Why does the effectiveness of bipap fade

[Sleeprider]

You have 3 nights of data posted, and it appears you dropped pressure 1 cm to 8.0 EPAP / 12.0 IPAP, PS +4.0. The last night actually has a lower AHI, which surprises me with the lower pressure since we usually go the other direction with OA and H events. Therapy is effective, but could be better.

You say you don't feel good with the current therapy. Is it the IPAP/EPAP pressure difference? You have some breaks in therapy. What is causing you to wake up? Leaks look okay. It looks like giving this some more time to see how it settles would be the best advise. The only other thing I can think to try would be a small reduction in pressure support with an equal increase in EPAP pressure.

[robysue]

Clinte89,

Thanks for posting the full Encore Report for the last three days of your therapy.

You are using a PR System One Series 60 BiPAP S/T (model 1060) machine and it looks like you're running in S/T mode, but I can't tell that for sure.

You write

Hello all I recently was switched to a bipap. I was recommended to push for an asv titration but they wouldnt do it for some reason. So either way I figure since my insurance is renting this machine and from what they told me if it didnt work then we would go on to the next step. Well I have been on bipap for about 3 months and it has been a big improvement over cpap however it seems as though that it is fading. I talked to the doctor about this recently and he is setting up for me a loan a auto titrating bipap to see over a month what pressure works best and then if it cant be nailed down I suppose they will go the asv route. not sure though. I am just wondering why initially it didnt seem to help at all even though my ahi numbers and events where down significantly over cpap but after a while I felt a good bit better and now i seem to be tired more and in a fog like before and my ahi numbers and recorded events have started to increase again. The ahi that my machine has recorded is still within acceptable range but im sure there is more to it than I understand. Thanks

I'm not a S/T user and so I don't know all the ins and outs of the ventilator part of the data. However, it appears that data looks pretty good on paper. In particular, the Average % Patient Triggered Breaths is at 99.9%, meaning that the machine is almost never "triggering" an inhalation because you are not breathing sufficiently well on your own. The AHI on the three nights is certainly in the target range.

I'm puzzled by the IPAP/EPAP data: It seems as though the settings were changed for the third night---the IPAP and EPAP settings for the third night appear to be 1cm less than the other two nights, but I might be reading the graphs incorrectly. Do you know what the therapeutic settings for your machine are supposed to be?

I don't know enough about Tidal Volume and Minute Ventilation to interpret those graphs. I can say that your average Tidal Volume and Minute Ventilation numbers are quite a bit higher than mine, but these things depend on the size of the person among many other things and I'm a tiny 5'1" female who weighs about 110 pounds.

The leak data is nice and flat at around 40-45 L/min on all three nights. I don't know what kind of mask you are using, but I suspect that its intended exhaust leak rate is right around that range for your pressures. So leaking does not appear to be a problem.

In the Patterns of Usage data, there is some evidence that you may have some irregular sleep habits in terms of bedtime and wake up time. All three nights show at least one or two places where the machine was turned OFF and then back ON. So it's possible that sleep fragmentation might be part of your problem. Do you think you are waking up a lot at night?

Unfortunately we don't have the flow rate curve because your machine is not compatible with SleepyHead (yet) and Encore doesn't show it. It appears your machine does not flag the same kinds of events the regular (and far less expensive) BiPAP Pro and BiPAP Auto machines do. In particular there are no flags for flow limitations, snoring, or RERAs. So if there are any problems with those things disturbing your sleep, we don't have data on them.

You say you were first put on CPAP, but did not do well, and that you were later switched to BiPAP. But the BiPAP you are now using is a highly specialized machine that is designed to treat central sleep apnea among other things. In other words the BiPAP S/T you are using is NOT a garden-variety BiPAP. And that raises the questions:

1) Why were you put on this particular machine instead of a BiPAP Pro or a BiPAP Auto? Did any of your sleep studies indicate that you had a problem with central apnea? Do you have any other respiratory problems such as COPD? Did your CPAP record events, and if it did, was it recording a lot of CAs? More CAs than OAs?

2) When your doc says he wants to get you an auto titrating bipap for a month, does he mean a System One Series 60 BiPAP Auto (model 760) or does he mean something else? As I said earlier, the BiPAP Auto does not do any of the ventilator stuff that the BiPAP S/T can do in S/T and T modes.

I'm sorry that this doesn't help much in answering your very real and important question of why you were feeling better, but are no longer feeling better. But there's nothing in this data that screams out FIX ME.

So that also means you need to look at other NON-apnea and NON-PAP related causes for your growing fatigue: What other medical conditions do you have? Are you on any prescription medication that might affect your sleep as a side affect? And what does your sleep hygiene look like?

[Clinte89]

Well I was put on this machine because most of my apnea before treatment in general where central apnea issues. I did have a change in pressu r as the doc recommended me trying a higher setting but after one night I found it made things worse. I'm sure it would have level out or gotten better but I had to work so I didn't want to risk being tired to much at work. He only set the backup rate at 4 and from what I understand that's oddly low so not sure exactly why it's that way as I don't understand it much. They are going to give me a loaner auto machine to try and get my pressure set right so they will take that month of data and set my pressure I suppose off the average of that. I'll go into more detail later. I'm at work right now but I Thank you for the reply. I have found I do tend to get up every now and then but I assume it's because I drool a lot because I usually have to clean out my mask at least once per night and then getting up to use the rest room. In the lab they noted that I do wake up sometimes even though I don't remember them and they are not sure why

[palerider]

Unfortunately we don't have the flow rate curve because your machine is not compatible with SleepyHead (yet) and Encore doesn't show it.

I've talked to Jedimark about this, and he and Grayghost4 investigated further while gray had a 1060. the 1060 doesn't create flow data files on the sd card!!!

[robysue]

Unfortunately we don't have the flow rate curve because your machine is not compatible with SleepyHead (yet) and Encore doesn't show it.

I've talked to Jedimark about this, and he and Grayghost4 investigated further while gray had a 1060. the 1060 doesn't create flow data files on the sd card!!!

Big Bummer.

Since the 1060 is one of the most expensive machines in the System One line up, I wonder if this is a potential sign that PR is losing interest in recording the flow rate data.

[palerider]

Unfortunately we don't have the flow rate curve because your machine is not compatible with SleepyHead (yet) and Encore doesn't show it.

I've talked to Jedimark about this, and he and Grayghost4 investigated further while gray had a 1060. the 1060 doesn't create flow data files on the sd card!!!

Big Bummer.

Since the 1060 is one of the most expensive machines in the System One line up, I wonder if this is a potential sign that PR is losing interest in recording the flow rate data.

I certainly hope not! I can't even begin to guess why it doesn't...

From what I get talking to jedimark, the PRS1 flow data is all in one of the many files that it writes for each set, and that flow file has never been on any 1060 card image he's been sent.

[archangle]

May I suggest you upload a copy of your SD card to dropbox? Zip up the entire SD card. (7z is better, but zip would work.)

It wouldn't help to have another SD card image to work with.