Your opinion please

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
scottyl
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Joined: Sun Apr 15, 2018 7:15 am

Your opinion please

Post by scottyl » Sun Apr 15, 2018 8:13 am

Hi,

I'm new here and seem to be having a bit of trouble uploading my charts.... do ok with one at a time so I'll just start with this;
I have several machines, the latest one being a Respironics series 60 AVAPs.
The read-out doesn't seem to have the capacity to break down the flow rate... but there are clearly problems:
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scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 8:24 am

Another machine I have is a ResMed 10 Bi-pap w/ ST.

Since I can't seem to get detailed info with the AVAPs machine I go to this one and turn the ST function off to try to get apnea lengths etc.

Here is one sample:
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scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 8:25 am

A close-up of a typical breathing pattern:
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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 8:27 am

What is your diagnosis?
Why this model machine?
What other machines have you tried...and why?
We are missing a lot of history that is real important here. Apparently you have other stuff going on more than plain jane vanilla obstructive sleep apnea.

Is your doctor aware of these results?
I may have to RISE but I refuse to SHINE.

scottyl
Posts: 17
Joined: Sun Apr 15, 2018 7:15 am

Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 8:51 am

Hi, and thank you for the reply.

I started with a ResMed Aircurve 10 auto cpap based on a sleep study which was believed to indicate OSA.
This autopap was not adequate so they switched to a Air Curve 10 Bi-PAP.

AHI's were still very high, and in the meantime my wife would complain that I would just quit breathing during the night.

I was switched to an Aircurve 10 Bi-PAP/ST.

This worked out well for a little bit, then we moved and I switched doctors. The new doctor claimed that I didn't need the ST function so I was switched to another plain Bi-PAP.

No good... AHI's stayed in the twenties and thirties and frequently in the 50's and 60's for periods through the night....

Then the Respironics series 60 AVAPs.

Yes, my doctor is aware of all of this but that is a long story in itself, so.... I can share it but I was hoping to get some feel for what anyone thought, just based on the readouts, before I went into the whole story.

Official diagnosis, as far as sleep goes, is still OSA... but that, to me, is clearly not the case.

scottyl
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Joined: Sun Apr 15, 2018 7:15 am

Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 8:57 am

I'll try to put up a whole chart for a typical night with the AVAPS:
Sorry... it's kind of in sections....

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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 9:02 am

Do you still have all these various machines in your possession?
If not which ones?
And the AirCurve 10 machines don't have "bipap" in the model name...bipap is actually a Respironics model marketing term.

I think part of your problem is the pressure support (the difference between inhale and exhale)...
and you are changing brands which means each brand has their own way of doing things and you are playing with some fancy modes there.

I don't see anything that leads me to believe you need AVAPS...man that's like using the atomic bomb to kill a fly..

So I think that part of your issue is that EPAP is a bit too low and your PS is a bit too high.

Tell me what model machines you have on hand...and I will come up with some sort of idea to try.
I may have to RISE but I refuse to SHINE.

TedVPAP
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Re: Your opinion please

Post by TedVPAP » Sun Apr 15, 2018 9:09 am

The detailed data clearly shows that your OSA is not adequately treated. You need more pressure.

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scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 9:10 am

I suppose I would consider this my pretty standard "good" sleep.....
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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 9:14 am

I have an idea....using the ResMed AirCurve 10 ST which you used last night.

Stay in S mode like you did...I see no need for a backup rate which is all that gets added in the S/T modes.
I see no need at this time for such a big PS number either.

Increase EPAP to 8 and lower IPAP to 12 and see what happens.
I may have to RISE but I refuse to SHINE.

scottyl
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Joined: Sun Apr 15, 2018 7:15 am

Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 9:16 am

Pugsy;

I have all of these machines on hand....
The one I use the most is the AVAPs.
I only switch to the Resmed to get a detail of the flow rate...

I just use the term Bi-PAP because it is what I know that is easy.... the resmed that I use sometimes is a bi-level with ST... though as I said, I turn the ST mode off to get the intervals and lengths of any apneas.

scottyl
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Joined: Sun Apr 15, 2018 7:15 am

Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 9:20 am

Guess it's time for a bit more history...

I have messed with these settings for many months now and have kind of settled on about 6 and 12..... once the ipap goes up over about 7 or 8 the central events go way up.... same with the epap... once it is over, say 13, the AHIs go way up.

I saw a different pulminologist and he recommended I try about a 10 on the IPAP....
I did and my average AHI was like 39 or so..... mostly central events (according to SleepyHead)

scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 9:21 am

Sorry, that was backwards.... a 10 on the EPAP.....
His thought was to reduce the obstructive events.... which it di but then the centrals took over.

scottyl
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Re: Your opinion please

Post by scottyl » Sun Apr 15, 2018 9:27 am

The AVAPs is set on 6and 12 with a max IPAP of 30.
Tidal volume was at 460, which seems about right for me... 5 foot 5...

Since I switched to the resmed for the flow rate chart I noticed that the AHIs went way down....
Unfortunantly I also noticed that the tidal volume tended to be anywhere from 180 to 300 or so.

So... I turned the tidal volume down on the AVAPS to about 420 and that brought my AHI down to about 18 or so for a few days, then it crept back up..

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Pugsy
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Re: Your opinion please

Post by Pugsy » Sun Apr 15, 2018 9:46 am

The general rule of thumb but remember it's a very general rule and there's more than one way to get a job done.

EPAP for OAs
IPAP for hyponeas

but sometimes we increase EPAP a bit so that IPAP gets pushed up because too much PS just to kill hyponeas can cause the breathing instability that manifests itself as centrals. With PS too high people can blow off too much carbon dioxide and the blood levels don't get high enough for the brain to send the trigger to breathe. It's actually carbon dioxide levels that are the driving force for the brain to send the breathe signals.
We can't just go having a really high IPAP and a low EPAP to deal with hyponeas...doesn't work that way. That's why we use EPAP even if all a person had was hyponeas.

If you are hell bent on using the AVAPS....your PS of 6 something is too high and your EPAP is too low.
Respironics machines historically respond slower to anything. You are going to need more pressure with the Respironics machine than with a ResMed machine....assuming same machine models.
I may have to RISE but I refuse to SHINE.