New BiPap S/T User

[tsduke]

I've been using a Dreamstation Bipap S/T now for about a week. My AHI #'s since start are as follows. 7.8, 17.1 11.1, 8, 9, 7.1, 7.4. In that time I've had just 2 total obstructive apnea. I've had some night with 10 and 13 clear airway, but the rest were 0-3 CA's. The high number I see every day is total hypopnea which has ranged from 32 - 118.

I know I'm new to therapy and assuming some of this may improve as my body gets used to sleeping with therapy, but I'm curious how the total hypopneas are managed/reduced. As I understand it they are basically periods of shallow breathing. Are higher pressures used to reduce them?

Are my AHI #'s normal for a new user?

I don't go back to my sleep doctor until 6 weeks after starting use so just looking for some insight. Thanks!

[Pugsy]

Hypnoneas are NOT just shallow breathing.
They are reductions in air flow of at least 40% to 79% that last at least 10 seconds. The criteria is specific.

Are my AHI #'s normal for a new user?

When the settings aren't correct...unfortunately I guess it is normal and that's sad.

Did they do an in lab titration sleep study with you and this machine to come up with the settings they are using?

What are all the settings they are using?

What was your diagnosis that earned you this type of machine?

[tsduke]

Yes, a titraction study was done. I can't say if it was the exact same model but it was a dreamstation bipap from what I could see. I know they started the night in CPAP and ended up on bipap get elimiate obstructions and get more even breathing.

My current settings are below. I was actually proscribed IPap of 14 but my past experience(long story) was horrible on pressures into the teens so doctor started me out a little lower on the IPAP pressure to start out of the gate. If this could be part of my issue it's my fault as I talked the doc into dropping it some because of my apprehensions.
IPAP 12
EPAP 7
bom 10

I'm not completely sure how to answer the question about diagnosis that earned me this machine. I had 41 AHI in sleep lab with periods where i don't breathe for as much as 30 seconds at a time as well as obstructive apneas and some snoring.

Long story short I was prescribed a Auto CPAP in december last off a moderate diagnosis from a home study(what a joke IMO). That went horrible with pressures as high as 18 some nights and by the end of 1 week I could barely breathe through my nose and I'm primarily a nose breather. I gave up on that and saw an ENT which resulted in nasal surgery which opened things up more and led to better breathing. Since that surgery I did a in lab sleep study in April and a titration sleep study in June which led to the BIPAP S/T. All this was ordered by ENT doc and before I'd let them put me on a therapy maching again I forced her to refer me to the sleep doc so I could get better information and understand my condition better. I got tired of doctors just order crap and not sitting down and review the study results with me.

On a positive note, other than a few leaks that wake me up, I'm doing night and day better with therapy now vs last year and can go the entire night using the maching.

[Pugsy]

You might want to request a copy of all your sleep studies so you have a written clear explanation of what brought you to this machine.
Especially that in lab titration report.

It is possible that once you are moved up to whatever original prescribed settings instead of the lower setting that your AHI will reduce.

Without knowing how and why you ended up on this machine with these settings I can't really offer much more than a guess.
So...my guess...assuming that those hyponeas are obstructive in nature...you may need that higher IPAP or maybe a little more EPAP.
Since you had trouble with the prescribed settings and thus the settings were lowered...stands to reason that once the settings get adjusted upwards a bit the AHI should come down.
Or in very general terms...you simply need a little more pressure to hold the airway open and prevent those hyponeas from happening.
They may or may not be related to sleeping position or REM sleep (both of which can cause OSA to worsen and need more pressure).

You can try OSCAR software so you can see when those events are happening which might give a clue.
I think it will work with your machine.
https://www.sleepfiles.com/OSCAR/

[tsduke]

I have the studies in writing now, but don't recall seeing anything that says "these things" are the reason for prescribing a Dreamstation BiPAP S/T, but I will review again. Being new I also don't understand why one would get this Dreamstation bipap over say the other bipap options. I've found the S/T hard to find info on too. I saw the sleep doctor before before starting on the maching and he was great at explaining what the studies show but didn't mention why he chose this machine.

I honestly can't figure out how those sleep studies provide good info. My 2 nights in the lab probably worst 2 nights of sleep in my life.

I will give the OSCAR software a try.

[raisedfist]

Did you get a copy of the sleep study report? Knowing why they decided to add a backup rate would be helpful.

Definitely do get OSCAR and post your screen shots.

Also go into the DreamStation menu and try and copy down and post the rest of your programmed settings, especially Ti (inspiratory time) and Rise Time.

[tsduke]

Here's some text from the titration study.

Screen Shot 2019-08-12 at 7.15.28 PM.png (610.22 KiB) Viewed 997 times

Screen Shot 2019-08-12 at 7.21.05 PM.png (779.33 KiB) Viewed 997 times

[tsduke]

Ti = 1.5
Rise time = 3

[tsduke]

Somethings not right here. I know my inhale pressure is higher than shown here. Wonder if my model isn't fully supported?

Screen Shot 2019-08-12 at 7.43.15 PM.png (40.6 KiB) Viewed 992 times

[Pugsy]

You may need to get Encore Pro and see what it shows.
Windows only though...
http://www.apneaboard.com/forums/
You have to register at the above forum and log in and at that time you can see the threads discussing how to get the software.

I thought that OSCAR was okay with the DreamStation ST but maybe it isn't ....or maybe it's just buggy in some areas.

[ajack]

Page 9 has the basic ST titration
https://philipsproductcontent.blob.core ... 3de0e6.pdf

[tsduke]

Now that I have some Oscar data to look at I wanted to share the last few days. Just under 6 AHI is the lowest I have achieved in just over 2 weeks usage.

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screenshot-20190821-165249.png (485.37 KiB) Viewed 887 times

screenshot-20190821-165257.png (531.34 KiB) Viewed 887 times

[zonker]

Now that I have some Oscar data to look at I wanted to share the last few days. Just under 6 AHI is the lowest I have achieved in just over 2 weeks usage.

good job!

as a slight aside to other, smarter folk here: what is that string of numbers under the orange ahi box? it's just under where it says EPAP 7.0 PS. i know i don't look at bilevel stuff so much, but is that a garbage string of numbers or is it meant to display that way?

sorry for the hijack duke. please carry on.

[tsduke]

good job!

as a slight aside to other, smarter folk here: what is that string of numbers under the orange ahi box? it's just under where it says EPAP 7.0 PS. i know i don't look at bilevel stuff so much, but is that a garbage string of numbers or is it meant to display that way?

sorry for the hijack duke. please carry on.

I think it's the formula to a perfect nights sleep. I just...can't..crack...it!!

Seriously though it's a test version of Oscar that's the first to support this machine so it might just be some cleanup on the settings import. For example the model isn't quite right yet. But I'm happy of the efforts to those updating Oscar!

[zonker]

I think it's the formula to a perfect nights sleep. I just...can't..crack...it!!

Seriously though it's a test version of Oscar that's the first to support this machine so it might just be some cleanup on the settings import. For example the model isn't quite right yet. But I'm happy of the efforts to those updating Oscar!

if you DO crack it, don't give it away for free! thar's gold in them thar hills!!