AHI still erratic, time to wingding?

any chance of a video camera with IR (so it can be dark) and time stamp to be able to correlate what your mom's doing with what the traces show? if she's struggling to breath, it should be obvious, if she's having real centrals and not even trying to breath, that should be obvious too.

I will do my best to be there when the RT next sees mom. He has been very good about scheduling on a day I could be there so far. I highly doubt he will recommend an increase in pressure since he was very concerned about the high pressure Mom was experiencing before he reduced it. He was also very disturbed at how high her tidal volume was. I feel very comfortable trusting his judgement.

I doubt Mom has any paperwork from her home study, but I'll try again to jog her memory. I'm thinking it was the same one I was prescribed when I did my home sleep study. I can remember it used a system that was called Alice or something like that, and shipped from the south, but I didn't really pay attention to it.

I'm not sure what Medicaid/Medicare covers as far as trying to get another study done. I do know we could insist anything further be done at the "main" hospital in the system vs the little Community Hospital that Mom has been going through, so that would be one change. That may make it possible for Mom to get a technician that knows what they are doing. It was ridiculous that the last tech didn't know or didn't care to know how to be sure there was an effective mask seal. Unfortunately, I don't think this gives a change in Drs. , but may increase the chance of actually seeing the Dr. He works at both hospitals. However, they know I am not going to let things rest as they are. He will not be able to ignore things.

No chance of a video with IR; no one in the family owns a video camera, and its not in the budget to get one.

Hopefully the SD card is working. Mom has not tried to download any data, preferring to wait for me and the RT. Last week, before the pressure changes, I popped her SD card in her computer, and no data showed up. I will be bringing a spare SD card, just in case. It's hard with Mom being 50 miles away; I can't get there as often as I would like to be. I'm always careful to lock the card when taking it out of the machine, and unlock it when putting it back in, but maybe it didn't unlock fully. That's what we are hoping happened.

College3girls wrote:I doubt Mom has any paperwork from her home study, but I'll try again to jog her memory. I'm thinking it was the same one I was prescribed when I did my home sleep study. I can remember it used a system that was called Alice or something like that, and shipped from the south, but I didn't really pay attention to it.

It would be most helpful to get the actual raw data file.

College3girls wrote:I'm not sure what Medicaid/Medicare covers as far as trying to get another study done.

They'll let you do as many as you want, but you still might be on the hook for the 20%.

College3girls wrote:...let me know what you think we should do next.

Also, ask why we are in VAuto (fixed PS) Mode.

I am having some difficulty understanding how if you have

robysue wrote:So it sounds like C3g's mom is still in auto mode with

• min EPAP = 10
  max IPAP = 17
  PS = 4

which should mean that the max EPAP is 13 since mom is using a VPAP Auto.

Then you have this 14/10 thing that can only go to 17/13 if it sees something.

How does that address hypopneas?

Sludge wrote:

College3girls wrote:...let me know what you think we should do next.

Also, ask why we are in VAuto (fixed PS) Mode.

So might a PR System One BiPAP Auto (which does not have fixed PS) have been a better choice when College3girls's mom was first switched to bi-level?

I am having some difficulty understanding how if you have

robysue wrote:So it sounds like C3g's mom is still in auto mode with

• min EPAP = 10
  max IPAP = 17
  PS = 4

which should mean that the max EPAP is 13 since mom is using a VPAP Auto.

Then you have this 14/10 thing that can only go to 17/13 if it sees something.

How does that address hypopneas?

Or are you saying that it's time to see if an ASV machine is warranted?

robysue wrote:So might a PR System One BiPAP Auto (which does not have fixed PS) have been a better choice when College3girls's mom was first switched to bi-level?
...
Or are you saying that it's time to see if an ASV machine is warranted?

I really am only asking

Then you have this 14/10 thing that can only go to 17/13 if it sees something.

How does that address hypopneas?

I am looking at data from 2 weeks ago at 21.8/13.0 PS 4.0 and seeing

(weird things).

College3girls wrote:All 3 nights at the lowered settings netted an AHI over 25.

...let me know what you think we should do next.

Without current detailed data and the diagnostic HST (preferably raw data), "IMHO" you are doomed to wingding.

By definition, "wingdingin' " means arbitrarily changing settings to either:

• "Get a good number"; and/or
• "Feel better"

While the current moves by the RT have some good basis, he's wingdingin' as well. That said, I think one of the questions has to be

What does that ~25 AHI mean?

Towards that end, here's a bunch of events (or maybe not) from the previous data. Identify how many and what they are:

Its very hard to correct long-term backsleeping. Ive tried just about everything, but i did retrain myself to my side
but it took 6 months.

The only thing that absolutely prevented roll over was a wrist band tied to the bedrail via cord. I short roped it so no way i could roll onto my back and still be in the bed.

Pillows, tennis balls, blankets, etc just dont seem to be effective.

I agree, while Mom says she goes to sleep on her side, and wakes in the same position, it is likely she is sleeping on her back some of the time, however, she has bigger issues than back sleeping going on.

Unfortunately, the SD card is not recording data, so there is nothing to download to sleepyhead with the new settings. The last recorded data is June 11. The RT is mailing mom a new SD card, but I probably will be able to get one to her faster, on Friday morning.

Still waiting for the sleep study results and we will keep pestering for that.

Sludge, Robysue- should I leave everything alone, or lower her both her IPAP and EPAP some more? I know we are flying blind with this, but I don't see where we can make things worse, so I'm willing to try more changes. Sludge, you were questioning one of her settings in an earlier post. Is this something I should change to a fixed setting and see what happens? I'm of the opinion if a new setting makes things worse, it's easy to change back to a previous setting with the push of a button. I can take mom through changes by phone, so no trip out to her house needed to do setting changes.

College3girls wrote: Sludge, Robysue- should I leave everything alone, or lower her both her IPAP and EPAP some more? I know we are flying blind with this, but I don't see where we can make things worse, so I'm willing to try more changes. Sludge, you were questioning one of her settings in an earlier post. Is this something I should change to a fixed setting and see what happens? I'm of the opinion if a new setting makes things worse, it's easy to change back to a previous setting with the push of a button. I can take mom through changes by phone, so no trip out to her house needed to do setting changes.

How long has your mom been on the current settings?

And, as bad as it was, have you seen the formal report from the BiPAP titration?

I think that if you do want to do further dial winging, the max IPAP certainly is a candidate for being reduced. And perhaps the min EPAP as well. You might also want to call the RT your mom is working with and ask about whether fixed bipap is worth considering and if so, what a starting IPAP/EPAP setting might be.

Sludge wrote:Identify how many and what they are:

Well let's see what the machine says:



So it scored is as:

• Hypopnea
• No call (the 2 breath flow reduction < 10 seconds duration)
• No call (incorrect - that's the worst (or next to worst) hypopnea in the lot)
• Obstructive apnea (incorrect - that's a relative hypopnea - the machine did not sense patient effort and trigger)
• Hypopnea
• Hypopnea

robysue wrote:I think that if you do want to do further dial winging, the max IPAP certainly is a candidate for being reduced.

But in the above example, ALL the events are hypopneas. Is not the BiPAP approach to SDB control the obstructive apneas with EPAP and the hypopneas with IPAP?

Unless they are central hypopneas?

Or post-arousal (like maybe these are a result of PLMs (e.g., LOLs frequently have PLMs))?

robysue wrote:And perhaps the min EPAP as well.

So the machine IS a LSOS (all the OAs are incorrectly scored)?

By-the-by, the machine Trigger would still seem to be able to be adjusted to offer a little more sensitivity to patient effort.

By-the-by2, since Medicare criteria must be used, without integrated pulse oximetry, there are NO hypopneas whatsoever.

I'm at Mom's house now, and have one night's data. The "new" SD card the RT mailed is working. Her AHI last night was only 3.69, so something worked last night. No sleep study data yet. We will keep pestering the RT. Hopefully Mom starts stringing some good nights together. I'm not trying to send any screen shots of this one night, since it's very late, close to midnight here, and I have an hour drive home now.

I suspect her really bad nights are supine sleeping as part of the issue. She will have to keep working on sleeping on her side. She admits some mornings she wakes up completely flat on her back without even a pillow.

When I have more data available from the BIPAP, or the sleep study titration becomes available, which ever comes first, I'll post more screen shots and send pm's to you, Robysue. With that 3.69, it was about 50% CA's and the other half OAs or HA's.