New to BiPAP Therapy: Seeking Guidance on Settings

[Kevinbipap]

Hi, 

I’ve been using my bi-pap machine for a little less than 2 years. I’ve struggled for the past year. The doctor upped the settings and seemed to help a bit for a while (not sure from what to what). I seem dependent on the machine at this point. My best days happen when I’m on the machine for about 6 hours and get 2 or 3 more without it.

Most nights my AHI is below .40  (it does spike higher occasionally)

I’ve had two sleep studies, the first I believe was a mix of obstructive and central. The second was mostly central. I was 50 lbs lighter for the second, but now my weight is back up again so maybe a bit more obstructive events?

I’ve never switched masks. Resmed F20 Full

I’ve attached 3 screenshots. 2 from the same night and 1 from another. Any thoughts would be greatly appreciated.

           

[Deborah K.]

Your machine is an ASV, not a Bilevel.  I will ask someone who knows all about ASVs to help you.

[HalfAsleep]

If you go to the pinned threads or Wiki, you'll find the exact Oscar layout that is most apt to get help here. And that's all to your benefit! If you look at some threads from other posters, you'll find some good examples.

Also, if you fill out your AB account settings exactly, you'll allow readers to get quick visual about your unit wherever you're posting, without them having to search for an Oscar chart. See how mine are over to the left? I have a Resmed biPAP with exact label terminology (Resmed's terminology can otherwise be confusing, and there are different Aircurves). You would almost certainly have a humidifier (you fill water every night, correct?). The pressure shows on the left hand Oscar panel.

[Sleeprider]

Kevin, you are using an ASV auto machine in AS01:V mode, which provides a single fixed EPAP pressure of 9.0 at your current settings. Your pressure support is at the default recommended minimum 3.0 and maximum 15.0. Your results have very low AHI, so I assume you are looking for alternatives that are more comfortable or perhaps lower pressure. In your screenshots I see clusters of very high flow limitation along with periods of very calm therapy without flow limits. On the 21st you can see the flow limits from 23:15 to 01:15 and 05:45 to 06:20, and I suspect something is going on at 03:00 with the high use of pressure support. On the 22nd, you can see the dark hashes of flow limits that rise to nearly full obstruction of 1.0, as well as a lot of clear space. I think these high obstructive flow limits are from positional obstruction as described and discussed in this wiki article. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

If we can find a way for you to tame the positional apnea problem, we can drop your EPAP pressure, and I would suggest using ASV Auto mode, so it can change according to your needs. My thoughts are to get you to ASVauto mode, with EPAP min 6.0, EPAP Max 9.0. We can probably reduce PS by limiting PS max. PS min 3.0, PS max 12.0. I'm certain this will work well for you. Your leak rate is zero, so your mask fit is great. If you want to experiment with other mask types we can discuss it, but for now the important task is for you to evaluate your sleeping position, pillows, and other factors discussed in that wiki article, and correct the problem.

[Kevinbipap]

Thanks for the wonderful response.  I will try to pay more attention to my sleep position. Looking back over the past few weeks on Oscar, I see similar clusters of high flow limitations. 

I will try to experiment a bit to see if I can fix the positional apnea problem.

I appreciate the response, thanks..  Kevin