Help with BiPAP ST settings and understanding study report

Hi All,

After having my titration study my DME set me up with a Respironics Synchrony ST set in S mode with IPAP of 26 and EPAP of 18. I've been using it in S mode since July. I just received a copy of my study report on Monday which show a recommendation that I use BiPAP ST mode.

I also suffer from COPD and use supplemental O2 at 2 liters at all times except while using BiPAP where my pulmonologist prescribed 3 liters.

I've used the following settings. Other then the IPAP and EPAP no other settings where given in my prescription.
IPAP=26
EPAP=18
RR=14
Timed Insp 2.1 sec
Rise time=3
VentRamp=0.5
O2=3liters

The problem is that it seems to change from either inhale to exhale or exhale to inhale prematurely before I've completed my inhalation or exhalation cycle. What setting changes would help to correct this problem? Once a sleep it doesn't seem to be a problem but while trying to get a sleep it is a very uncomfortable felling when it switched prematurely. Also would the report sugest I have both central and obstructive apnea?

Thanks in advance for your suggestions and help

Study results below:

HISTORY:

This is a 53-year-old gentleman who was recently diagnosed with obstructive sleep apnea. Sleep study is done for CPAP titration.

Epworth Sleepiness Scale Score is 7 while on daily CPAP at 10

SLEEP DATA:

Sleep latency was 9 minutes, with a REM latency of 124 minutes. Total sleep time was 213.5 minutes, with decreased sleep efficiency. Only 31.5 minutes of REM sleep was noted. Arousal index was 23.3.

RESPIRATORY DATA:

A total of 13 central, 14 obstructive, 10 mixed obstructive, and 24 hypopneas were noted. Total apnea/hypopnea index was 17.1. REM apnea/hypopnea index was 9.5, and supine apnea/hypopnea index was 16.2.

No snoring was documented during this study. Lowest saturation was 63%. The patient spent 48.1 minutes with saturations less than 90% and 2.7 minutes with saturations less than 80%. No significant cardiac arrhythmias or periodic limb movements of sleep were noted.

(part of report seems to be missing here) maximum of 16 cm of water pressure. Subsequently, CPAP was switched to BiPAP. Optimum BiPAP appeared to be 26/18 with ST mode.

Assessment:

Axis I: Obstructive sleep apnea.
Axis II: CPAP/BiPAP Titration study.
Axis III: Hypertension.

Suggest:

1. Daily BiPAP at 26/18 with ST mode via medium Respironics Comfort Gel Full face mask and heated humidification.
2. Supplemental O2 at 2 liters to be bleed in.
3. Strongly advised the patient against operating heavy machinery and driving motor vehicles until symptoms of sleep apnea are controlled.

your backup rate of 14 is set too high

Guest wrote:your backup rate of 14 is set too high

\

Is that banned ??? posting (very banned like comment )

You may well be right, 12 seems a more intuitive value but, the pressures I am seeing tell me the person involved is significantly overweight & that factor will complicate all settings until weight can be improved. Else, the original poster is habitually hypervetilating ? (which should not be the case).

I may well be quite wrong about this.

DSM

To make your inhalation and exhalation longer you'd have to increase your timed insp. Problem is if you do that it may have an adverse impact on your sleep comfort. If your sleeping well and your numbers are good then I'd suggest trying to get used to the pre sleep feelings that your having. Remember when in ST mode or on psv or asv when you make a change in one number, your probably going to affect all numbers. Changes should be made carefully and one at a time. Unless your fully versed in the therapy your receiving I'd be hesitant making any changes without some guidance from your sleep doc.

Yes I'm over weight. I'm 6' and 270 lbs now but I've lost about 35 lbs since I was first diagnosed a little over a year ago.

I found out I had SA by accident.

Around Thanksgiving 2008 I had what I thought was a sinus infection and a flair up of my Asama. I ended up in the ER and found out I actually had a sever case of pneumonia. I almost ended up on a ventilator my pneumonia was so sever. The last time I ended up in the ER for what I thought was a major migraine headache but ended up being a ruptured aneurysm with a second one that had not yet ruptured. It took me two days after it occurred before I finally went to the ER. I was only 31 at the time so it couldn't have been anything serious. Two surgeries latter both aneurysms have been fixed.

I was put into the respiratory care unit where my O2 sat was monitored all the time and every time I fell asleep my saturation would drop into the 70's and the alarm would sound. Once awake it would go back to the upper 90's. I was on oxygen when this happened. It was then that I had a bedside sleep study done and I was put on a CPAP at 10. After recovery I had the titration study done and that was the results I posted above. It also during this hospitalization that I was diagnosed with COPD and prescribed full-time oxygen.

Last night was the 2nd night with the new settings and it was much more comfortable. I don't think it will take more then another night or two to get used to the new settings. It seems that I'm sleeping better with ST mode over just S mode. It may take a few more days to know for sure.

Thanks for your suggestions.

Ron

rhuszar wrote:Yes I'm over weight. I'm 6' and 270 lbs now but I've lost about 35 lbs since I was first diagnosed a little over a year ago.

I found out I had SA by accident.

Around Thanksgiving 2008 I had what I thought was a sinus infection and a flair up of my Asama. I ended up in the ER and found out I actually had a sever case of pneumonia. I almost ended up on a ventilator my pneumonia was so sever. The last time I ended up in the ER for what I thought was a major migraine headache but ended up being a ruptured aneurysm with a second one that had not yet ruptured. It took me two days after it occurred before I finally went to the ER. I was only 31 at the time so it couldn't have been anything serious. Two surgeries latter both aneurysms have been fixed.

I was put into the respiratory care unit where my O2 sat was monitored all the time and every time I fell asleep my saturation would drop into the 70's and the alarm would sound. Once awake it would go back to the upper 90's. I was on oxygen when this happened. It was then that I had a bedside sleep study done and I was put on a CPAP at 10. After recovery I had the titration study done and that was the results I posted above. It also during this hospitalization that I was diagnosed with COPD and prescribed full-time oxygen.

Last night was the 2nd night with the new settings and it was much more comfortable. I don't think it will take more then another night or two to get used to the new settings. It seems that I'm sleeping better with ST mode over just S mode. It may take a few more days to know for sure.

Thanks for your suggestions.

Ron

Ron,

You are lucky to have 1) been diagnosed with OSA & 2) to have found this web site. Your current weight is going to work against you constantly (just as mine did with me). Have you checked with your doctor as to the state of your LES ( lower esophageal sphincter). I am taking a punt here that you will find out that you have (or are about to have) GERD symptoms. The COPD may already be a result (I am no expert in this area at all but believe I am seeing something obvious).

Your sinuses & respiration can & will be affected by a failing LES which happens when we get overweight. Do you have GERD that you know of ?

Really hoping you can get on top of this.

Cheers

DSM

DSM

I do have GERD. Luckily it's very well controlled. It was caught early and medication has prevented it form getting worse.

The sinus and respiratory problems where present since I was a child and long before weight became an issue.

I'm working on loosing weight but it's a slow process with my limited physical abilities. But it's happening although slowly.

Ron

rhuszar wrote:DSM

I do have GERD. Luckily it's very well controlled. It was caught early and medication has prevented it form getting worse.

The sinus and respiratory problems where present since I was a child and long before weight became an issue.

I'm working on loosing weight but it's a slow process with my limited physical abilities. But it's happening although slowly.

Ron

Ron,
Seems we both had similar challnges - I had my nose operated on as a pre-teen - always had sinus & breathing difficulties.
Am though so lucky to have got the GERD under control as that works against us.

At night if you sleep on your back, there is a greater tendancy for the throat to close off (OSA) and this also allows some
seepage through the LES which in turn leads to stomach acid finding its way up to the throat nose area. The LES leakage is also bad if
sleeping on the right body side & causes least problems when sleeping on our left body side. It is all related to where the
LES is positioned & the extent of pressure (from excess weight) pushing on the stomach. GERD meds mainly reduce the
acidity but don't really stop the escape of the stomach contents. The intensity of the acid is what does most damage over time.

Even now I find there is a weight where the LES breeching occurs more than normal. I am right on that weight now &
have to get another 2-3 KG off to get back to where the LES is more effective at sealing. The side effects for me are
another sinus infection (using nasal salt flushing to help clear that up) and also the irritation of constantly clearing my
throat.

At times we are at war with our own bodies

Good luck with your efforts & cpaptalk is a great place to get encouragement from others in the same boat.

DSM

Ron

This link is a bit on the scary side but does contain important points. Well worth a good read.

Cheers

DSM

http://ezinearticles.com/?The-Connectio ... &id=562550