BIPAP making my CSA worse

[ImAlwaysTiredd]

progress? Got an asv finally, seemed like I was actually falling asleep with it but not staying asleep more than an hour. I seem to have quite a bit of hypopneas

Here's the longest snip so far of 2 hours 



zoomed in a bit, I thought the machine would compensate for the shallow breathing? looks like one H counted even while the mask was off. Or maybe they were all during mask adjustments while awake

[Sleeprider]

I believe the hypopnea are actually a positional issue due to the clusters. It is interesting that the ASV is not providing any pressure support above PS min as breathing volume reduces. You may need to take steps to prevent chin-tucking. Let's increase EPAP min to 6.0, keep PS min 3.0 and try PS max at 10.0. This is to help clear obstruction leading to hypopnea and to determine if you need the higher PS mas for central events.

[ImAlwaysTiredd]

They set me up with a 30 min ramp as well, maybe that's why it's not providing support?

Is chin tucking an issue with CSA? I dont have OSA, or is ASV now causing OSA?

[Sleeprider]

I missed the fact you were using ramp. Resmed does not recommend ramp with ASV because there is no therapy during that time. I am suspicious of chin-tucking (obstruction) because of the clusters of events. Our positional apnea article specifically shows an ASV example of obstruction, and it is generally where apnea or hypopnea are not responsive to pressure support which is trying to maintain the vent rates. In your case, what is perplexing is that the machine is not doing anything to resolve the hypopnea. Now that we know that all occurred during ramp, we know the real solution is to turn off ramp, not to change settings or suspect positional issues. Totally my miss, but next time give me a heads up when something like that is changed. Pretty obviously, dump the ramp.

[ImAlwaysTiredd]

Somehow I didnt think the ramp would affect actual operation, odd my dme only now enabled it, never on vauto bipap.
I'll keep ramp off from now on.
Here's a chart, it seems to always repeat this pattern, then I wake up, often taking off the mask, I notice the pressure climbing even while just laying there. Oscar said no ramp on the chart below, but I'm not sure, I've turned it on and off at times seeing if it makes any difference.

I noticed I'm getting quite a bit of aerophagia as well. Which makes me wonder if my mask is too low, causing my nose to be a bit blocked, if I move it any higher I get major leaks near my eyes, drying them out. I wouldnt say the mask is too big, as the lower part is just under my lip (medium), small would be exactly on it, which is what they used for my titration and felt small



I'll look into a collar, maybe an airplane pillow would work in the mean time

[Sleeprider]

Eliminating ramp is going to give you proper therapy from the beginning, and may help you to control mask leaks by challenging you with therapy pressure before you're asleep and can make mask adjustments. I could never use a full face mask that fits over the bridge of the nose. A hybrid mask with nasal pillows and a mouth cup is much easier to tolerate and fit, and no potential for leaks into your eyes.

[ImAlwaysTiredd]

seems it likes to run up the pressure while I'm just laying in bed awake, I've noticed ps will hit 8, while I'm awake.

[Sleeprider]

You are breathing slower with deeper breaths while awake, and the machine may be trying to bring up your resp rate pacing. It's kind of unusual, and you can probably blow-back on that pressure and reset it. You are event free for a lot of time at minimal pressure, so limiting PS max does not seem to be hurting therapy. How is the aerophagia today?

[ImAlwaysTiredd]

aerophagia has been better, but maybe because I've been sleeping less with the mask on, if at all lately, I've been falling asleep unexpectedly mid day and whatnot. 

I've been trying the f30i hybrid mask, but it's too sticky or old, it was a trial mask I got with the cpap over a year ago and never used, almost no nasal leaks, but isnt nice on the skin.

Regardless of mask, I rip them off in my sleep. I'm at the point I'm thinking of wrapping my head in duct tape to keep it on

[Sleeprider]

Removing a mask in your sleep is a habit or behavior, and you just have to find a way to break it. Start by using as comfortable a mask as possible. If you must bind the mask to your face, then maybe pull nylons over the mask and face and look like a robber. At least you won't have duct tape adhesive all over your hair.