APAP Results - Help from BPAP / ASV Users?

[Tom W]

.....

[Tom W]

.....

[Tom W]

......

[Pugsy]

Can't read the AHI breakdown but those clusters of Obstructive Apneas sure look a lot like REM sleep pattern clusters.
I think we have discussed this before. The CA component of the AHI is not all that remarkable. The bulk of your problem is obstructive.

Obstructive...needs more pressure to maintain open airway. Might not need 15 cm minimum. But obviously needs more than 13 cm minimum. With ear discomfort....tough call. You are getting real close to where BiPap would be likely more comfortable. One of the members here posted a PR S1 BiPap Pro for sale. Low hours.
It would likely enable you to use the higher pressures more comfortably but no guarantee.

Your central (CA) component is not significant enough to warrant ASV machine I don't think. Those machines will breath for you but are for open airway events. The bulk of your events are obstructive. Probably would be overkill for your needs and those machine carry a heft price tag.

[Pugsy]

Is your doctor aware of the ear pain issue?

[Tom W]

.....

[Pugsy]

Is an AHI above 5.0 reason enough to justify 'medical necessity' for a straight BPAP?

BiPap is not just necessarily for AHI but in conjunction with a higher than wanted AHI and pressures that bring discomfort when using regular cpap/apap therapy...it might be enough. One could need it simply because of pressure requirements are difficult to become adjusted to. Like your ear thing. Or someone's aerophagia.

Medical necessity as in getting insurance to swing for it? That depends on the insurance company. While adjusting to high pressures is a common "necessity" different insurances will have different requirements. Also gotta be careful as there is even a PR S1 BiPap Plus which offers no data except hours of use.

Medical necessity in your mind? Would it help you control those obstructive events that seem to need higher pressures? Well..it would sure make those pressures easier to get accustomed to. Would it eliminate the ear discomfort? In theory it should but one would just have to try it to see.

Obviously the ear thing needs to be checked out to make sure that nothing else is going on. Then if pressure is the only culprit involved with the ear pain, a person needs to figure out how they can treat the events effectively and not cause ear pain. Would straight cpap at 14 cm do it? Is it the increases to 16 cm or 18 cm that causes it? How much do we compromise in this situation? Lots of things to examine and consider.

[moresleep]

If you do a "for sale" search here, you'll find a member selling a used ASV. You probably don't need the ASV function, but should be able to use the machine in straight BiPap mode...

Pressure discomfort causing pain is not good. You need to get those ears checked out. You probably need a BiPap, even if just for the comfort issues.

[Tom W]

.....

[Pugsy]

The machine's pressure drops down like it should towards its minimum pressure. When the next cycle begins it takes forever for the machine pressure to get to its max pressure again. I wish I could adjust the machine so it would take larger steps when it adjusted the pressure upwards.

Yep, that is what APAPs do. The minimum must be high enough to give the machine a head start, so to speak, so it can get to where it needs to go quickly enough. The 13 minimum is obviously too low in your case.

BiPap will make the transition quicker and actually easier. Your EPAP (exhale pressure will still need to be sufficient to take care of the obstructive apnea events) though. Even in BiPap auto mode you still have the same time constraints on the minimum EPAP getting to where it needs to be in a timely fashion though. Now in straight BiPap mode EPAP at whatever and IPAP another and it is done. No dilly dallying around.

I could be wrong but I suspect your EPAP will need to be higher than 12 cm since your 13 min APAP isn't cutting it now.

Anyway you could try a BiPap to see?