Auto BiPAP vs Bi-Level Questions

[Kevin M]

Hello,
I would like to reach out for some advice. I have suffered for years from Apnea to the extent that it has caused high Blood Pressure and heart palpitations. I went through every test in the book from the cardiologist and they have said everything is fine. I've had a CPAP machine that I have refused to wear because I am a shallow breather and the continuous forced air makes me suffocate. So last month I went and purchased a brand new Phillips Dream Station BiPAP Auto and I am using a full face Res Med mirage Quattro because I am a mouth breather. This thing seems to work great! ( Or I should say it has helped, but needs tweaking) I've completed 32 consecutive days and my AHI numbers vary between 3.3 and 4.3 sometimes lower.
Looks like my Periodic breathing and mask fit is at 100%
with IPAP is 12 and my EPAP is 7.0 (30 day average)
My concern is that I am experiencing high Hypopnea's of around 20 per night with 7hours of sleep. Does this mean I am not getting treatment? Should I be concerned about that? I also experience around 5 to 10 Clear Apnea's a night and and only 2 to 3 obstructive Apnea's in a night. I feel good and refreshed first thing in the morning, but I have a feeling that something is off because it seems like my heart pounds harder during the day and I get winded very easily. I do suffer from Bradycardia and Hypothyroid in which I just started Meds for the HYPO. I am wondering if my heart is fighting at night for oxygen while at sleep. Should I maybe switch over to BiLevel with settings of 7.0 EPAP
and 12 IPAP to see if that helps? Your thoughts are appreciated. I am scheduled for a sleep test next week. My blood pressure has been great with meds and even lower since therapy.


Kevin M

[DeepBreathing]

G'day Kevin, welcome to Apnea Board.

The first target of CPAP therapy is to get your AHI under 5. This is the average number of events (apneas and hypopneas per hour). It sounds like you've achieved that already, so now the thing is to optimise your therapy to give you an AHI as low as reasonably possible but importantly to make you feel rested and refreshed. The fact that your AHI is low enough to be regarded as "clinically treated" indicates that your heart is not fighting for oxygen, unless the apneas and hypopneas are coming in clusters which could cause desaturation. The other thing you should consider is whether you're experiencing a lot of RERAs, which aren't counted in your AHI but will cause broken sleep.

As to the proposed pressure change, I'm not sure what you're actually asking - if I'm reading it correctly you want to change to 7/ 12 EPAP / IPAP but you're already on those settings? Or have I misunderstood? Given that you have an imminent sleep test (which I assume is a titration test) I'd hold off making any changes until the test. Make sure you arrange time to talk over your entire experience to date with the doctor or therapist to ensure the whole picture is taken into account in any new prescription.

[Asjb]

Hello Kevin M,

I'd echo DeepBreathing about not changing anything until you can discuss the results of your next sleep test with your doctor, and echo DB's comments about how encouraging your results are right now.

The 'heart pounding' and 'winded' you describe might just be due to you maybe not being entirely fit yet (heart and lung stamina) - an underactive thyroid gland can make one very tired, difficult to keep active and fit. There's every chance that this will improve soon now that you have started treatment for the thyroid but you could maybe ask if there are any exercise programmes that your doctor can recommend.

A pounding heart can also sometimes be due to temporary changes in the speed of the heart rate - but I guess that would have been ruled out if your cardiology tests included the Holter test - wearing a continuous electrocardiogram (ECG) recorder during normal daily life for 24 hours (sometimes for three days). An overnight sleep test at home will not record the ECG, a sleep lab test will. Which type are you scheduled for? And both types of sleep test measure the overnight oxygen levels, so again, something to discuss with your doctor after the test.

And if you have any reason to remain a bit concerned about your overnight oxygen levels and pulse rate you could always buy (or get a loan from your doctor or equipment supplier) a little finger-tip pulse oximeter. There's lots of information about them on this forum. I use a Contec CMS50F which I can personally recommend.

Just a small point but you might want to bring it up with your doctor when you discuss the new sleep test results - your proportion of central apnoeas is coming near to 50% of all your events. This could be due to CPAP/BiPAP treatment itself, and then will later settle spontaneously, but you might want to ask if an ASV machine might suit you better - and if your test is in a lab, they might be able to try you out on ASV that night. And although 'shallow breathing' is not an indication for a change to ASV, my experience is that that is one of the many things that my ASV has improved a lot. But, ASV machines are more expensive and most healthcare systems are very reluctant to prescribe them unless absolutely vital.

Please come back to the Forum if you'd like to once you have your new test results.

best wishes

PS - forgot to add. Welcome to the Board!, great that you've found the forum - members have helped me enormously since I started CPAP.

..............................................................................................

My current settings: Auto-ASV. EPAP 12-15 PS 3-9

[justMongo]

If I understand the OP correctly. He has been running bilevel auto on a PR machine.
One thing I recently learned from Robysue is that PR machines can vary Pressure Support.
The OP states his 30 day average IPAP is 12 and EPAP is 7.

Again, if I understand the OP, he's asking if he should switch mode to straight bilevel (non-auto) with fixed IPAP of 12 and fixed EPAP of 7.

To the OP, I would echo the advice given. Wait for your sleep test.

Best Wishes.

[Sleeprider]

Hello,
I would like to reach out for some advice. I have suffered for years from Apnea to the extent that it has caused high Blood Pressure and heart palpitations. I went through every test in the book from the cardiologist and they have said everything is fine. I've had a CPAP machine that I have refused to wear because I am a shallow breather and the continuous forced air makes me suffocate. So last month I went and purchased a brand new Phillips Dream Station BiPAP Auto and I am using a full face Res Med mirage Quattro because I am a mouth breather. This thing seems to work great! ( Or I should say it has helped, but needs tweaking) I've completed 32 consecutive days and my AHI numbers vary between 3.3 and 4.3 sometimes lower.
Looks like my Periodic breathing and mask fit is at 100%
with IPAP is 12 and my EPAP is 7.0 (30 day average)
My concern is that I am experiencing high Hypopnea's of around 20 per night with 7hours of sleep. Does this mean I am not getting treatment? Should I be concerned about that? I also experience around 5 to 10 Clear Apnea's a night and and only 2 to 3 obstructive Apnea's in a night. I feel good and refreshed first thing in the morning, but I have a feeling that something is off because it seems like my heart pounds harder during the day and I get winded very easily. I do suffer from Bradycardia and Hypothyroid in which I just started Meds for the HYPO. I am wondering if my heart is fighting at night for oxygen while at sleep. Should I maybe switch over to BiLevel with settings of 7.0 EPAP
and 12 IPAP to see if that helps? Your thoughts are appreciated. I am scheduled for a sleep test next week. My blood pressure has been great with meds and even lower since therapy.


Kevin M

Kevin, my suggestion would be to change your strategy in the settings. You describe a fixed BiPAP mode. I think you may benefit from using the BPAP Auto mode. Since your OA is well managed at current EPAP, let's set EPAP Min to the current 8.0. I think much of your problem is from the constant pressure support of 5.0 with the fixed IPAP at 12. My recommendation is to set PS min to 3.0 and PS max to 6.0. If you want to cap IPAP, I would use 14 as IPAP max.

These settings bracket your current successful titration but will back off on pressure support unless the machine detects a need for greater PS or higher IPAP. This may offer some relief on the hypopnea, but if it does not, or worsens it, then you can simple increase PS min gradually to get back where you are, while maintaining some of the auto functions you paid for in that machine.

[trish6hundred]

Hi Kevin M,
WELCOME! to the forum.!
Good luck to you with your sleep study.
Much success to you with your CPAP therapy and getting your machine fine-tuned to meet your needs, hang in there for more responses to your post.