Graduating from Bi-pap to ASV (maybe)

[Fred D]

Just returned from meeting with my sleep doc and going over the results of my tests. Starting with the first visit where I used Bipap only.

The respiritory paragraph states:
The patient was observed to have had a total number of 98 resp. events with an AHI index of 15.5 per hour during total sleep time. The REM AHI index was 16.1. The normal AHI index is less than 5 per hour.There were 25 obstructive apneas, 6 mixed apneas, 36 central apneas, 31 hypopneas, and 4 RERA's. The total RDI was 16.1 Mild to moderate snoring was noted prior to Bipap increases.

The Bipap Pressures: Bipap was initiated at the beginning of the study on a pressure of 8.0/4.0 cmH2O. Bipap pressure was increased to a pressure of 16.0/11.0 cmH2O. A possible optimal level was not achieved where respiratory events and desaturations were eliminated. Bipap was not succesful in treating this patient. Bipap was tolerated.

What I found interesting is the graph that shows the number of events with each stage of pressue increase that they tried. The pressure at which my bipap machine I have now is set (14/10) had the most central events (8) of any pressure tried during the test

Now for the ASV report:
Respiritory: The patient was observed to have had a total number of 2 resp. events with an AHI index of 0.3 per hour during total sleep time. The REM AHI index was 0.0. The normal AHI index is less than 5 per hour. There were 0 obstructive apneas 0 mixed apneas, 1 central apnea, 1 hypopnea, and 2 RERA's. The total RDI was 0.7 Mild snoring was noted prior to pressure increases.


ASV pressures: Auto Servo-Ventilator was initiated at the beginning of the study with a max pressure support of 18.0 cmH2O, a min pressure support of 8 cmH2O and an epap of 5.0 cmH2O. The pressures were increased to a max press. support of 23 cmH2O, min press. suport of 13.0 cmH2O and an epep of 13.0 cmH2O Auto servo-ventilator was tolerated. Final VPAP pressure was achieved in supine position in stage R sleep.

So, that's it in a nutshell. She recommends the asv with max press. 23.0, min. press. support 13.0 and epap 13.0
with heated humidifier.
Any thoughts or is there more I need to find out? There is more data on the report but my typing skills are such that I would be here all day if I tried to input all of it.lol

[JohnBFisher]

I'm not 100% sure about the numbers. But it sounds as if ASV will definitely make a difference for you.

You will want to request a copy of your prescription. It's all too common for the DMEs to mangle your prescription. So, when you get your machine you will be able to check the settings. I do not recommend anyone with an ASV unit changing them without discussing it with your doctor. But we've had several cases where the settings were completely mangled by the DME. There is a lot more to set and if not done correctly it only makes matters worse.

Also, you will want to request a full copy of your sleep study report.

[Fred D]

Hi John,
I had copies of both the first study with the bipap and the second with the ASV made before I left the doctors office.
I don't know which machine will be the one I use yet. I slept with the Respironics model at the lab so maybe that will be the one they bring.
She said it would be one that records the activity during the night and able to be downloaded to a computer when I asked her about it.
Haven't had any experience with a humidifier. Reading other posts, it seems it can be a love/hate relationship.

The DME remarked to me during an earlier conversation that they did not keep this type of machine in stock and would have to order it.
Living in Houston, I am hoping they mean order it from a place here close and not have to wait for it to be shipped from another part of the country.

The doc was sure quizzing me about whether I had any heart problems or congested heart failure and listened to me breathe through her stethoscope to make sure. Said that can be a contributing factor to this type of apnea. Anyway, she seemed satisfied with what she heard
and I wasn't too worried. The G.P. doctor listened to my breathing and gave me an EKG last month when I was at his office. Plus he has me coming back this Spring to do a full-blown stress test.

Fred

[JohnBFisher]

... She said it would be one that records the activity during the night and able to be downloaded to a computer when I asked her about it. ...

They both do. ResMed requires a null modem cable to serial or USB interface. Respironics uses a SmartCard to record the data. But it's a good sign that she wants to see the data.

... Haven't had any experience with a humidifier. Reading other posts, it seems it can be a love/hate relationship. ...

Depends mostly on the relative humidity. I live in a fairly humid area. Houston area is also fairly humid. If you lived more toward the pan handle / arid area you wold REALLY need it.

The secret is that if you increase humidity it can cause congestion. Of course if you decrease the humidity it can cause congestion. Wait! What did I just say? BOTH cause congestions No way!

Unfortunately, that is exactly the case.

... The DME remarked to me during an earlier conversation that they did not keep this type of machine in stock and would have to order it. Living in Houston, I am hoping they mean order it from a place here close and not have to wait for it to be shipped from another part of the country. ...

Even if it is quite a ways away, with shipping these days you won't wait long.

... The doc was sure quizzing me about whether I had any heart problems or congested heart failure and listened to me breathe through her stethoscope to make sure. Said that can be a contributing factor to this type of apnea. ...

Congestive heart failure and cardiac problems is the most common reason for someone having problems with central apnea. Essentially without any heart problems you are in a vanishingly small percentage of a vanishingly small percentage. If you take all the people who have problems with apnea, only about 5 percent have problems with central apnea. Of that percentage only a small percentage (unknown number, but I suspect about the same - 5 percent - but no one has studied it, to the best of my knowledge) have central apnea without heart problems.

So, if you have problems with central apnea it is always wise to check on possible heart problems.

... Anyway, she seemed satisfied with what she heard and I wasn't too worried. The G.P. doctor listened to my breathing and gave me an EKG last month when I was at his office. Plus he has me coming back this Spring to do a full-blown stress test. ...

Understand the situation. Same thing happens for me. Now I am not in the best shape, but my doctors keep wondering how I do what I do. Essentially they seem to think that if I am this overweight I must also have cardiac problems. They think I get winded just walking to my mailbox. I explain that I walk a mile or two almost every day. (Well, not recently due to a foot injury). But they keep thinking (even unconsciously) that it is linked to cardiac problems. So far, it does not appear to be connected.

We have a few others here without any underlying heart problems, so it happens. It's just a smaller percentage.

Anyway, best wishes with your new unit. You might want to request a prescription for the Ambien to get used to the new machine.

[dsm]

>>
ASV pressures: Auto Servo-Ventilator was initiated at the beginning of the study with a max pressure support of 18.0 cmH2O, a min pressure support of 8 cmH2O and an epap of 5.0 cmH2O. The pressures were increased to a max press. support of 23 cmH2O, min press. suport of 13.0 cmH2O and an epep of 13.0 cmH2O Auto servo-ventilator was tolerated. Final VPAP pressure was achieved in supine position in stage R sleep.

So, that's it in a nutshell. She recommends the asv with max press. 23.0, min. press. support 13.0 and epap 13.0
<<

Fred,

Good to hear how well the ASV went at dealing with your SDB. That is quite impressive.
Again John has offered a good summary.

Can you ask what model of ASV you were titrated on
-Bipap Auto SV
-Bipap Auto SV Advanced
(I am assuming you weren't titrated on a Vpap Adapt SV even though you mentioned the accronym Vpap )

The settings you have mentioned sort of lean towards a Bipap Auto SV (standard model).

Cheers & Good luck

DSM