Help with interpreting Sleephead readings

[jpshunt]

Will someone please help me interpret this reading?

[Pugsy]

A bit of history please?
What was your original diagnosis?
Did you have a sleep study using this machine (or any machine) to determine pressures?
Did you have a sleep study without a machine...but in a sleep lab...and do you have a copy of the results?

You are using a very special machine usually prescribed for people who either have a problem with a combination of obstructive apnea and central apnea or maybe just central apnea.
The settings aren't working at all for the central apneas and I am wondering how they came up with these settings.

As far as an interpretation of this report....horrible report..no where near adequate therapy and it's not just because of the large leak periods.
Clear Airway events are centrals...and I wouldn't be surprised if the bulk of the hyponeas aren't also central in nature.

[jpshunt]

I was originally diagnosed with mild sleep apnea in April 2012. Used a ResMed S9 Elite CPAP with fixed pressure of 6 cmH20. I lost weight in 2014 and did not use the machine as much (wrong choice). Then when I gained weight again I started using the CPAP again and needed a new prescription for my insurance. Insurance approved a Home Sleep Study which was on 8/27/15. Results were 9.0 AHI mild sleep apnea. Was scheduled for an overnight titration study on 9/16/15 and the results were severe sleep apnea. I started out with my CPAP machine during the titration but was switched to BiPAP. The only thing I was told is the BiPAP was needed to control the central apneas. The original settings were PAP Mode AVAPS; EPAP 10.00 cmH20; IPAP 16.00 cmH20. The issue I have with this machine is excessive bloating and swallowing air - I have a hiatal hernia. At these pressure settings, I was waking up throughout the night with stomach pain and feeling like I was smothering. The settings were changed to EPAP 9 and IPAP 13 on 1/5/2016. Not much relief from bloating; however, I make myself use the machine because the nurse practitioner basically told me 'this is as good as it is going to get.' When I discovered this software I was shocked at the readings. If these are true readings, I am definitely going to seek help with determining a better treatment. Here is a reading from the early settings and a reading from my CPAP machine. Any suggestions are greatly appreciated.

[Pugsy]

Picture me scratching my head here.

Here's the deal....your machine needs to be able to go a lot higher than it can go right now to deal with the centrals. IPAP needs to be near the max of 25 and depending on how many centrals and how often it goes up there man, that stands a good chance of making the bloating worse.

Right now your settings are making it work like a regular bilevel machine and that isn't going to work because the machine needs to be able to actually breathe for you (with a burst of pressure) and it can't do it at these settings. Now it may not need to sustain that high pressure for very long so that could maybe limit the negative impact of the higher pressures to some extent.

See if any of this makes sense to you..I know it's pretty technical
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

In terms of ideas...all I know is to go back to the basics and try some settings that will deal with the centrals and hopefully maybe not blow you up like a puffer fish.
Starting point...Minimum EPAP maybe 6.0
Minimum PS 3..maximum PS 15
Maximum IPAP 25

Might need a little more EPAP later for the OAs but the centrals are right now the main issue.
These settings will start the night with 6 exhale and 9 inhale but will allow the machine to increase as it sees fit for the centrals. Hopefully the time spent at the higher pressures will be short and not cause the aerophagia issues to worsen.

[jpshunt]

I just discovered that my machines is NOT AVAPS compatible. It is set to S/T Mode. I do not know why the Sleepyhead Software shows AVAPS. The reason I looked into this is I remember my nurse practitioner saying my sleep doctor does not like the auto machines and will rarely prescribe one. My nurse practitioner did say she thought the auto machine would help with the bloating. Do you think my readings indicate an auto machine is needed? I am so discouraged and am ready to look for another provider if necessary.

[Pugsy]

Well crap. I thought you had the model 960 but I guess it's the 1060 maybe.
I don't know how the S/T mode/model machines work to address centrals. I know that they are commonly dispensed when the only issue is the centrals but it's mainly for centrals and not for people who have both centrals and obstructives going on.

The S/T pretty much forces you to breath with the machine all the time at whatever set rate has been set up...the auto ASV models only kick in with the big bursts of pressure to deal with centrals to help you breathe when you need the help.

Tell whomever prescribed this machine that it isn't getting the job done and either give you some settings to make it work...or you will go finds someone who will.
In all honesty I don't know enough about this mode of operation to offer any ideas on how to improve your results. Maybe one of the other forum members knows??? Anyone else reading this know what could be changed to better address the centrals with this particular machine?
I will ask around and see if anyone I know has any ideas.

Did you have an in lab titration with this particular mode?

[palerider]

Well crap. I thought you had the model 960 but I guess it's the 1060 maybe.
I don't know how the S/T mode/model machines work to address centrals. I know that they are commonly dispensed when the only issue is the centrals but it's mainly for centrals and not for people who have both centrals and obstructives going on.

The S/T pretty much forces you to breath with the machine all the time at whatever set rate has been set up...the auto ASV models only kick in with the big bursts of pressure to deal with centrals to help you breathe when you need the help.

Tell whomever prescribed this machine that it isn't getting the job done and either give you some settings to make it work...or you will go finds someone who will.
In all honesty I don't know enough about this mode of operation to offer any ideas on how to improve your results. Maybe one of the other forum members knows??? Anyone else reading this know what could be changed to better address the centrals with this particular machine?
I will ask around and see if anyone I know has any ideas.

Did you have an in lab titration with this particular mode?

I think it's important to confirm, via REF/model number which machine jpshunt has, for sure, since the avaps and the S/T behave differently, have different settings, etc.

as best as I can tell from the manual, *if* it's the S/T (1060) then it can do cpap, S and ST modes, with no purely T (timed) mode. there really is very little info in the manual unfortunately, unlike resmed manuals that explain things in much greater detail.

if it is the 1060, then treating it like a regular bipap and going for those settings/tunings would be the thing to do, being mindful that if a breath isn't taken by the time set in the BPM (backup rate, breaths per minute) setting, then the machine will switch to IPAP to force a breath.

[palerider]

I just discovered that my machines is NOT AVAPS compatible. It is set to S/T Mode. I do not know why the Sleepyhead Software shows AVAPS. The reason I looked into this is I remember my nurse practitioner saying my sleep doctor does not like the auto machines and will rarely prescribe one. My nurse practitioner did say she thought the auto machine would help with the bloating. Do you think my readings indicate an auto machine is needed? I am so discouraged and am ready to look for another provider if necessary.

I would *strongly* suggest you download encore (or encore pro, I'm not sure which would be needed) or find someone that has one of them already installed that you can send your SD card to.

support from sleepyhead is *very* preliminary, and we have no way of knowing whether any of that data is right.

if it is, I'd suggest a higher IPAP (to help with the hypopneas) and lower epap (to help with the bloating)... but I'd really like to see some reliable data first.

[jpshunt]

On the bottom of the machine ... BiPAP S/T C Series Dom 30 REF 1060P.

[palerider]

On the bottom of the machine ... BiPAP S/T C Series Dom 30 REF 1060P.

ok, good, a timed basic bilevel machine. no asv or avaps magic involved in that one (the asv is the 960, the avaps is the 1160)

Encore is the next step, to get some trustworthy data.

[jpshunt]

Encore data as of 5/25/2016:

CA: 12.5
OA: 4.2
H: 69.1
AHI: 85.7

[jpshunt]

Dec 20 2015 readings at higher settings:

CA: 2.0
OA: 4.1
H: 33.9
AHI: 40.1

[Pugsy]

What were those settings back in Dec and why were they lowered?

[jpshunt]

The original settings were EPAP 10, IPAP 16. They were lowered due to the bloating.

[avi123]

If I was you I would then seek a Sleep Physician holding an MD in Sleep Medicine to check me. You probably have underlying medical ailments which need to be treated. You did not register your local and age. Members on this forum are not qualified to solve your problem but they might have suggested to where you should go for help.