Weired Numbers From New Treatment (UPDATED)

Hi All,

I changed from my CPAP to a BIPAP last week. The numbers are all over the place, but I am felling a little better for most of the day. Any ideas why the numbers may be jumping like they are? You can check the images out here.
http://sleepwiggler.imgur.com

Yea!!! I found my data transfer cable for my oximeter so here is last nights shot with my oximeter data.


Thanks

Next time you do your screen shots can you turn off the pie chart? It isn't particularly useful and in your situation it might be more useful to see the % of time in large leak territory.

The usual culprits when we see nights with not much going on and other nights with clusters of something....either supine sleeping or REM stage sleep.
Whichever it is...that 22 cm isn't quite getting the job done when you see those clusters of OAs or hyponeas.

Exactly what settings are you using? It looks like from the pressure graph that it's straight 22 cm except for the short ramp time.

Pugsy wrote:Next time you do your screen shots can you turn off the pie chart? It isn't particularly useful and in your situation it might be more useful to see the % of time in large leak territory.

The usual culprits when we see nights with not much going on and other nights with clusters of something....either supine sleeping or REM stage sleep.
Whichever it is...that 22 cm isn't quite getting the job done when you see those clusters of OAs or hyponeas.

Exactly what settings are you using? It looks like from the pressure graph that it's straight 22 cm except for the short ramp time.

My prescription calls for 22/18, so that is what the DME set the machine for. During the titration study it stated that at 22/18 my apnea was controlled at 1.5. I also just looked at the SPO2 assistant or my oximeter and man was I a wreck, my O2 levels down and heart crazy. Which I am sure my cardiologist will see because they started e on a 1 month event monitor yesterday. I have fainted once and had dizzy spells along an extra heart beat but she was also concerned about my BP yesterday as it was 101/65 which she said is low, and two EKG's were "Nasty" that was the Tech's word.

One more thing as for time spent in Hypopnea there were 36 events lasting 10 seconds each.

This may be a situation where SleepyHead is having trouble with the AirCurve settings.
From the Statistics column and the pressure graph it looks like fixed 22 and no 18 cm involved anywhere.
I would suggest that you
1...confirm that the machine is indeed set up in S mode with EPAP 18 and IPAP 22
2...use ResScan software if at all possible if you confirm that the settings are indeed 18/22 because SH may be having some issues. While I don't think the issues relate to AHI and are just related to the settings...I would want to confirm with ResScan.

Go to the clinical setup menu on your machine to confirm settings.

Hyponeas have the same minimum duration as OAs and Centrals...10 seconds.
The amount of air flow reduction though is less than OAs.
With hyponea the air flow reduction might be 50% for 10 seconds and it gets a flag...and with OA the air flow reduction needs to be at least 80% (or more) for the 10 seconds to get the OA flag.

Pugsy wrote:This may be a situation where SleepyHead is having trouble with the AirCurve settings.
From the Statistics column and the pressure graph it looks like fixed 22 and no 18 cm involved anywhere.
I would suggest that you
1...confirm that the machine is indeed set up in S mode with EPAP 18 and IPAP 22
2...use ResScan software if at all possible if you confirm that the settings are indeed 18/22 because SH may be having some issues. While I don't think the issues relate to AHI and are just related to the settings...I would want to confirm with ResScan.

Go to the clinical setup menu on your machine to confirm settings.

Hyponeas have the same minimum duration as OAs and Centrals...10 seconds.
The amount of air flow reduction though is less than OAs.
With hyponea the air flow reduction might be 50% for 10 seconds and it gets a flag...and with OA the air flow reduction needs to be at least 80% (or more) for the 10 seconds to get the OA flag.

ResScan confirms 22/18 and so does the machine. I posted earlier if sleepy head could be used fro the Aircurve 10 VPAP and other members said yes but it would not show the pressure correctly.

As long as the AHI and other stuff match between SH and ResScan then I wouldn't worry about the pressure.
Just be sure to mention it in the future if you have another thread where someone might spot the weird pressure stats.

The AirCurve machines were released about 4 months after SH was updated to deal with the AirSense machines and SH hasn't really been updated since that time...so that's why the slight bug with the stats and pressure graphs.

If you do have the VAuto model....if the ugly clusters get too frequent you might see about changing over to Auto mode and not S mode and let the machine go a little higher in an effort to break up the clusters of OAs and/or hyponeas. Since you don't have much room left in terms of pressure...probably Auto mode with similar settings as now but with IPAP max to 25. Just a thought...certainly not anything urgent.

Thanks

Pugsy wrote:As long as the AHI and other stuff match between SH and ResScan then I wouldn't worry about the pressure.
Just be sure to mention it in the future if you have another thread where someone might spot the weird pressure stats.

The AirCurve machines were released about 4 months after SH was updated to deal with the AirSense machines and SH hasn't really been updated since that time...so that's why the slight bug with the stats and pressure graphs.

If you do have the VAuto model....if the ugly clusters get too frequent you might see about changing over to Auto mode and not S mode and let the machine go a little higher in an effort to break up the clusters of OAs and/or hyponeas. Since you don't have much room left in terms of pressure...probably Auto mode with similar settings as now but with IPAP max to 25. Just a thought...certainly not anything urgent.

I took my card and laptop to my RT at my DME's office she reviewed the data and she said compared to what my numbers were before any treatment I was doing good but the fact that I was still tired and had those nasty clusters she was going to talk to my doctor about changing from S mode to auto with a min of 18 and the max of 25. I do have the Auto so I came home and changed it myself and the clusters look better and I fell pretty good today. I will see how the the rest of the weekend goes. I did notice that the machine had to stay above 22 most of the night and that it did hit 25 several times. I am not at my computer right now so I will post a screen shot shortly.

Due to the bug with SH in terms of pressure reporting...you can't assume that the machine was at 22 most of the night...the graph is inaccurate. It's not showing your 18 EPAP at all and it should be showing it.

When you do your images...do the AHI on the left side in the detail tab instead of the events tab. If someone wants to see the events tab they can ask it. Most of the time we don't need to see the time.

Also....I can't read anything on this last image...it's too small and I can't click on it to make it any larger.
I can just barely see the marks and the events graph.
For future images maybe see if you can make them easier to read and see??? Not critical at this point but just wanted to mention it.

But I can see that the clusters are less dense and that's a good thing. I call it "breaking up the clusters" and for me I am okay with breaking them up and not striving for total eradication..
Further reduction is likely going to call for a little more EPAP but at this point it doesn't appear to be urgent.

Pugsy you are right on the numbers, I will look in Res Scan as well. I will work on the posting of screenshots i was a little trouble with it will refer back to some information. On EPAP can you explain a little more. I am still Learning and just starting to get really involved in my therapy. I am taking charge and refusing to settle for mediocre treatment becuase I want to be as healthy and fell as good as possible.

NM did some quick research got it on EPAP. Need to figure if that needs to go up. Time to experiment.

Not sure what about EPAP that you need clarified so a direct question would help if what I say below doesn't answer whatever questions you may have.

In general think of EPAP as a baseline pressure that is always there to hold the airway open....very similar to a minimum pressure setting when using apap mode. It's the minimum pressure that does the bulk of the work and is therefore the most critical setting.
So with APAP or Bilevel pressure machines it is the minimum pressure that holds the airway open and the higher IPAP (with bilevel) or higher maximum available APAP can't do their job effectively/optimally.

For the bulk of your night the baseline pressure does a good job (no clusters) but for some reason or other at other times during the night that baseline pressure isn't enough.
With bilevel machines and pressure support that is fixed (as with your machine) in auto mode if the machine needs to go up then EPAP pushes IPAP up and if the machine thinks IPAP needs to be higher then it will pull EPAP up.
When in fixed S mode...the machine can't go up in response to whatever is causing those ugly clusters so they just happen. There are 2 options when this happens...either use fixed bilevel pressures that are set higher or allow the machine to use auto mode and then the machine can decide and only use the higher pressures when it needs to.
Even in auto mode sometimes the EPAP isn't quite enough to get to where it needs to be to prevent the clusters...so we sometimes still have to give EPAP a little better head start which of course means IPAP will increase because of PS...even when using auto mode because the machine can't can always respond fast enough.

Given the definite improvement with just changing to auto mode and letting the machine go higher...I suspect that EPAP wouldn't need to be much higher to give optimal performance because you are so close right now. Maybe as little as 0.2 to 0.6 more EPAP and that is only if you really feel it necessary to break up the clusters more. It certainly isn't urgent though and I don't know that I would do it just for 1 or 2 random clusters that have the number of dense events get cut in half like yours appear to be.