Fragmented Sleep on BiPAP

[TheFuzziestPickles]

Hey everyone, new user. I've been on BiPAP therapy since June 27th. Just to give some history, I was diagnosed with moderate sleep apnea at an AHI of 18.5 (4 OA's and 123 H's). I started on BiPAP with a pressure of 20 IPAP and 11 EPAP, but that turned out to be too high as my numbers increased steadily over the 3 days I was on it. One night it went as high as 58.2. It was adjusted to Auto BiPAP on July 1st at 20 over 10 with a PS of 5. 

For the next couple weeks my numbers were below 5 average. I noticed my fatigue was gone, but my cognitive issues were only getting worse. I deal with pretty bad memory problems and have difficulty focusing, which is what prompted my sleep study. So, then suddenly, I can't seem to sleep through the night anymore. I wake up at least 2-3 times a night. I have no idea what caused this to start happening. 

I looked at my data through OSCAR, but can't seem to find a pattern. I've started resetting my machine when I wake up just to make it easier to track. I have the ramp function on so it's easy to see when I wake up. Can anyone offer any insight?

Thank you so much!

[PeaceLoveAndPizza]

First, it would be helpful to be able to see everything on the same screen. Read the link in my signature “Formatting OSCAR Charts”.

I suggest trying an experiment. Let’s see how you do with less pressure and pressure support. You may simply have too much of both and that is disrupting your sleep.

Try this:

Mode VPAPauto
EPAPmin 6
IPAPmax 14
PS 4
No ramp
Trigger high

Depending on how things go we can help fine-tune from there.

[TheFuzziestPickles]

Hey! Thank you so much for your reply! I'll upload some better snapshots of my OSCAR reports tomorrow according to the guide. 

Regarding your suggestion about adjusting my settings, I have been advised by my doctor that I shouldn't mess with anything without consulting them first, so I'm afraid I'll have to wait until I speak with them again (although I wish I could just do so on my own, as appointments take weeks or months...). 

I appreciate your insight and willingness to help. I hope I can find some answers to the problems I've been facing here.

Take care!

[sauerkraut]

TheFuzziestPickles;
If You look at the top of the main page there is a black bar look for cpap setup manuals ..
Find Your machine on the list and down load the clinician manual .. It will tell You how
to adjust Your Aircurve 10 ..
To My limited knowledge there is No Law against You taking control of Your treatment
and making adjustments to Your machine .. Folks that help out on this site are pretty good
at getting things setup to Your best benefit ..
Good Luck With Your choice ..

[Sleeptechmaster]

Your pressure support is huge with can increase the risk of complex apnea leading to higher central events. Minimum pressure support is 4 and you were starting at 20/11 which is a pressure support of 9. People do best typically with a pressure support of 4 to 6. 
You are experiencing less fatigue but reduced mental recovery. 
If you are having mixed or central events you could be seeing reduced sleep efficiency. REM sleep will not majorly be effective buy stage 2 and stage 3 sleep will be disrupted by central apneas and central hypopneas. The machine registers a central hypopnea as an obstructive event which will increase your pressure if you are on auto causing increased central apneas and severity. 
You may be getting the benefit of REM sleep but reduced stage 3 time and quality of sleep due to mixed events affecting your transition into stage 3 sleep. 
REM sleep typically shows no central events with increased obstructive events. That would mean the machine is controlling your obstruction fine but not your central activity. 
For some people any type of PAP can increase chance of central but with bipap that risk is further increased. With the massive pressure support further increasing the risk. 
An auto bipap is not able to control central events so it seeing all your central events and constantly adjusting itself during the night to combat these is likely disrupting your sleep.
You might need ASV or possibly BiPAP ST. 
Were you on CPAP previously or did you do an in lab study where they tried you out on it? 
If you are on certain medications those also increase central possibility. 
Probably best at 15/11 non auto but ST or ASV looks like it may he the best option.

[Crimson Nape]

Sleeptechmaster - I see no evidence that support the pressure values you list.  Please state where you are seeing them.  His chart is stating PS 5 over a 10-20 pressure range.  His 99,5 percentile IPAP pressure was 15.34, so he wasn't even getting close to the 20cm ceiling.
- Red

[Sleeptechmaster]

Oh I understand I was misreading what he said about his auto settings.
The first 20/11 is what he started out at before switching to the auto.

[SarcasticDave94]

As others have mentioned, you are free to change the settings on your CPAP now. If it makes you feel better about it, make a note on what you changed, why you changed it, the results afterwards. Then tell the doctor.

There's 2 somewhat typical ways to edit settings:

1. You ask the doctor, they make you come in via appointment in so many days, charge a fee, you'll discuss and attempt to explain what CPAP issue you're facing, doctor changes the script for the DME to edit remotely when they get to it, turnaround maybe a few days to many weeks, cost of co-pays or full visit

2. Get the free CPAP setup manual for your CPAP, you learn how to access the clinical menu, members here say this it that can be made better via OSCAR charts, you edit the setting in seconds free, try the edited therapy and post OSCAR charts with commentary, edit again or leave it depending on results, time less than 24 hours typical, no cost

As for the CA in the chart, it's possibly the higher PS is inducing them. I don't see the need to get higher level bilevel at this time, ST wouldn't work well and need to get ASV isn't likely unless your sleep study had a lot of CA or mixed Apnea.

By the way, you do have your sleep study? You need your copy for your records.

[HalfAsleep]

I generally find it's important to follow the guidance of board monitors and administrators (advisers sometimes, too) when it comes to settings. They are hand-selected for reliability and experience. They also have a history with xPAP devices of their own. No one is infallible, but I think you will find members with these tags have the most solid advice.

Yep, medical professionals like to impress upon you never to change the pressure settings without their permission. DME’s likewise. Many want you to believe it’s some kind of magic only MD’s get to have, or else they want to convince you (erroneously) that xPAP is plug-and-play. On the other hand, they’re on a mission to get your AHI below 5. That’s how they get paid by insurance companies. IMO they will tone down their lectures if you achieve this number. Besides, you have to meet compliance usage in 3 months, and if they can’t squeeze you in for 6 months, how do they imagine they’ll get paid? Clearly, they haven’t thought this through.

I recently got a biPAP myself. You’re not doing too badly for someone who’s only been on it a month. I was waking up quite a few times a night, too, for the first 2 months or so, but that’s resolving. I have found it takes the body time to adjust to having good sleep. It does look like your settings could use some help, and this should make a big difference. It doesn’t seem as though your current settings are tenable. @Crimson and @PeaceLove will get you going in the right direction.

[TheFuzziestPickles]

Thank you everyone for your valuable insight! The consensus seems to be that I am well within my right to adjust my BiPAP settings to suit me better. Right now I am waiting for my doctors interp of my latest sleep study done this past Thursday to see what our next course of action will be. Perhaps I will be put on ASV, but I can't say for sure just now. I will wait to adjust my pressures until we talk about this. Should be within the week.

I will hopefully be hearing from the sleep center's clinical staff today on these issues I've been having. I fear my memory loss/brain fog is only getting worse by the day. I only hope these issues are reversible so I can return to work. I have taken a month leave from office as I was not in any shape to work due to my cognitive issues and fatigue. They seem to be related to my treatment.

Also I have posted more screenshots of my OSCAR reports.

Thanks!