Do I need a BiPAP S/T or ASV machine?

[wearysoul]

I would appreciate input from some of you with knowledge of central apneas and BiPAP S/T and ASV machines.

I started CPAP therapy about 2 ½ months ago and haven’t experienced any significant improvement. Occasionally I have a day where I feel a little better but that is the exception. In fact, many days I think I feel worse than I did before I started CPAP therapy. I continue to have insomnia in the form of early morning awakenings, usually between the hours of 2 and 4 am. Read the following and you’ll see why I’m wondering if I need a different machine.

My initial PSG report states that I had 102 episodes of hypopnea and many respiratory effort-related arousals. It also states that there was no obstructive apnea, central apnea, or mixed apnea. The overall AHI was 20.2. The REM AHI was 50.5. SpO2 nadir was 87%. So it sounds like all the events in my sleep study, except for the RERAs, were hypopneas. The diagnosis was moderate obstructive sleep apnea.

The titration study report states “there was no obstructive apnea or mixed apnea during this titration study. There were 21 episodes of central apnea and four episodes of hypopnea. The overall AHI was 5.8. SpO2 nadir was 87%. CPAP was titrated to 9 cm H2O. BiPAP of 13/9 cm H20 and 14/10 cm H20 with backup rate of 10 per minute were also attempted during the study. At CPAP of 5 cm H20, AHI was 0. The patient did have REM sleep in the supine position at this setting. SpO2 nadir was 93% at CPAP of 5 cm H20. Of note, residual snoring and RERAs were still present at CPAP of 5 cm H20. CPAP-emergent centrals were seen at CPAP of 6 cm H20 and higher settings. At CPAP of 6 cm H20, AHI was 6.4. Most of the events at this setting were post-arousal central apneas. There was no Cheyne-Stokes respiration. BiPAP S/T device with backup rate did eliminate central apneas. However, the patient failed to tolerate BiPAP at 13/9 and 14/10 cm H20.”

The prescription: CPAP at 6 cm H20. In the recommendations, the titration report states “in case of poor tolerance to CPAP therapy, BiPAP S/T titration or adaptive servo ventilation (ASV) may be attempted.”

I do not yet own the data reader and software so the only information I have available is what I can retrieve from the “Results” screen on my machine each morning.

My leak rate (mostly due to mouth breathing) was too high when I began and I have reduced it some by wearing a chinstrap. I know it could be better still. Here are the leaks rates for the last week: .32, .18, .2, .24, .14, .18, and .14. And for the last week, my AHI has varied from a low of 5.2 to a high of 11.3. The corresponding HI is always higher than the AI. As you can see, my results are quite variable.

I see my doctor again soon and plan to ask about getting a different machine. I’m wondering if the current therapy is creating as many problems (in the form of central apneas and hypopneas) as it’s solving. Does that sound right

wearysoul

[dsm]

Wearysoul,

From the info you have provided it appears the doc & sleep lab are doing their job fine.

As for the benefit of a SV over an S/T, the Bipap AutoSV does have a lot of flexibility & can do what an S/T can do but can also do a lot more. The challenge with taking on such a machine is that the choice has to be yours as to if you are willing to do a little experimenting.

I consider myself to be extremely fortunate that I had the chance to try different machines & build up awareness of what each could do *for me*. I believe I won't be going go back to a std cpap (or even a plain bilevel). After nearly 2 years of using SV machines, I am totally sold on their dynamic response to my own breathing and can say that for me, I only really got completely on top of my cpap therapy after going to SV machines.

I sort of regard mine as my own personal supercharger. But, there are so many factors that come into play & what may have me singing its praises may not suit everyone. But your doc has suggested one & I would *grab* the opportunity as you can not do any better, after all it can still be set as a cpap, a bilevel, a cpap with SV & a bilevel with SV.

Good luck

DSM

[wearysoul]

Thanks DSM for the reply.

Yes, I'm mostly satisfied at this point with my doctor. When I last saw her at the end of June, I was struggling a lot (and I still am). She said she wanted to see me again in a couple of months to see how I was doing. At the same time, she also indicated that they don't ordinarily do another follow-up that quickly. Even though she said nothing then about the possibility of a BiPAP or ASV machine, I think she must have wanted to see a couple more months of results on the CPAP before we considered the other machines. I didn't know about the centrals I had during the titration until I got home and read the copies of the reports I got from my doc.

I have read these reports many times and have often wondered if these centrals (that are being provoked by a mere 6 cm of pressure) are the reason I'm not doing well. Although I'm new to all of this, it seems to me that I don't have a classic case of OSA. But on the other hand, I guess nobody does. From what I read on this forum, everyone's situation is unique and requires customized therapy.

I was hoping I wouldn't need a more sophisticated machine--that we could keep things simple--but maybe that's not in the cards. At this point, I'm willing to do whatever it takes to get my life back. And if that means I have to learn how to operate an even higher-tech machine, I'll do it. Just not looking forward to dealing with the "system" to make it all happen.

Would welcome additional input from others acquainted with centrals and/or BiPAPs and ASVs.

wearysoul