Could someone guide me? Sleepyhead graph

[Satchfan]

So I just started using a bilevel with backup rate. 12/7 and backup rate of 11. I can't sleep well with it. Doesn't sync well with my breathing and Dr is pretty much ignoring me or it's going to take a while for him to get messages and reply. So I don't have much to put up but I did do the sleepyhead graph. I hope I did this right. Tons of information on here and it's going to take time to get on top of it all with a full work schedule as well. So this is only about 2hrs but it's the most solid I have had. Thanks.

[Pugsy]

How did they come up with these settings? Did you have a sleep study done in a lab where they tested this machine at various pressures?
Your PS is 5 (difference between inhale and exhale) and everything I have read and heard points to needing more PS than 5 to deal with centrals.

Did you ever actually sleep during these 2 hours?

Omit the snore graph and include the Events graph...you snore graph isn't exciting at all but your Events graph will be.

God...I hate ST machines.

[Satchfan]

Yes I did sleep during this time from 2AM until 345. Pretty solid and that's why I posted this. The other nights have an hour here a half hour there. I just took it off and slept without most of the time but I want this to work. Its my 3rd sleep Dr. Excuse my ignorance but how do I do an events graph and omit snore? scroll down and do a screenshot? My backup rate was 20 when I got it and I confirmed with Dr office that it was right. It was unbearable. I don't want to mess with the other settings though until he's seen it. I did ask his office to request my report. And thank you

I want to add that I had Docs permission to change backup rate to 11.

[Pugsy]

You should be able to just turn off the viewing of the snore graph.
Lower right corner where there is a little arrow...click on the arrow and expand the menu...click on the snore graph to turn it from green to red. This turns it off.

Make sure "event flags" is green...looks like it might be turned off and that's why it didn't show up at the top like it normally does.

Accelerate your appointment with the sleep doctor...if you were asleep...the settings are all wrong for you and it has nothing to do with the back up rate either. Changing the back up rate didn't cause this mess.

[Satchfan]

Hope this does it. I tried to get everything relevant and it came to two shots. Thanks

[Satchfan]

From this little bit of data i would like to know if asv would be better. There may not be enough information. And should I use it or is this thing doing more harm than good. I did not have csa until using cpap which I guess is a thing. I do take meds regularly that may affect this also. Oxycodone, synthroid, testosterone, liothyronine, atorvastatin, humalog insulin, lisinopril. Just wish I had something that worked. I will call tomorrow.

[Pugsy]

My personal opinion....ASV should be used when people get treatment emergent centrals after starting cpap unless there are some significant contraindications for using ASV.

With ASV the machine will auto adjust as needed for the obstructive stuff and only kick in to treat the centrals with that puff of big PS when/if you have a central.

right now with the ST....the negatives...
Number one you need more than 5 PS to jump start the breathing for a central...number two you are getting 5 PS with every breath which isn't enough to deal with the centrals anyway...and you are getting it whether you are having centrals or not...
number 3 your EPAP has to be fixed high enough to deal with the obstructive stuff first which I am thinking that all your hyponeas (assuming they are obstructive) point to not enough EPAP.

ST machines can be used for both obstructive and central apneas but the EPAP has to be higher and the PS has to be significantly higher and it all boils down to the patient simply not being able to handle the settings.
IMHO ST machines are for when someone has central apnea only...and even then I don't really like them.

ASV will auto adjust all the way around...for the obstructive stuff and the central stuff and you only get what the machine thinks you need when it thinks you need it. So much easier to breathe and sleep with.

I asked a sleep tech friend of mine how much PS is needed when someone has centrals that need to be dealt with...minimum of 8 is what I was told and ideally at least 10.

My opinion...start pushing for ASV....you will be pleasantly surprised at how much easier it is to use than the ST.

[Pugsy]

You might find these guides enlightening.

Respironics but the basics are the same no matter which brand.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

and the similar ResMed version
https://www.resmed.com/us/dam/documents ... er_eng.pdf

[Miss Emerita]

I’m curious why the focus is on centrals. Looks like most of the events are hypopneas.

[Pugsy]

I’m curious why the focus is on centrals. Looks like most of the events are hypopneas.

Hyponeas can be central in nature and not always obstructive for one thing. I have seen the machine call them wrong.
So I don't always trust it and in this situation especially when I see the pattern like we are seeing here.
The ST is essentially a fixed bilevel pressure machine with a back up rate to force breathing.

2 things are possible here....either the EPAP isn't sufficient for the hyponeas if they are obstructive and if they are central in nature the lack of adequate PS and the back up rate forcing the breathing might actually be creating more unstable breathing and creating central hyponeas.

ST machines don't differentiate between OAs and centrals. Everything gets lumped in the UA basket and hyponea basket.
We tend to assume that hyponeas are always obstructive but I have seen cases where they were central. Heck, I have seen OAs flagged that were really centrals.

So in this situation we really can't offer our normal "increase the pressure" advice safely anyway. ST machines aren't nearly as forgiving when using the back up rate when dealing with centrals and also trying to deal with the OSA side of things.
Besides... if I remember right, the OP here works in the profession and wants to let his medical care team manage things...which they should be doing anyway in this situation. He has complex sleep apnea brought on by cpap therapy. Not run of the mill plain jane OSA.

[Satchfan]

Doc is going to have an asv titration study done. Need to have ins approve. Anyone know if the Resmed 9 asv is much diff than the 10? .

[Pugsy]

Do you mean the ResMed S9 Adapt which is the ASV model?...compared to the AirCurve 10 ASV??

Not much difference if you are talking about the Adapt model 36037 compared to the AirCurve 10 ASV
but the older S9 Adapt model 36007 there is a whole mode of operation difference.
The 36007 has only fixed EPAP available....the 36037 has another mode that lets EPAP auto adjust and the AirCurve 10 has the same extra mode.

So S9 Adapt model 36037 is pretty much the same as the AirCurve 10 ASV except for minor setting offerings and cosmetic differences. The algorithms are the same and the basic setting options and defaults are the same.

I would avoid the model 36007 Adapt because we don't know how much you might need or want EPAP to be able to auto adjust.

[Miss Emerita]

Pugsy, many thanks for the very informative discussion of hypopneas and also of S.T. machines. You are such a great teacher!