CPAPtalk.com

Mr Bill wrote:I felt better but I remarked to my friends that now that I was getting some sleep I actually was starting to feel lack of sleep! I'm up to a little over 6 hours a night average. I just can't seem to stay asleep most nights much longer than that. But the nights I have slept 8-9 hours; Oh man! Its wonderful, my mind is so clear and sharp!

avi123 wrote:Brian, if you really have Complex Sleep Apnea Syndrom then, I keep reading that there are other issues to deal with besides the ASV machine settings.

1. Nowhere in this thread did I suggest disabling the ASV
2. Nowhere in this thread did I mention an AVAPS

BiPAP autoSV Advanced has at its core the clinically-proven 1, 2 REMstar Auto algorithm. Utilizing a blend of advanced Respironics technologies (Digital Auto-Trak and REMstar Auto titration algorithm plus auto EPAP) the device is uniquely able to continually and effectively manage the patient's airway. Our proven servo ventilation algorithm then works to assure that with each and every breath, the patient is appropriately ventilated.

BrianinTN wrote:I wouldn't say I'm sleeping very well, but the air pressure is a LOT less disruptive than it was on CPAP (13 cm) and BiPAP (20/16).

http://bipapautosvadvanced.respironics. ... otocol.pdf

*If pt has known CPAP pressure of
< 10 set EPAPmin at 4 cm H2O
or patient comfort

*If pt has known CPAP pressure of
> 10 set EPAPmin at 6-8 cm H2O
or patient comfort

BrianinTN wrote:ozij, the current settings for my machine are precisely those from the end of my titration. They left it basically in the same mode it comes out-of-the-box, and the clinician did not have to adjust a single setting throughout the entire night. He told me this, and I saw the sleep study which showed only a couple hypopneas throughout the night.

My emphasis.

You have a known CPAP pressure of 13, a BIPAP of 20/16, they left you with an EPAP minimum of 4, they did not try you with an EPAP min of 6-8.
And with EPAP Min=4 your are having residual hypopneas and unsatisfactory therapy.

My problem is simply that my home results, despite matching those in-lab titration settings, are not coming out as good.

BrianinTN wrote:I'm fully prepared to give it time; I've been at this for a year already. Mostly I'm just hoping to figure out some tweaks to make this work better for me, both in the short-run and the long-run.

back in the beginning of the thread JohnBFisher wrote:Brian, I agree with avi123. It appears most of your AHI score is due to hypopneas. You probably should talk with your sleep doctor about this. It might be you need a slightly higher EPAP pressure to help keep your airway open. But as is true with anyone with an ASV unit, there is a lot to consider (such as, higher pressure can trigger more central apneas). In such cases, it is always advisable to discuss the details with your doctor.

StillAnotherGuess wrote:

BrianinTN wrote:It's been two days. I don't have all that data yet. I've tried PS=2 and the results are mixed (AHI of 4 on the first night of seven hours, 15 for additional three hours of sleep the next morning, and 4 last night for six hours). Subjectively, I've felt meh.

Throwing out the AHi 15 for the "additional 3 hours sleep", it would appear that a slight separation between EPAP and PS Min is already trending better for you. This would be consistant with the sleep communities expectation for bi-level therapy.

avi123 wrote:I can't find anything out of the ordinary in above PSG besides the BMI being on the hi side (obese), but I am not a Doc. Also, I can't see a reason for using an ASV. So I am out of here.

While obstructive events respond well to continuous positive airway pressure (CPAP) therapy, the response of central events is often incomplete and not sustained over time. CPAP treatment of obstructive events can, itself, lead to the development of central sleep apneas (CSA) or a Cheyne-Stokes respiratory (CSR) pattern in some patients. This syndrome of obstructive events or mixed central and obstructive events with short cycles of obstruction, minimal disease in rapid eye movement sleep, and incomplete response to positive airway pressure (PAP) has been labeled “complex sleep apnea syndrome” (CompSAS)