Treating CSA and mitigating CHD symptoms with ResMed Lumis ST/ BiPAP - am I doing it right?

[forohfor]

Hi all!

My dad is 58 years old and he suffers from several conditions:

• He has had reverse-dipping hypertension (meaning his blood pressure is higher during the night) and CHD (coronal heart disease) for years

• In the last 3 years or so, for most nights, he would sleep 3-4 hours, wake up, and couldn't fall asleep again. I asked him what kept him awake and he told me that he usually felt tightness of chest, and occasionally shortness of breath. From what I gather, these are common symptoms of CHD.

• He has a diagnosis of CSA. It was when he did an overnight heart condition study 2 years ago, and the report has "central sleep apnea: 163 apnea events from 12:30 to 7:00" written on it, which I reckon makes the AHI 25, which is not that bad, but definitely not good. No further information about the CSA, but the doctor did advise him to "use a PAP machine if you can manage it" (didn't specify which kind).

I've Googled a lot about CSA and PAP therapy and what I gather is:

• CPAP can induce CSA, so I chose to avoid it.

• BiPAP is inconclusive - some patients respond well to BiPAP, some don't.

I was coming to stay with my parents for a few weeks, so I bought a BiPAP for him just to see whether it helps. It is a Lumis 100 ST VPAP. Apparently it's not sold globally and I couldn't find it in the profile dropdown, so I chose another ResMed BiPAP that seems similar in capabilities.

My dad started the therapy 10 days ago. For the first few days he struggled with the full face mask that came with the machine (a Mirage Quattro). After buying and switching to an N20 nasal mask, the machine has been doing wonders to his sleep. He would still go to sleep without the BiPAP initially because he's still not used to the mask, but after he wakes up he would put on the mask, turn on the machine, and he can now sleep another 2-3 hours, doubling his previous sleep time in the best case. He said that the inspiration pressure makes it easier to breathe and mitigates his tightness of chest and the occasional shortness of breath. I figure that's what's enabled him to fall asleep again.

I've also looked at daily reports in OSCAR and they look good. He's been having < 5 AHI recently, even 0 last night. I've attached the report for last night.

Now, my questions...

• Is the BiPAP machine the right therapy for my dad? For the CSA, I guess my dad happens to be in the lucky group that responds well to BiPAP. But what about the CHD symptoms (tightness of chest, and occasional shortness of breath)? I can't really find any information supporting using BiPAP to mitigate CHD symptoms. It is undeniably helping my dad immensely but could there be long-term adverse effects?

• This machine has fixed EPAP and IPAP, with the default being 4.0 and 10.0 cmH2O. I've dialed down both to pretty low levels - as you can see in the OSCAR reports - 3.0 and 7.6 cmH2O - and with the longest possible ramp-up time of 45 minutes. I did this back when he was still using the full-face mask and he complained feeling pressure on his cheeks, and haven't dialed it back up after switching to the nasal N20. He said the pressure was "quite comfortable" and I figure if the AHI is under control there's no need for higher pressure - is that correct?

• Anything in the report that I should pay attention to?

Thanks a ton in advance!!!

[forohfor]

Also attaching the report of the night before - this is a more typical one, with a few unknown apneas and hypoapneas.

[Pugsy]

The unknown apnea thing is just what the ST machine does when it senses that someone isn't breathing.
It doesn't distinguish between Obstructive apneas and Central apneas because it can't.
So the only flags it will ever use are the Unclassified Apneas and the hyponea flags.

[ChicagoGranny]

Is the BiPAP machine the right therapy for my dad?

Well, it prevented most apneas in the chart you posted. That seems like the right therapy.

Why did he only sleep 3.5 hours? How is he feeling?

By the way, it's probably easier for you to post charts and members to analyze them, if you get a free account at SleepHq.com. Once you upload the SD card, you only need to post the link in this thread.

[Miss Emerita]

It seems the CSA is being well treated with the settings he's currently using. Some machines don't report events during ramp time. I'm not sure whether that's true of your father's machine, but I'd suggest gradually paring back the ramp time.

Can you persuade him to use the P10 mask starting when he goes to bed? That's the one big issue I see in the charts you posted.

I doubt very much that using the machine could harm your father, but I think he should raise all questions that might be heart-related with his cardiologist.

[Pugsy]

To avoid confusion it might be best if you just don't choose a machine from the drop down menu since the ST isn't listed.
Just don't choose any machine and leave the comments as is as that explains things well.

[forohfor]

Thanks everyone for your replies!

From the replies so far, I guess people don't see any obvious red flags? I'm still keen to know whether anything could go wrong - in general, what kind of risk could BiPAP have?

(I'm also getting my dad to book a pulmonologist to officially "sanction" this therapy, but it's a bit hard to get an appointment where my parents live so it'll take a while...)

The unknown apnea thing is just what the ST machine does when it senses that someone isn't breathing.
It doesn't distinguish between Obstructive apneas and Central apneas because it can't.
So the only flags it will ever use are the Unclassified Apneas and the hyponea flags.

Thanks, that's good to know!

Is the BiPAP machine the right therapy for my dad?

Well, it prevented most apneas in the chart you posted. That seems like the right therapy.

Why did he only sleep 3.5 hours? How is he feeling?

By the way, it's probably easier for you to post charts and members to analyze them, if you get a free account at SleepHq.com. Once you upload the SD card, you only need to post the link in this thread.

He's only been using the BiPAP machine for ~3 hours per night because he'd go to bed without it - he was still not quite used to the mask - and only use the BiPAP when he woke up after 3-4 hours, which has allowed him to get another 2-3 hours of sleep. Not ideal - I'd really love it if he could just sleep 6 hours straight but he's already feeling much better than before (when he couldn't fall asleep again after waking up).

I'll look into SleepHq.com!

It seems the CSA is being well treated with the settings he's currently using. Some machines don't report events during ramp time. I'm not sure whether that's true of your father's machine, but I'd suggest gradually paring back the ramp time.

Can you persuade him to use the P10 mask starting when he goes to bed? That's the one big issue I see in the charts you posted.

I doubt very much that using the machine could harm your father, but I think he should raise all questions that might be heart-related with his cardiologist.

I've tried turning off ramp time but my dad said the target pressure still feels a bit too high for him when he's awake, and he was reluctant to have it reduced.

He tried putting on the mask when he went to bed, but he said he couldn't fall asleep easily with the mask on. He was still using N20 when I posted, but I've since got him a P10, which he found more comfortable, but still couldn't fall asleep with. (This is about when he first goes to bed; he seems to have no problem falling asleep with the mask on after waking up for the first time.)

I suppose there's an acclimation period with both the mask and the air pressure and I'll nudge him to try going to bed with the BiPAP on again in a few more weeks.

And yes, I've told him to bring up the BiPAP therapy the next time he sees his cardiologist.

To avoid confusion it might be best if you just don't choose a machine from the drop down menu since the ST isn't listed.
Just don't choose any machine and leave the comments as is as that explains things well.

Done, thanks!

[forohfor]

SleepHQ links for 24th and 25th of June:
https://sleephq.com/public/17b43264-a68 ... 4728ee2335
https://sleephq.com/public/5fa658e4-431 ... 0a0021a24f

[ozij]

Does your machine have an option for "Auto Ramp"? Mine, an AS10 has the ability to realize my breathing has become regular, and to raise the pressure pressure only then. If you do have it, it's worth trying with your Dad.
It correlates very well with when my Polar watch says I've fallen asleep.

[Miss Emerita]

About using the mask at the start of the night: it might help if your father can set up his machine outside his bedroom during the day or evening and use it while he reads, watches TV, or uses his devices. This helps the mind and body get used to the sensations of mask and the air pressure.

[forohfor]

Does your machine have an option for "Auto Ramp"? Mine, an AS10 has the ability to realize my breathing has become regular, and to raise the pressure pressure only then. If you do have it, it's worth trying with your Dad.
It correlates very well with when my Polar watch says I've fallen asleep.

Unfortunately not...

About using the mask at the start of the night: it might help if your father can set up his machine outside his bedroom during the day or evening and use it while he reads, watches TV, or uses his devices. This helps the mind and body get used to the sensations of mask and the air pressure.

That's a great suggestion! I'll try to get him to do that.