EXHAUSTED--Trying to get AHI down

[zimm4er]

Have been using BIPAP with full face mask for over 3 years. Have adjusted my settings, but recently my AHI is all over the place. I sleep awful. Wake up at least once, sometimes 3 or 4 times a night. I am exhausted in the am, by 1000 in the am I am ready for a nap. Last sleep study I had was over a year ago. Had a hard time going to sleep, couldn't stay asleep, then the sleep doc told me "it was good enough." Of course he would not look at my sleepyhead data. So here I am on my own trying to figure out what to do.

[Steve of Cornubia]

I'll leave the data interpretation to others, but can I ask why you started tweaking your settings? Was something else going on that might have affected your sleep?

[palerider]

My first question is "why do you have a ST-A iVAPS machine?"

Do you have some lung disease? (a variant of COPD, etc?)

[zimm4er]

[*]started tweaking my numbers because my ahi was running 7-10. On bipap because original dx was central sleep apnea.

[palerider]

[*]started tweaking my numbers because my ahi was running 7-10. On bipap because original dx was central sleep apnea.

The Resmed ST-A iVAPS isn't a "bipap", it's a specialized machine for people with lung conditions, and doesn't work well for people with ordinary central sleep apnea.

Running it in St mode isn't going to give the best results.

[zimm4er]

Suggestions???

[palerider]

Suggestions???

The ideal thing would be to trade the machine for an asv. Short of that, .. I'll have to look into settings, which I can't do right now... Hopefully raisedfist will pop in

[zimm4er]

New machine not an option at this time. $$$$$
Can change the mode on my machine to ivaps, pac, t or just s. Tried a asv machine 2 years ago and my numbers were awful. I think I need the backup rate to deal with my hypopnea

[palerider]

New machine not an option at this time. $$$$$
Can change the mode on my machine to ivaps, pac, t or just s. Tried a asv machine 2 years ago and my numbers were awful. I think I need the backup rate to deal with my hypopnea

Backup rate is *only* for centrals.

[zimm4er]

Central apnea was my original diagnosis

[palerider]

Central apnea was my original diagnosis

Yes, but backup rate is not effective for hypos, which is what you said

[palerider]

You can try going to iVAPS mode, it's more complicated than setting up an ASV... but might provide you with a better result.

You'd need to start by requesting the clinical manual off of the link at the top of apneaboard.com, and then check out the section on page 25 to set up the targets.

I'd suggest using the about the same EPAP you have now... which, is a lot, for someone who was diagnosed with central apnea.

do you have a copy of your sleep study report?

[zimm4er]

Don't have a copy of sleep report. Changing to ivaps should I leave my ipap/epap the same? Thanks

[palerider]

Don't have a copy of sleep report. Changing to ivaps should I leave my ipap/epap the same? Thanks

IPAP is handled automatically by iVAPS.

[raisedfist]

Your SleepyHead charts show your treated central apnea index to be zero. You have a lot of untreated hypopnea. One easy way of seeing whether Centrals are an actual issue would be to switch to Spontaneous (S) mode and see what happens to the CA index.

One thing that stands out to me, since I look at respiratory data primarily, is that your median tidal volumes and minute volumes are very low. That could be due to all those untreated hypopnea. The answer to that is generally more IPAP/Pressure Support, but it has to be done carefully.

What is your current backup rate set as? And, on the machine itself, what does it say your Percent Triggered Breaths % is on the report screen after a night of therapy?

Your median respiratory rate is rather low, so if your natural RR while asleep is bumping against the backup rate a lot while you sleep, it can cause you to “fight the machine” and unwanted arousals may happen as a result.