Do I need BiPAP

[subin]

Hi ,

I have been using my APAP for over a year now, I have definitely noticed improvements such as brain fogginess (almost gone) and how I still feel tiredI still feel like I'm only at 50% . My daytime sleepiness has definitely gone tho.  There is so much overwhelming information on the internet and I need help.

Do I need BiPAP ( do I have UARS )  ?

I have low AHI but still I wake up feeling tired. I tried to play with my settings e.g. Turning EPR off or below 3 , but this gives me Aerophagia ( swallowing air ) , I wake up with upset stomach and I believe it disturbs my sleep as well.

Turning on EPR 3 lets me sleep but I think my Central apnea goes up. I'm not sure what to do or check at this point, any help would be greatly appreciated !

Here are some data :

(With EPR 3 )


[no image attached - see next post]

[subin]

I made a mistake with attaching files, can a mod or edit as I can no longer do that.

EPR off;

   


EPR on:
   

Summary:
   

[staceyburke]

Welcome - there are many people here that are very knowledgeable and will help you along with suggestions.
You said your EPR was off BUT the chart shows it at 3. Your main events are Centrals. They are more prone to be there if you are using EPR, so if you have EPR set at 3 change it to 1. If you have it a O then leave it there. The second thing to do is to turn off the Ramp. While it is in ramp (you have it set for 45 min) you are getting no therapy. they put it there to try to help beginners to go to sleep. If at all possible turn it off. Now for the Centrals, They are when you just quit breathing (holding your breath) and no amount of pressure change can make It go away. If these continue and get worse you may need a different type of machine. They are more expensive and hard to get the Dr. to prescribe. But that is some time off. Most Centrals slowly stop as your body gets accustomed to the therapy. If you have the EPR off and stop the ramp lets see how you do tomorrow. Good luck...

And to answer your question, you don't need a bipap. You just need to get use to the therapy and a few changes and you will be fine.

[subin]

Thanks for your reply , I currently do have EPR turned on mainly because I was swallowing air when I turn it off or reduce it. I will turn off EPR again and see how it goes. 

Just out of curiosity when does one require BiPAP , I read that UARS is better treated with bipap but I could not determine if I had it. I do feel that certain position/tilt of my head makes my breathing difficult. I also suffer from a deviated septum which blocks one of my nostrils 90% of the time.

[SarcasticDave94]

On one end of the see-saw you would probably be better served on a BPAP, as your therapy heads to 18 or so. Also you have flow limits that EPR 3 isn't addressing. Also on that side of the see-saw. However, you have some CA/clear airway/central apnea. This is on the other side of the see-saw. If there's more weight on one side to treat CA, likely the flow limits would increase as you'd need to lower pressures and limit pressure swings like EPR and Ramp. And vice versa, if you attack flow limits and pressure needs with BPAP that doesn't have backup breath rate, CA will likely go up.

Either way, you should try EPR and Ramp off. If these CA are deemed serious enough by possibly sleep study data and by seeing how they respond to limiting pressure swings by no Ramp or EPR then we discuss a BPAP that is helpful against CA. But we're likely crossing a bridge before we need to. Let's see how this changes by turning those 2 settings off. And either the flow limit or CA or both may be why your not as well rested as you could.

PS tilting your head certain ways can cause what's called positional apnea. You are kinking the airway when you notice head tilting restricts breathing. There is a remedy called a soft cervical collar. Read up on the wiki for it, but basically a collar very much like neck injury collars is used. You'd want one that fits a bit differently to combat positional apnea. And as I mentioned, a BPAP would normally be a good idea for your higher pressure requirements as seen in OSCAR on the left panel pressure data.

[staceyburke]

The 2 major differences in the machine you have and a bipap. 1st Your machine will only go up to 18.5 (I think you can give it a try in setting), while a bipap can go up to 25 as a top pressure. You are doing ok at 14 so no need as of now. 2nd on a bipap you have PS (like EPR) that goes up by .2 clear up to 25 - so it has a huge range with many stops in between. The machine you have has just 1, 2, 3 as the only setting. So maybe a bipap could be helpful is for instance EPR 1 is not enough and EPR 2 is to much... you could make it 1.6. But your machine is a type of bipap now when you use the EPR. Older CPAPs were continuous pressure which had the SAME pressure for inhale and exhale. Your machine will allow you (EPR) to change the exhale by up to 3 cm of pressure - that is a bipap.

I really don't explain things well (ask my wife) so there is a lot of material on the site that explains this much better. But right now I don't think you need a bipap.

[Sleeprider]

Your flow limitation and results seem much better with EPR, but you experience therapy related CA events as ventilation increases. We have a solution for that called EERS (Enhanced Expiratory Rebreathing Space). This is a simple modification of the CPAP mask and tube to move the expiration vent farther from the mask. This creates a small reservoir of exhaled air that is rebreathed and increases the CO2. This compensates for the same mechanism that is causing you to exceed your apneic threshold and experience the loss of respiratory drive (hypocapnia) that causes the CA events. Take a look at the wiki and see what you think.