Macro-control of treatment for sleep disordered breathing

Abstract

A method and apparatus for treating sleep disordered breathing. An arousal index is determined for use in an outer loop of a control algorithm, the arousal index being a measure of the frequency of sleep arousals. The respiratory airflow signal in an inner loop of the control algorithm is monitored to detect an airway obstruction. If the arousal index is high, then the sensitivity of obstruction detection and/or the aggressiveness of the treatment is increased, and if the arousal index is low, then the sensitivity of the obstruction detection and/or the aggressiveness of the treatment is decreased.

1 . A method for monitoring and treating sleep disordered breathing by using two control loops, one inner and one outer, wherein the inner loop is adapted to provide at least two treatment modes and the outer loop is adapted to monitor the effectiveness of therapy provided by the inner loop and to control a change in modes if necessary, wherein the effectiveness of therapy is monitored by assessing the number and/or types of respiratory events occurring over a period of time, and the outer loop exerts control over operational parameters of the inner loop. 
     
     
         2 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 1  wherein the period of time is at least one hour. 
     
     
         3 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 1  wherein the inner loop does not exert control over the operational parameters of the outer loop. 
     
     
         4 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 1  wherein treatment modes provided by the inner loop include at least two selected from the group of basic CPAP, automatically adjusting CPAP, bi-level CPAP, and treatment of Cheyne-Stokes respiration. 
     
     
         5 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 4  wherein the outer loop distinguishes between central and obstructive apneas, or detects oxygen desaturation events, or monitors snoring, or does two or more of these. 
     
     
         6 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 4  wherein the outer loop determines at least two of the number of central apneas, obstructive apneas, hypopneas, and desaturation events. 
     
     
         7 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 4  wherein the outer loop determines appropriate indices such as the Apnea Hypopnea Index (AEI), Central apnea Index (CI) and desaturation index (DI). 
     
     
         8 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 4  wherein the outer loop monitors the intensity and severity of snoring. 
     
     
         9 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 4  wherein the outer loop monitors flow flattening. 
     
     
         10 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 1  wherein the outer loop distinguishes between central and obstructive apneas, or detects oxygen desaturation events, or monitors snoring, or does two or more of these. 
     
     
         11 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 1  wherein the outer loop determines at least two of the number of central apneas, obstructive apneas, hypopneas, and desaturation events. 
     
     
         12 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 1  wherein the outer loop determines appropriate indices such as the Apnea Hypopnea Index (AEI), Central apnea Index (CI) and desaturation index (DI). 
     
     
         13 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 1  wherein the outer loop monitors the intensity and severity of snoring. 
     
     
         14 . A method for monitoring and treating sleep disordered breathing by using two control loops in accordance with  claim 1  wherein the outer loop monitors flow flattening. 
     
     
         15 . Apparatus for monitoring and treating sleep disordered breathing comprising an inner loop control mechanism adapted to provide at least two treatment modes, and an outer loop control mechanism adapted to monitor the effectiveness of therapy provided by the inner loop control mechanism and to control a change in mode if necessary, wherein the effectiveness of therapy is monitored by assessing the number and/or types of respiratory events occurring over a period of time, and the outer loop control mechanism exerts control over operational parameters of the inner loop control mechanism. 
     
     
         16 . Apparatus for monitoring and treating sleep disordered breathing in accordance with  claim 15  wherein the period of time is at least one hour. 
     
     
         17 . Apparatus for monitoring and treating sleep disordered breathing in accordance with  claim 15  wherein the inner loop control mechanism does not exert control over the operational parameters of the outer loop control mechanism. 
     
     
         18 . Apparatus for monitoring and treating sleep disordered breathing in accordance with  claim 15  wherein treatment modes provided by the inner loop control mechanism include at least two selected from the group of basic CPAP, automatically adjusting CPAP, bi-level CPAP, and treatment of Cheyne-Stokes respiration. 
     
     
         19 . Apparatus for monitoring and treating sleep disordered breathing in accordance with  claim 15  wherein the outer loop control mechanism distinguishes between central and obstructive apneas, or detects oxygen desaturation events, or monitors snoring, or does two or more of these. 
     
     
         20 . Apparatus for monitoring and treating sleep disordered breathing in accordance with  claim 15  wherein the outer loop control mechanism determines at least two of the number of central apneas, obstructive apneas, hypopneas, and desaturation events. 
     
     
         21 . Apparatus for monitoring and treating sleep disordered breathing in accordance with  claim 15  wherein the outer loop control mechanism determines appropriate indices such as the Apnea Hypopnea Index (AEI), Central apnea Index (CI) and desaturation index (DI). 
     
     
         22 . Apparatus for monitoring and treating sleep disordered breathing in accordance with  claim 15  wherein the outer loop control mechanism monitors the intensity and severity of snoring. 
     
     
         23 . Apparatus for monitoring and treating sleep disordered breathing in accordance with  claim 15  wherein the outer loop control mechanism monitors flow flattening.