I am seeking some advice regarding my recent experience with bilevel therapy for severe sleep apnea. Although I tolerate the therapy well and have no issues with the mask, I have been feeling worse since starting it. I have suffered from severe nocturnal panic attacks for many years and take medication for this condition. Over the past six years, these panic attacks had mostly subsided, with only one or two major events per year.
However, after beginning bilevel therapy, I experienced one of the worst panic attacks I've ever had upon waking up. That day, I felt like I couldn't breathe and wasn't getting enough oxygen. Surprisingly, my Oscar readings showed an AHI of less than 1. I tried adjusting to more comfortable therapy settings to avoid triggering my panic attacks, as they seem to be related to very high pressures affecting my ear canal and causing vertigo. I eventually settled on a therapy of PS 4, IPAP 12, and EPAP 8. My AHI remained under 1, and I didn't have another panic attack.
I decided to buy a pulse oximeter to measure my SpO2 levels. The first night after the panic attack, I did not use the bilevel machine and measured my oxygen levels. I was horrified that I spent most of the night well below 85%, with dips into the 60s. When I measured my SpO2 levels using the bilevel machine, they were even worse, staying between 80 and 70 most of the night and with the lowest SpO2 of 57%, lasting well over a minute. Additionally, my heart rate seemed to stay very high during bilevel therapy in the high 80s.
I am unsure how to proceed. I know how to change the settings on my machine, but I don't know what adjustments to make to improve my SpO2 levels without triggering panic attacks, especially since my AHI is under 1. Any advice would be greatly appreciated.