Why doesn't APAP respond to apneas?

[OutaSync]

I'm ready for my next experiment. What shall I try next?
Bev

[-SWS]

If it were me I'd grab two baselines on the BiPAP autoSV before once again turning SV modality on. I realize that you just tried CPAP @ 14cm. But I'd specifically want to see all the autoSV machine measurements (and even subjective assessments) using CPAP @ 14 cm on the new machine. I personally wouldn't want another machine's measurements for that 14 cm baseline data. That means I'd first collect data on the BiPAP autoSV machine using CPAP mode @ 14 cm as follows:

EPAP=14;IPAP min=14;IPAP max=14

That's an important measurement and subjective comparison point IMO. The following night I would try to grab a baseline at standard BiLevel to see just how tolerable/disruptive/restorative that standard BiLevel modality happened to be. That means running the machine at:

EPAP=14;IPAP min=17;IPAP max=17

Alright. There are two extremely important baselines above---with autoSV/Encore measurements for later comparison. If one of the modalities was the clear winner, regarding comfort and measured SDB, then that would be the modality I would use on the third night's experiment in conjunction with SV. So if CPAP modality above was the clear cut winner, I would next try CPAP+SV as follows:

EPAP=14;IPAP min=14;IPAP max=22 (that's a maximum EPAP/IPAP gap of 8 cm)

However, if standard BiLevel modality was the clear winner, regarding comfort and measured SDB (in that very first CPAP/BiLevel comparison above), then I would instead try BiLevel+SV as follows:

EPAP=14;IPAP min=17;IPAP max=22 (once again a maximum EPAP/IPAP gap of 8 cm)

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Unfortunately, we have three nights of experiments above: 1) a measured CPAP baseline at 14 cm, 2) a measured BiLevel baseline at 14/17 cm, and 3) an SV trial with EPAP set at 14 cm. So that gives you Friday and Saturday to grab those first two baselines. Then I'd assume you may want to run that third experiment, the SV trial with EPAP=14 cm, the following weekend.

That's just what I would do if it were me. As always there are plenty of ways to skin a cat.

[ozij]

As always there are plenty of ways to skin a cat.

However, tracking any of those ways while using the SV's detailed reporting is an excellent idea.

O.

[-SWS]

As always there are plenty of ways to skin a cat.

However, tracking any of those ways while using the SV's detailed reporting is an excellent idea.

O.

If SV is being trialed I sure would think that's a given----since that's the only data set capable of reporting PB and a few other parameters that haven't been comparatively scrutinized yet.

Not that the data sets on the OSA machines are utterly lacking data. They're simply a different set of parameters---of which comparison thus far has yielded very little conclusion and daytime improvement. So yes.... using a data set with different parameters for comparison is potentially useful I would think.

But then again those tricky cats tend to have nine lives....

[-SWS]

Unfortunately, we have three nights of experiments above: 1) a measured CPAP baseline at 14 cm, 2) a measured BiLevel baseline at 14/17 cm, and 3) an SV trial with EPAP set at 14 cm. So that gives you Friday and Saturday to grab those first two baselines. Then I'd assume you may want to run that third experiment, the SV trial with EPAP=14 cm, the following weekend.

That's just what I would do if it were me. As always there are plenty of ways to skin a cat.

If you wanted to fit an SV modality experiment in this weekend, then you could always grab a CPAP @ 14 cm baseline measurement another weekend. You could start with experiment 2 above---and then subjectively compare whether recent CPAP@14 cm felt better or worse than BiLevel@ 14/17 cm. That would be a Friday night BiLevel subjective comparison and baseline data measurement, right off the bat.

Then you could take the subjective winner between those two and use that modality+SV (experiment 3 above) on Saturday night. However, if you were scoring PB on any of those nights, I'd think that you eventually want to find out if you also "machine score" PB while using CPAP @ 14 cm. And that CPAP baseline measurement should then be collected another day/weekend while using the BiPAP autoSV machine.

All depends on whether you're anxious to fit in another SV modality experiment this weekend, or don't mind waiting to finally turn SV modality on next weekend instead. Again, that's only what I would do. That doesn't mean there aren't other ways to methodically experiment with SV pressure and modality comparisons.

[dsm]

One other choice that may need to be made is if to set BPM=AUTO (which will use the SV's 4 min monitoring of rate to track & adjust) orr to set BPM=10 & set an Insp time which means getting the INSP number right or experimenting with it.

Because tuning INSP could be problematical for Bev, I lean toward leaving BPM=AUTO. Snoredog, do you have any thoughts re this ?

DSM

[-SWS]

Rise time is probably one parameter that needs to adjusted for maximum comfort in this case. It's currently set at 3, but for Bev likely needs to be at 4 or greater. I would suggest that while in standard BiLevel mode, while awake, Bev should experiment with a 4 or 5 rise time---maybe even see how a 6 feels.

That may help keep the aerophagia at bay as well as that disconcerting sudden pressure-pulsing sensation.

[Snoredog]

I'm ready for my next experiment. What shall I try next?
Bev

EPAP=14
IPAP Min=14
IPAP Max=18

BPM=10
IT=1.2
Rise Time 4 or 5

and take a melatonin

[-SWS]

That's a pretty darn good experiment in my book too...

There you have CPAP+SV... with SV's EPAP/IPAP_peak gap limited to only a 4 cm differential. Then you have a more comfortable rise time and manual BPM as well as manual IT. And you have CPAP set at 14 cm.

[StillAnotherGuest]

Did you get a graph at straight 14 cmH2O (sans bidets, and seeing where the events were)?

SAG

[-SWS]

I'm positive that I'm not the only one comforted and relieved that SAG is keeping tabs on this thread. Thank you SAG.

[OutaSync]

This from last night. Time in apnea 3.1 minutes.



I had problems with leaks near my eyes and it shows.

So, are we agreed to try Snoredog's numbers for tonight? I don't do well with choices. I need specific instructions.

I'm guessing that when I change the BPM to a number that I'm going to have a choice of rise time> Because I don't recall seeing that choice.

Bev

[Snoredog]

This from last night. Time in apnea 3.1 minutes.



I had problems with leaks near my eyes and it shows.

So, are we agreed to try Snoredog's numbers for tonight? I don't do well with choices. I need specific instructions.

I'm guessing that when I change the BPM to a number that I'm going to have a choice of rise time> Because I don't recall seeing that choice.

Bev

Are those obstructive apnea or central?

From first looks of that report it would look like you have plain vanilla Obstructive Sleep Apnea, but lab reports say there is most likely some central events included in those tics. You don't have enough of them to trip the NRAH circuit (while in auto mode) and that circuit is disabled in CPAP mode. OA tics seem to follow 90 minute or thereabouts patterns. But did she get any REM?

if you look at the lab PSG's is she going to "wake" during those OA's, Sleep Staging from the 8/31/07 report (if the same) shows she is probably going to a wake state, she was titrated at 14 cm CPAP. Not very many events (think there was 1 Hypopnea), but she only stayed there a total of 1 minute.

NO REM found at 14 cm on the 8/31/07 report, in fact it was N/A for REM in that entire report. The poor girl needs some REM.

From the last night Encore report, you can assume:

Snore is snore
Leak is leak
and that other stuff could be just about anything.

Doesn't sound like you had a great night of sleep how do you rate last night as compared to others?

[OutaSync]

I'm still looking forward to my first great night of sleep I don't know why I had such a high leak rate, I thought I had that pretty much under control.

I found where to set TI and rise time. I'm all set up for tonight. I have to go to a wedding tomorrow night. I hope I can stay awake for it.

Bev

[Snoredog]

I'm still looking forward to my first great night of sleep I don't know why I had such a high leak rate, I thought I had that pretty much under control.

I found where to set TI and rise time. I'm all set up for tonight. I have to go to a wedding tomorrow night. I hope I can stay awake for it.

Bev

LOL as long as it is not yours