Suggested changes to improve AHI and Sleep Quality

I'm almost through my 5th week on Dreamstation BiPap ST and will be heading in for a follow up with sleep doctor next week. My sleep study had my AHI at 41. My average is around 8 so obviously there is room for improvement. I called doc once to see about making changes before the follow up by he didn't want change anything and wanted 6 weeks of data to review.

I can't really say that I'm sleeping any better on treatment. Some days maybe slightly more refreshed in morning than before, but I do seem to have less days where I want to fall asleep on the couch at night. I still get woke up a lot. Not entirely sure why. Sometimes I see RERA and I feel like leaks on my eyes wake me up although no much large leaks registering.

Curious what all the forums experienced think are next steps. I swear people in these forums that are complete strangers care more about optimal treatment than all our care givers.

Did you have a diagnosis of central apnea or complex sleep apnea or obstructive apnea from the diagnostic sleep study?

What to do for you now depends on if those hyponeas are obstructive in nature or central in nature and it's hard to tell for sure from the data the machine provides.

Pugsy, you asked me at the beginning of my treatment when I posted why the doctor prescribed the BiPap ST. I didn't really know for sure so I called and asked. I don't know why he chose this machine over say a AUTOSV, but his response was that I have complex sleep apnea with centrals. Had total of 7-8 minutes of not breating in mostly less than 30 seconds or so timings. I had both OA and centrals in both sleep studies with the OA's more likely with back sleeping.

I do see anywhere from 300 to 1300 time breathing events in an hour. Guessing that is the ST kicking in to make me breath??

Edit: So how do I determine of what nature the hypopneas are?

The ST kicks in essentially with every breath depending on the back up rate setting.
It's essentially a fixed bilevel pressure machine that if you don't breathe on your own at the minimum back up rate it will kick in.

You need EPAP to be high enough to deal with any obstructive components that might happen.

You already know how I feel about ST machines and obstructive stuff....not ideal IMHO.
For plain central apnea...probably fine but it doesn't respond to anything except with the back up rate. It's essentially a ventilator.
It's going to make you breathe whether you do it on your own or not.

I am going to assume those hyponeas are obstructive in nature for the time being.....and if that's the case more EPAP which would force IPAP up if PS is kept the same.
Hyponeas are normally obstructive in nature but it isn't impossible for them to be central in nature.
Obstructive meaning related to airway tissues partially blocking the air flow vs central meaning there is maybe minimal effort but the airway is open.
Apneas and hyponeas can also be mixed...start out at one category and end up being another.

More IPAP via more PS might also deal with the hyponeas but more PS can sometimes make centrals worse so when already dealing with centrals I personally think using more EPAP to push IPAP up is what I would do if it was happening to me.

So are there ST type machines that are auto? It seams like some of the swings could be resolved with auto so that adjustments could be made with PS being changed.

tsduke wrote: ↑

Sat Sep 07, 2019 10:05 am

So are there ST type machines that are auto?

Not really.

The only real auto adjusting for complex apnea is the ASV.

You can treat with fixed but settings are much more critical and specific and involves using stuff all the time that might not be needed all the time. Like the back up rate or a much higher EPAP.

You may have already seen these

https://www.aastweb.org/blog/pros-and-c ... leep-apnea

https://www.sleepassociation.org/sleep- ... ntilation/

https://www.usa.philips.com/healthcare/ ... ion-system

Respironics has a similar line as ResMed but I couldn't find this sort of page that showed Respironics
https://www.resmed.com/us/en/consumer/p ... ml#Bilevel

Each bilevel devices is designed with a certain function in mind.

For some reason Phillips Resp hides the ST. I was trying to research it before I picked mine up and couldn't find it. CAlled them and they didn't know why either.

I will be asking my doctor more specically why the ST for me, but I guess he has to start somewhere. Sure don't give the thing away.

The ST is part of the journey, you are not adequately treated by it, ASV next