP 4 years. Hence VAuto, though she did want me only on S mode first. I mentioned the disruptive behavior I felt from ST during the sleep study, so she edited the order to VAuto but trying S sometimes.

Anyway, I really have forgotten. Has a higher but smaller pressure range agreed with you? Something like 6-9, 7-10? I would do PS 3 to help give more exhale differential, unless it failed you somehow.

[shallbreathe]

What a journey you've had. Hope VAuto will resolve those issues for you.

Thanks, I'll try the smaller pressure range. I think the higher I put the PS the worse my centrals get, but I realize there's a lot of overlapping factors here I'm still uneducated about so willing to keep tweaking that PS in either direction.

[SarcasticDave94]

Higher PS can affect CA, yes that's true. Given that CA has a stubborn, contrary attitude, they might respond well for you with that. I suppose try it and if it goes bad switch it back to last known good.

[OpalRose]

shallbreathe,

Your threads have been merged per your request.