Switched from APAP to BIPAP

[AmirKas]

Hey guys,

I'm a 20 years old male, who recently got diagnosed with OSA despite an AHI of 4.9. According to a WatchPat test that I did, I had an RDI of 9.4 with an ODI of 2, and a nadir of 92%. The only thing is that my symptoms of daytime fatigue, brain fog, irritability, and mood changes have made dealing with College and a difficult financial situation basically impossible. I'm anxious all the time and have even had bouts of doubt that I'm going schizophrenic (which I'm not) from the inability to properly manage intrusive thoughts. Excited to feel better, I got my APAP shipment expedited after nagging the sleep doctor for weeks on end.


Thing is, is that I feel even worse when I wake up. My brain fog and inability to study have become even worse since starting APAP therapy. I have the classic Resmed Airsense 10 Autoset with an f30i mask. I ordered the Airtouch f20 mask since I've noticed a lot of apneas occurring in my OSCAR data after mask leaks. I require a full face mask since I have an undiagnosed (but still very obviously) deviated septum and possibly enlarged turbinates. Hoping that the new mask will address a lot of my issues in my sleep, but I'm skeptical about the ratio of CAs to OAs recorded. I'm aware there can be false CA's, but my sleep still seems to mess up my entire day, making me feel alert and mentally clear only once I've stayed up for at least 18-20 hours, which is less than ideal. I've attached my OSCAR data from the past few weeks so that you kind members can help me assess my results and try and come up with a conclusion, especially since it takes weeks for my sleep doctor to decide to have an appointment available. 

Every single night I end up waking up fully after around 2- 4 hours and go back to sleep  . I've attached the photos for yesterday and the first part of the night before and I'm hoping you guys can help me figure out what's up. Let me know if I need to make another post to upload more specific screenshots. You'll notice a lot of CA's. 

06-22-21

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06-23-21 (Second part of the night)

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[Sleeprider]

With pressure of 7.0 to 14.0 and EPR off, your results are just okay, and most notably feature high flow limitations, which suggests the real problem here is an upper airway resistance and mainly hypopnea, rather than apnea, before you started therapy. The solution is quite easy and I think you will be surprised at how much more comfortable your machine can be. Enter the clinical menu, go to Comfort, turn on EPR Full Time at a setting of 3. This will make your Autoset machine a bilevel PAP device. With your current settings, the new pressure will be 7.0/4.0 (inhale/exhale), to 14.0/11.0. TURN OFF RAMP! Give that a try first, then after a night or two, increase the minimum pressure to match your median pressure from Oscar. That should get you dialed in.

It is important that you turn off the ramp feature. Your flow rate graph shows that this 45 minute ramp is really distressful, and you're not getting enough air. The ramp appears to have some EPR, but it is set to ramp only. You need EPR full-time.

[Ratchick]

I'm sure an admin will combine your other posts with this one at some point. But hi again!

Honestly, your raw numbers look pretty good, and that's not a lot of centrals, but I can understand why they're a concern. Did your WatchPat test come with a respiratory effort belt to go around your chest and/or belly? Do you have a copy of the full results that you can post for us? It might help to zoom in on a couple of those centrals at a 10-minute and 2-minute level so we can see what's going on.

Some centrals are common when someone first starts on CPAP. A certain number of people will find that, because the CPAP makes them breathe more effectively, they blow off extra carbon dioxide. The problem is that what drives your body to take a breath is actually raised carbon dioxide, not low oxygen levels. So when you breathe more effectively with the CPAP, your body has to get used to these new "Normal" levels of CO2 in your bloodstream. That usually happens over the first few days or weeks. I'm hopeful that's what your chart will show zoomed in.

I would suggest that you turn off Ramp, if you can tolerate that, and I would also suggest that perhaps you turn on EPR full time at 3. Then see how that goes. You might also want to pop your minimum pressure up to 9 too later on if needed.

[AmirKas]

I had EPR full time for the first night but turned it off myself after I apparently had 4.11 CA's per hour (at least according to OSCAR) and did some research to find out that EPR can cause central apneas to occur due to the reason Ratchick was talking about (Apparently EPR makes you hold in more oxygen which in turn leads to more central apneas.) I had an awful first night so I was compelled to try different settings myself. 


Unfortunately, the results I was given were lackluster and didn't involve any graphs are charts displaying my breathing patterns. I'm going to do a PSG in late August so hopefully, I can get more details as to where the issue lies. I'm also waiting for my sleep center to send my results to the ENT doctor so they can actually let me book an appointment (hate the American healthcare system), so that I can get my deviated septum and turbinates resolved, hopefully clearing up a lot of flow limitations.

I'll definitely remove the Ramp feature, although some of that breathing during one of the photos might've been me watching tv while using the mask... too foggy to remember. However, I'm concerned EPR is going to make my sleep worse :/

[SarcasticDave94]

Just a small heads up thing, I've got a deviated septum also, and not considering ENT doing any surgery. I would be on PAP or similar machine regardless. If your deviated septum is severe OK maybe you need both surgery and PAP. Most that have these surgeries are on PAP eventually.

It's sad to hear some like yourself given some lame excuse on testing delays. I had a new diagnostic and Titration done recently. Both were less than a month out from scheduling to doing. Maybe it's because your test site will give realistic results.

[Sleeprider]

Since you were sensitive to the EPR, it might help to gradually implement it. Try a setting of 1 and see where that takes you for now. It's not an all or nothing proposition. I do think the long ramp time was not helping at all.

[Ratchick]

Yep definitely, if you saw a spike in the centrals, try and implement the EPR slowly. If it's bad, you can always turn it off again.

[AmirKas]

Hey guys, 

I made another post regarding my settings and sleep results since I'm still experiencing pretty debilitating daytime symptoms that have impaired my ability to do well in College. The post can be found at:
http://www.apneaboard.com/forums/Thread-...s-wors-V2e

Yesterday, after taking advice from the people who replied to my post, I switched off the ramp setting on my APAP and turned on the EPR setting at a level of 3. I looked at my OSCAR results this morning after another terrible night of sleep and found out that I had more central apnea episodes than ever before. Uploaded images of my data are down below. One thing to note is that my CA's always seem to occur after an exhalation. Not sure if that's related to the CO2 / O2 concentration that affects how my brain decides when it's time to breathe, but some more help would be appreciated. 

Overall view:

[attachment=33186]

A closer look at some central apneas:

[attachment=33187]

Appreciate the help and advice as always!

[AmirKas]

Hey guys, I made another post regarding last night's results after tinkering with the settings on my machine. I may have missed the suggestion to only raise the EPR setting by 1, and instead set it at 3. I had more CA's last night than before so some more help would be great. 

New post:

http://www.apneaboard.com/forums/Thread-...ral-apneas

[Crimson Nape]

Please keep all your posts about your therapy in this thread. Your other threads on this subject have been merged here.