CPAP to BiPAP...

[Korndog]

Good evening, all-

Started my CPAP journey back in 2021, and recently had another study accomplished and prescribed a BiPAP. The CPAP treated my OSA, but never really resolved the CA's or central apneas. I have attached two screen shots from my last two nights. Going from CPAP to BiPAP, does not seem like anything has changed  as far as "how I feel" every morning. Since I have been in treatment, I can count on two fingers where I recall waking up and feeling like I slept, and was ready for the day. Problem I run into, even now, is if I do wake feeling somewhat rested, it only takes about an hour into my day where I have that exhausted feeling. I have noticed with BiPAP, that my mid-day crashes are less frequent, but nevertheless still present. I keep pretty close track in OSCAR on how I am progressing and try not to obsess over AHI in the morning, but can say with certainty that the differences from an AHI and 1.something, the feeling is much different.

Current:
V10 Auto
IPAP 11
EPAP 7
PS 3
TiMax 2
TiMin .2
Trigger High
p30i

recently changed trigger from med to high; seemed to have an affect on my numbers. shifted PS from 3 to 4, significant increase in CA and H, so returned to 3 which then returned me to scores shown in screen grabs.

Former:
Resmed Airsense 11
6.6
epr off
p30i

EPR had a signigicant affect on CA, but never resolved them. I started with ramp but quickly abandoned that because I felt suffocated. I have been on no EPR on both C and BiPAP therapies.

My goal has never been to chase the 0 AHI score, but to make the therapy effective. While I know it has essentially treated OSA sufficiently, its not been dialed in to treat/eliminate centrals. I am a back sleeper, with a head cradle type pillow which doesn't let me turn a whole lot during the night.

Any insight would be very much appreciated. I have scrubbed these forums looking for possible answers, but yet to find anything really definitive for my personal situation. Some of these sleep reports in this forum I am wow'd by and wish I had the same, ever, from night to night. Hopefully we can get there.

[staceyburke]

The changes I would make.

Ps 4
Epap4
trigger very high

lets see what that does for you

[zaienk]

according you chart, you still have some OA with an EPAP starting from 7 and limited to 8 with a lot of variaton of pressure between 7 and 8 during the night, and with pressure remaining many times at 11/8.
So if it would be me, I will increase the EPAP of 1, and give a little more room to Vauto to ajust pressure to see what happen like below:

V10 Auto
IPAP 13
EPAP 8
PS 3
TiMax 2
TiMin .2
Trigger High

Also variation of pressure can lead into CA, so I would try first to stabilise the EPAP with the right number required to cure OA, and if CA doesn't no decrease by using something close to a fixed pressure, change trigger to very high and then increase the PS is there is still hypopnea and RERA to cure.

[Korndog]

Appreciate all of the quick replies. I have attached last nights graph. You will see two "sets" of information in this one. I was feeling a little under the weather, and came home and napped on the first; the details of that one are (because I made some changes before I napped and posted yesterday):

IPAP 11
EPAP 7
PS 4 (this seems like it drove more CA and H, as I had the same effect when I used EPR on CPAP)
TiMax 3
Trigger High (moving this from med to high initially got me hopeful but surmise that VH may have helped with CA and H)
 1:39 for that nap period put me at an AHI of 3.64

CA 1.21
OA .61
UA 0
H 1.82

I didnt see any of these replies until I was up this morning, but seeing the affect those settings had on H and CA, I changed my settings to:

IPAP 11
EPAP 7
PS 3
TiMax 2
Trigger Very High

These settings by themselves got me under 1 @ AHI .61. Combined got me to 1.12

For those who have been gracious enough to respond, does this change anything? Looking at the OA's overall, I would like to try the pressure changes to settle the OA. Even though I slept, my lovely wife told me I had a mild snore at times throughout the night. Please see the attached graphs and see if you agree or would change your initial suggestions based on data provided.

Thank you thank you thank you! @zeienk and @staceyburke. I just want to emphasize what this means to me, as I spent a lot of time on military errand and my specialty had me up at very odd times and didn't exactly lend to restful, recovered sleep. Since I retired last year, I have been making adjustments to my health to get me back to a somewhat normal person, but the sleep thing has been ultra elusive to say the least. Again, thank you very much!

[zaienk]

You're welcome!
Good result with trigger very high.
On the last one your share, flow rate, pressure are missing, please provide it next time.
Your med pressure is still close to 8, and you have more flow limitation. According your feedback and these new results I would recommend to try this:

V10 Auto
IPAP 14
EPAP 8
PS 4
TiMax 2
TiMin .2
Trigger very High

Try it 2 or 3 nights and share your chart with, at least, flow rate, pressure, flow limitation, tidal volume and resp rate.

[Korndog]

6 Feb graph attached with the requested items. Still an improvement, moving in the right direction.

Thank you and have a great day!

I will make those suggested adjustments and report back in a couple of days.

[zaienk]

You're welcome, great!
You see, now your med EPAP goes up to 9. But maybe it is because of flow limitation.
Let see first what happens with a PS of 4, EPAP of 8 and IPAP of 14 for 2-3 nights, and let's ajust according.
Have good nights of sleep!

[Korndog]

Quick update since I’m out of town…
IPAP on Thursday night at 13.7 and EPAP 9.7 and it seemed uncomfy but I came in with an ahi of 1.1 which is still a fantastic improvement. Last night (Friday) I’d entertained changing my pressure settings but decided to increase my PS to 5 from 4, to see which direction that would take me. My ahi came back at a .2! Checking my settings from the console I had 0 CA events. I’ll have to check OSCAR when I get home and see what my tidal info is. My leak rate is sitting at around 6 L/min and that’s been an increase since we plugged in the 8/14 setting. Wife told me this morning that she didn’t think I moved at all last night. 
So far so good. I’ll send the graph info when I get back home. 
Thanks all!

[zaienk]

Amazing, great news and great improvement, bravo ! Let see the graph ;-)

[Korndog]

Night of 7 & 8 Feb

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Night of 9 Feb