87 yo fem trying to use Respironics BiPAP unit

[Mike Mitchell (Artimus60)]

Greetings all,

If you think you might have some words of advice for a guy trying to help his elderly mom get a handle on effectively using a Respironics BiPAP AutoSV Advanced unit, please read on - we're about 6 weeks into our Sleep Apnea adventure so I'm not a complete newbie but I'm sure my tentative grasp on this crazy stuff will become apparent if you read my story. I am past the innocent stage of assuming that you just plug in the box and slap on the mask and it works its magic (maybe that happens with some folks but I don't think we fall into that category). I was tremendously heartened to run across this forum and I've been observing for a few days but I think it might be time to speak up. Here goes nothing!

In Short
My mom has been diagnosed with sleep apnea, we started with a CPAP machine which didn’t help much, and we’re now using a BiPAP machine that also hasn’t improved her symptoms very much. I’m trying to be patient and have realistic expectations but the pace at which we’re progressing seems to be frightfully slow. At the outset, I wrongly assumed that we’d just turn on the device, use it consistently, follow the instructions, and we’d be on our way. So you’ll note that I’m playing a little bit of ‘catch up’ as far as gathering and understanding the data as it relates to my mom’s treatment.

Me
I’m not conversant with computers and software at the code level but I’m not spooked by technology and I don’t mind rolling up my sleeves to solve a PC, software, or OS issue if it comes to that.

Our story so far:
CPAP
My mom was initially diagnosed with severe sleep apnea a couple months ago. She has a long list of symptoms that loosely fall under the general heading of 'exhausted all the time'. After a sleep study the Clinic sent us home with a CPAP machine. After using it faithfully for a couple weeks it appeared to me that she was still displaying what looked to be sleep apnea (she stops breathing followed by gasping to catch up), but now she was doing it with a mask on her face and a CPAP machine attached and running. The Sleep Clinic looked at the data compiled during this two week period and suggested a 2nd sleep study.
BiPAP
This time they said it appeared her particular malady (or set of symptoms) would most effectively be treated by using a BiPAP machine. They sent us home with the above listed Respironics unit – we’ve been through a couple masks and we’re now on a Resmed Quatro Mirage (I have some questions regarding the mask but I think I’ll post them in another msg to try to keep this from being TheLongestPostEver). We’ve had two follow up appointments since starting with the BiPAP machine and they’ve tweaked the settings both times. I know this isn’t a detailed enough description of the adjustments that they’ve made to the unit but they increased the various pressures that the unit responds with dependent upon my mom’s breathing. The first time in they bumped it up a little bit and last time (a couple days ago) they increased the pressure significantly. As you can probably tell by the lame descriptions of the adjustments that they’ve made I’ve only recently come to the realization that I need to have an intimate understanding of how this device works and how it needs to be best set to be therapeutic for my mom. I was assuming that the doctors would do the heavy lifting that that we’d just make sure that we used the machine as told. I’ve finally gotten it through my thick head that this probably isn’t going to work unless I proactively interact (or at least understand) the BiPAP machine and that I need to understand how to get the stats and how they reflect on my mom’s well-being. I don’t want to alienate the doctors and (worse yet) bung up the adjustments by blundering in without knowing what I’m doing but I think we’ve been fairly patient and we’re still not seeing a lot of improvement. The sleep doctor said that my mom was having something like 45 apneas in hour before adjusting the unit the first time and that it improved to 35 apneas during the use period after the adjustment. The second adjustments were only made two days ago but to my eyes she appears to be having approximately the same amount of apneas as before (or perhaps more!). I know that 2 days isn’t a great sample size and my impressions are somewhat anecdotal because I don’t know how to retrieve that actual data. The doctors also talk a lot about an ‘adjustment period’ during which the user’s behavior and body adjust to what the BiPAP machine is doing and I doubt they would consider 2 days a sufficient adjustment period.

Questions:
Can I retrieve statistics like ‘average sleep apneas per hour’ and ‘total sleep apneas per usage period’ through the Resperonics unit’s display screen? The doctors have firmly implied that gathering and evaluating stats is their domain but I’d feel much more comfortable being able to monitor how things are going and to gauge improvement. When I point out that my mom’s symptoms don’t seem to be abating they get awfully vague about what the data shows regarding improvement/lack of improvement.

If not, is there software and hardware (card reader) that I can use to this end?

Should I be knowledgeable enough to adjust the unit so it’s set up correctly for my mom or is this something that should only be attempted by someone with the proper medical training? Is the sleep doctor likely going to bristle (or worse yet, give us the boot) if I adjust the unit? Our doctors have been pretty cool but if I look at the results to date there isn’t much to celebrate. I’m trying to be reasonable and have a modicum of patience but my mom is suffering and I’d like her to have what she needs to have a decent opportunity to feel better. We’re not expecting miracles.

I’m not expecting anyone to lead me by the hand or spoon feed me every little answer but I’d be thrilled if anyone has faced similar quandaries and would like to share their experiences and advice. I’m also all ears if anyone has suggestions for other helpful sites or other information sources for folks that find themselves in circumstances such as ours. I’m really sorry about the epic post but I couldn’t find a way to shorten it while still including the relevant information. I promise to exercise a bit more brevity in my replies or any future posts. I haven’t had anyone to talk to or to lean on for support so it kind of all came flying out of my fingers when I sat down at my PC!

Thanks!

Mike in Seattle

[Maxie]

I can tell you that you have come to the right place and that people on this forum far more knowledgeable that I am will be able to help you. You are to be commended for getting involved in your mother's care as you are right, you will most likely be doing the "heavy lifting" in this case. Good luck and keep reading because I know you are going to get lots of very good advice for your situation.

[DavidCarolina]

I wish i could help you more, im on the verge of considering bipap myself and dont have enough experience to comment. But may i ask why the second study
indicated bipap but not the first?

Other questions are is she experiencing central apneas? And have you purchased a portable oximetry unit (about fifty bucks) to determine what her 02 level is looking like at night?

I assume they hope the bipap gives her muscles some help in breathing which would lead to better rest and less agitation and exhaustion.

Have they also recommended using 02 alongside the bipap to increase 02 levels, and does she have an oxygen concentrator to oxygenate during the day?

I've discovered that a small dose of clonazepam is very helpful with the daytime symptoms if she's struggling to breathe or anxious but im not sure of the implications for an elderly person.

[chunkyfrog]

I gather that she is coherent and cooperative, which is good, as maintaining a seal all night may require
some active participation on her part. For her comfort, may I suggest a mask liner,
as silicone on skin is not the best for frail, aged skin.
It should also help with noises (face farts) that might disturb her sleep.
Good luck with your mom. Sending love her way . . .

[mayondair]

Hello and welcome! Most don't see instant improvement, and with an elderly person using an ASV , it is not realistic to expect quick results, that said you are wise to keep an eye on things. Most see slow improvement over several months. Do you have a copy of her sleep studies? Do you know what the settings are. I wouldn't change anything, but having a look at the data isn't a bad idea. Not sure if Sleepyhead works with ASV, I'm pretty sure Encore Pro does. I'm not familiar with that machine, but someone who is will be along soon. As for mask comfort, you may want to look at Pad a Cheek liners, they help with the seal and are kind to skin. You'll get lots of help here kathy

[mayondair]

You may want to edit the title of your thread to BIPAP auto SV, you'll get ASV users attention, not plain old BiPap. Kathy

[LaurieP]

Mike, Welcome!!! You have come to the right place. I'm on APAP and I have been helping my Mom (72 yo)on BiPap with the help of this board. She was fighing at first but I do have her all settled in now with the correct settings and a mask that works great for her. It won't have been as easy if it wasn't for the great people here.

They will be along shortly to help you so stick around, you will be amazed with the help and knowledge!!

Laurie

[robysue]

Mike,

It would help us help you and your Mom better if you would take the time to register and also enter your equipment in your signature.

Some questions about stuff that needs a bit of clarification:

If you think you might have some words of advice for a guy trying to help his elderly mom get a handle on effectively using a Respironics BiPAP AutoSV Advanced unit,

The AutoSV Advanced is a rather expensive and specialized machine that is not commonly prescribed. It's fundatmental purpose is for treating Central Sleep Apnea (CSA) and Complex Sleep Apnea (CompSA) rather than the more run-of-the-mill Obstructive Sleep Apnea. It is also a bit unusual to be swapped from a CPAP directly to an AutoSV machine without a trial of a plain bi-level (BiPAP or BiPAP Auto) machine. But plain bi-level PAP machines are often prescribed to OSA patients who are having difficulty with adjusting to CPAP for a number of reasons. They are also commonly prescribed to CSA and CompSA patients whose insurance company insists upon "failing at BiPAP" before the insurance company will authorize a move to the much more expensive BiPAP AutoSV machines.

So the first thing is: Can you make sure you've got the machine correct? And the generation of machine correct.

Does your mother's machine look like this picture:

If so, then your Mom does indeed have a Resprionics BiPAP AutoSV Advanced of the "older" generation. And that machine uses a proprietary data card. (Keep in mind that the humidifier is NOT shown in this picture. The heated humidifier attaches to the front of this unit.

Or does your mother's machine look like this pictures:

If so, then your Mom has the newer PR System One BiPAP ASV machine. And this machine uses a standard SD card to store the data.

Next: Do you and your mother have copies of her sleep study reports? If not, that's were I'd start: Request the complete sleep study report with the summary graphs for the data in addition to the doc's dictated report. The whole report will typically run somewhere between 3 and 7 pages for each sleep study. And you need the reports for all the sleep studies your mother has undergone. This is important so that you can both better understand exactly what her diagnosis is and why the AutoSV machine has been prescribed---if that is indeed the machine she has.

If central apnea or complex apnea is not mentioned on any of the sleep studies, then it's important to find out whether your Mom is actually on an ASV (AutoSV) machine or just a plain BiPap like mine.

You also write:

We’ve had two follow up appointments since starting with the BiPAP machine and they’ve tweaked the settings both times. I know this isn’t a detailed enough description of the adjustments that they’ve made to the unit but they increased the various pressures that the unit responds with dependent upon my mom’s breathing.

Do you know your Mom's exact settings? Her prescription for the machine should include the settings. It's important to have a copy of the prescription for your Mom's medical records, although many sleep docs seem very reluctant to provide patients with written copies. They tend to strong arm you into just letting them fax the prescription over to the DME.

If your mom is using a plain BiPAP, then the clinical settings are the IPAP and EPAP settings; if she's got a an Auto BiPAP, the settings will be a min EPAP, max IPAP, and a PS setting. If she's using an ASV machine running in ASV mode, then in addition to the EPAP, there will be settings such as min IPAP, max IPAP, and a PS setting. There should also be a backup breaths per minute setting. As you read more here, you will get a better sense of what each of these settings is for.

In addition to the clinical settings, there may also be a number of patient-comfort settings that the doc may have specified on the prescription.

The first time in they bumped it up a little bit and last time (a couple days ago) they increased the pressure significantly. As you can probably tell by the lame descriptions of the adjustments that they’ve made I’ve only recently come to the realization that I need to have an intimate understanding of how this device works and how it needs to be best set to be therapeutic for my mom. I was assuming that the doctors would do the heavy lifting that that we’d just make sure that we used the machine as told. I’ve finally gotten it through my thick head that this probably isn’t going to work unless I proactively interact (or at least understand) the BiPAP machine and that I need to understand how to get the stats and how they reflect on my mom’s well-being.

Yes, it is sad that many sleep docs seem to prefer to keep their apnea patients completely in the dark about the machine's settings, how they are supposed to work for making therapy more effective, and how we seem to need to know nothing about our own statistics concerning our therapy. But the more we know, the better off we are in my opinion. So kudos to you for wanting to learn and help your mom figure this out.

I don’t want to alienate the doctors and (worse yet) bung up the adjustments by blundering in without knowing what I’m doing but I think we’ve been fairly patient and we’re still not seeing a lot of improvement. The sleep doctor said that my mom was having something like 45 apneas in hour before adjusting the unit the first time and that it improved to 35 apneas during the use period after the adjustment. The second adjustments were only made two days ago but to my eyes she appears to be having approximately the same amount of apneas as before (or perhaps more!). I know that 2 days isn’t a great sample size and my impressions are somewhat anecdotal because I don’t know how to retrieve that actual data. The doctors also talk a lot about an ‘adjustment period’ during which the user’s behavior and body adjust to what the BiPAP machine is doing and I doubt they would consider 2 days a sufficient adjustment period.

While it is true that there is an adjustment period, that usually means "adjusting to being able to sleep with a six foot hose attached to your nose and wake up feeling like you DID get some sleep instead of lying in bed awake worrying about the hose or just plain being uncomfortable."

In a high quality titration study, the pressure setting is determined with enough accuracy for the patient to expect that their treated AHI should be pretty low right from the start. It's not uncommon for folks with good titrations to have a treated AHI < 5 right from the start. However, there are people whose titration pressure is not sufficiently high (often caused by limited amounts of REM sleep or supine sleep with the mask on). And they often have problems with the AHI not being reduced enough on therapy until the pressure is adjusted.

In your mom's case: 45 apneas/hour on the diagnostic study does make her untreated apnea severe since her AHI > 30. (AHI is the apnea/hypopnea index; it is the average number of apneas+hypopneas per hour.)

Getting her AHI down to 35 apneas/hour is not much of a clinical improvement: That means that her treated AHI is still above 30---in the severe range. No wonder they docs increased the pressure. But the real question is whether her machine tries to distinguish between central apneas and obstructive apneas. And this is particularly relevant if your mom is indeed using an ASV machine instead of just a plain-jane BiPAP. The reason it's significant is this: Most folks who get put on ASV machines have real problems with either central apnea or complex apnea.

A central apnea event is scored on a sleep study when the the airflow into the patient's lungs drops to 0 L/min for at least 10 seconds and the patient is making no effort to breathe. Central apneas (CAs) occur when the brain forgets the send the signal to breathe. Obstructive apneas (OAs), on the other hand, occur when the patient is trying (desparately) to breathe, but no air is getting into the lungs because the upper airway has collapsed.

An OSA patient winds up with a diagnosis of Complex Sleep Apnea when their diagnsotic study has no or very few CAs scored; but once the patient is put on PAP, the patient starts to experience CAs. These "emergent CAs" are thought to be caused by the positive air pressure causing problems with the patient's ability to maintain an appropriate CO2 level OR the brain's ability to interpret the CO2 level. It's the CO2 level in the blood which is the trigger for nighttime breathing, and in CompSA, the positive air pressure is what causes the patient's probelms with emergent CAs.

Now some folks with emergent CAs eventually have their bodies and brains figure out how to deal with the CO2 level problems and eventually the number of CAs diminishes. But some folks with CompSA have the problem that their body/brain never figures it out AND there's a tendency for the problem to get worse when the pressure is increased. And these are the folks who properly need to wind up on an ASV machine before their treated AHI can be sucessfully reduced to less than 5 or something close to 5.

So it's imperative that you figure out whether your mom has been diagnosed with CompSA. Because if she has CompSA, then blithely increasing the pressure just because the number of apneas remains way too high may just be the wrong thing to do. Before increasing the pressure, the doc should try to determine that the excess apneas are indeed OAs instead of CAs. And some machines (such as the System One BiPAP AutoSV Advanced) will attempt to determine whether each apnea is a CA or an OA, but other machines (including the older Resprionics BiPAP AutoSV Advanced do not try to distinguish between CAs and OAs. So since she's your mom, you need to proactively demand that the doc show you the machine data he is using to justify his decision to substantially increase your mom's pressure.

Questions:
Can I retrieve statistics like ‘average sleep apneas per hour’ and ‘total sleep apneas per usage period’ through the Resperonics unit’s display screen?
...
If not, is there software and hardware (card reader) that I can use to this end?

Whether it is easy or hard to check that data yourself depends on the exact machine your mom has. While docs and DMEs are reluctant to share the software with us mere patients, we have our way of getting the software. Regardles of which BiPAP ASV your mom has, the patient oriented software called Encore Viewer is available for purchase from our hosts. There is a newer version of the patient software called Encore Basic that can be downloaded once you know where to find it. PM a user named pugsy; I think she keeps up on the links. If she can't help you, pm me and I'll go through my records and see if I can help. If your mom has the System One ASV, then I believe that SleepyHead may work with your mom's machine's SD card. SleepyHead is still in beta testing, but it has been written by own of our own forum members. Since it's main developer is an OSA patient himself, it has features of great interest to us patients.

The machine's LCD data will give only give you seven and thirty day average AHI's that are NOT broken down into CAs, OAs, and Hs. There real limitations on how useful this information is when you are still in the troubleshooting stage of therapy. To get a better idea on how these seven and thirty day averages are computed and why they don't allow you to adequately determine what's going on on a nightly basis, see my blog entry Understanding how the 7-day and 30-day average AHI's are computed

The doctors have firmly implied that gathering and evaluating stats is their domain but I’d feel much more comfortable being able to monitor how things are going and to gauge improvement. When I point out that my mom’s symptoms don’t seem to be abating they get awfully vague about what the data shows regarding improvement/lack of improvement.

It's up to you to be polite, but firm in insisting that the docs share the data printouts with you and your mom. Simply ask them to have their staff print out the data downloads for you every time you go with your mom to the doc's office. Heck, you could also just ask the office staff to please print off a copy of the data report for your mom's home medical records.

Look at it this way: If you had high blood pressure, would you be comfortable with the doc never telling you how high today's reading actually was? If you had type II diabetes, would you want to monitor your blood glucose levels on a regular basis? The AHI data gathered by your mom's machine is the same kind of data. And it doesn't take a rocket scientist to figure out when it's good and when it's not so good.

Moreover, given the high pressure, the ASV machine and the full face mask (FFM), you and your mom also should be monitoring her leak data. FFMs can be quite difficult to get and maintain decent seals with, and sometimes a leaky mask can cause some serious sleep problems all by itself.

Should I be knowledgeable enough to adjust the unit so it’s set up correctly for my mom or is this something that should only be attempted by someone with the proper medical training? Is the sleep doctor likely going to bristle (or worse yet, give us the boot) if I adjust the unit? Our doctors have been pretty cool but if I look at the results to date there isn’t much to celebrate. I’m trying to be reasonable and have a modicum of patience but my mom is suffering and I’d like her to have what she needs to have a decent opportunity to feel better. We’re not expecting miracles.

I personally would not be comfortable playing around with the setting on an ASV machine without some guidance from the doc. But once I understood the basic settings and their purposes, I would not hesitate to offer to offer ideas for improving mom's comfort. And if the doc's seem to react badly to your offering ideas, there's always the option of finding a different sleep doc.

But for now, I think you and your mom need a better understanding of exactly what her diagnosis is, exactly why the docs have prescribed the particular machine she is using, and what those settings are and what each setting is supposed to do. After you know that, you'll be in a much better position for understanding why the docs seem to be saying nothing more than "it takes time."

And I'd be asking some pretty pointed questions about why her treated AHI is still above 30 and why the doc seems to think a pressure increase is what's needed.

Best of luck to your mom! She's lucky to have a son who is as caring and concerned as you are.

[avi123]

It is not clear to me why the Docs can't arrange for Clinicians to come over to mom's house to set the machine, and explain to you?


The sleep doctor said that my mom was having something like 45 apneas in hour before adjusting the unit the first time and that it improved to 35 apneas during the use period after the adjustment. The second adjustments were only made two days ago but to my eyes she appears to be having approximately the same amount of apneas as before (or perhaps more!). I know that 2 days isn’t a great sample size and my impressions are somewhat anecdotal because I don’t know how to retrieve that actual data. The doctors also talk a lot about an ‘adjustment period’ during which the user’s behavior and body adjust to what the BiPAP machine is doing and I doubt they would consider 2 days a sufficient adjustment period.

According to neurology physicians aids it takes, on the average, two months to get adjusted to these machines.

[NightMonkey]

You asked a lot of questions but many of them cannot be answered until you can see some data.

Work on posting the exact model machine and you will get advice on how to get the data.

God bless you and your mother,

[Mike Mitchell (Artimus60)]

Thank you all for the info and your words of encouregment. I realized after that fact that I didn't provide the details that would help you help me. I'm picking up the sleep studies and office notes this afternoon. I'll post the details that were missing in my initial post (including equipment details) this afternoon. I feel a little like I'm stumbling around a dark room at this point but I'm sure I'll some context for this to stick to if I keep plugging. More to come...

[Pugsy]

Hi,

I can help with the software. I do need to know for sure which machine your mom is using and what your computer specs are...like Windows version and is your computer 32 bit or 64 bit?

If the machine is the older model that has a Smart Card that looks like this
https://www.cpap.com/productpage/respir ... -card.html then we need a special card reader (cross that bridge if we need to but $40 plus S&H) to utilize the software that is available and your only choice is an Encore product.
EncoreViewer will work but it won't install on a 64 bit computer and it costs $100.
EncoreBasic will work and it will install on a 64 bit computer and it is free.

If the machine is the new PR S1 machine and uses a SD card then you can use SleepyHead (links in my signature line) and process is a bit simpler. There is even a Mac version available.

I will let the others help with the actual settings and such...since it is an ASV type of machine (very special) please add ASV to your subject title to get the attention of the forum members who have a lot of experience with this type of machine.
You can go ahead and register and add the equipment anyway even if you aren't the user. We have spouses here that do it when it is their spouse who is actual user.

For the software though...I can help either way you end up needing to go. I just need to make sure I can get you the software that will work with your computer..and machine.
I also need to be able to send you a private message if you end up needing an Encore product. So you need to register so that you can receive and send private messages.

[VikingGnome]

Just a note of encouragement. My mother is 87 and she's been on regular CPAP for 6 years now. My sister took Mom for the sleep study because she shared a room with her at a hotel and witnessed her apneas and struggles to breathe. First, the sleep people prescribed oxygen at night. What good is oxygen when a person is having apnea and not taking breaths. How stupid is that? They finally did a sleep study and found she indeed had severe obstructive sleep apnea but no centrals.

The adjustment period to straight CPAP wasn't too bad. At first, my sister would wake Mom up in the morning and she had the mask on top of her head. Gradually she adjusted to having the mask on. She had to learn what to do when she got up at night and remember to connect hose back to mask. Eventually, she learned everything she needed to do. She even remembers to use it for naps during the day. (She has memory problems from a ruptured cerebral aneurysm 20 years ago which she miraculously survived.) So your Mother may be way ahead of the game in these little details.

Mom no longer needs any supervision in her CPAP therapy. She doesn't use a humidifier (hates it). So it's all very simple for her. She gets regular replacements of mask, cushion, filters on schedule with what Medicare allows automatically from her DME. She has secondary insurance so none of it costs her anything.

The bottom line is that elderly people CAN adjust to treatment for sleep apena. If your mother has complex or central apnea, the adjustment may be a little more difficult and take longer. Why is she using a full face mask? Did they tell you that she breathes through her mouth or did the DME just make that decision? A nasal mask is much easier to adjust to, less leaks, and better treatment. So find out WHY she is using a full face mask?

[Artimus60]

Hello all,

Thank you all for taking in interest in our situation. In retrospect my original post was heavy on whining and low on detail. I hope this helps me get it back on track.

Equipment:
The machine that my mom is currently using is the Respironics BiPAPautoSV Advanced. It has the humidifier attached and contains an Encore Pro Smart Card. She is currently using a Mirage Quatro full face mask. I think the equipment supplier suggested this mask as she breathes primarily through her mouth. She started with a Quatro FX mask (the one that doesn't have a ‘stabilization apparatus’ that rests on the brow) but it seemed to get moved during the night and they opined that a full face style mask would remain anchored more securely.

I asked for and received that results of both my mom's sleep studies and her subsequent consultations with her sleep doctor. My mom initially took a 'home sleep study' using a portable device that her primary care doctor provided. The home tests seemed to indicate to the sleep doctor that my mom had moderate to severe obstructive apnea. They prescribed a CPAP machine with a tritation study for follow immediately. The CPAP machine was initially set to a pressure of 6-9cm. When we went into the office they downloaded the data from the CPAP machine and it reported AHI of 44.3. I told the doctor that I could visually observe my mom gasping in her sleep while wearing the mask.

First Sleep Study
Total Number Apneas: 176
Total Number Hypopneas: 5
Apnea Index: 31.5
Total AHI 32.4
REM index: 9.5
Supine index: 32.3

Interpretation: patient titrated from 6 to 16cm of water with heated humidification. Application of positive airway pressure resulted in dramatic appearance of central apneas and central hypopnea events. Therefore, an optimal pressure setting to obtain normal breathing and oxygenation levels above 90% could not be obtained. The patients clinical use of opiod pain medication likely contributes to this effect. Rare premature ventrical contractions were noted, otherwise there were no cardiac arrhythmias on a single lead EKG recording. The patient should be titrated on BiPAP SV Auto Advanced therapy.

…so we went back for a second overnight sleep study…

Second Sleep Study
Total Number of Apneas: 157
Total Number of Hypopneas: 4
Apnea Index: 22.8
Hypopnea Index: 0.6
Total AHI: 23.4
REM index: 22.4
Supine index: 0.6
Interpretation: This is a BiPAP SV auto advanced titration study performed for obstructive and central sleep apnea (i.e. complex sleep syndrome). The patient was titrated from EPAPmin=5-9, EPAPmax=15, Pressure Max=25, PS=0-10, BUR = auto with heated humidification and a Mirage Quatro FX small mask. Sleep disordered breathing was improved at the lowest pressure with subtle central hypopneas noted in the setting of the mask leak. Rare PVC’s were noted, otherwise there were no cardiac arrhythmeas on a single lead EKG recording. The patient should be initiated on BiPAP SV auto advanced therapy at EPAPmin=5, EPAPmax=15, Pressure Max =25, PS=0-10, cm of water, BUR=auto with heated humidification. Mask refitting is recommended at the time of set up. A Mirage Quatro standard may be better for achieving a good air seal.

We used the BiPAP faithfully for a couple weeks and went back in to see the doctor…

From her notes: download shows she is using it 92.3% of nights for an average of 7 hours and 32 minutes a night. Average EPAP=10.6, 17% of the night in periodic breathing, average time in large leak=9 minutes, average breath rate 12, minute ventilation = 5.8, AHI = 30.6 (mostly obstructive events recorded by the device). Recomendatons: add BURR=10, increase EPAP min to 8cm of water, EPAP max to 18

After using the machine for another 3 weeks we went back in for another consultation…

From the doctor’s notes: compliance download reports that she is wearing it 100% of the night. Average usage is 6 hrs and 21 minutes, 90% EPAP=12.4. Periodic breathing=12.6%, average breath rate=12.9%, average minute variation= 4.8, AHI=33.7. Detailed report shows the majority of AHI are obstructive apnea. Recommendations: change settings to EPAP 12-22, PS=3-10, Max pressue=25, BUR=10, flex=off.

Those changes were made 3 days ago. I haven’t noticed any changes during this admittedly short time period.

I hope this provides the information that was missing from my first post. Just going through the process of reviewing the notes from the doctor and compiling them for this msg has helped me understand this stuff a little better, but I realized that I have a long way to go before I can effectively advocate for my mom. I would really like to be able to evaluate how she’s doing/if she’s improving, during the time between visits to the doctor’s office. We're 6 weeks in and she seems just as fatigued as when we started. On the positive side, I think we have a good doctor, my mom wants to get better, and I'm thrilled to have found CPAP talk. Thanks in advance for any future thoughts and/or advice. I'm going to respond to some of the other replies I've recieved in seperate msgs to follow as this one is getting frightfully long!

Thanks again - Mike in Seattle

[avi123]

Hi Mike, it's important to consider if mom has any other medical condition that could effect the sleep treatment, such as Diabetes, Hi blood pressure, neurological ailments, etc. If yes, then the treatment would be to concurrently treat these underlying conditions while dealing with the machine set- up.