Help Please w/Aircurve 10 VAuto/Sleep Issues

[bluemom51]

Hi - Still trying to improve my Sleep and use of the Aircurve 10 VAuto.  Below are a couple of recent nights. I included the AHI numbers throughout the night, because they can get pretty high despite a "not too horrible" AHI average.

I go into deep sleep later in the night and have very involved dreams, etc.  Still have trouble falling asleep and don't really achieve that until after 2 or so.  Lots of pain at night and wake up exhausted, and can easily go right back to sleep after breakfast even with about 8 hours of sleep.  Never feel rested.  Used an S9 Autoset for many years until last November and despite many adjustments, etc., still do not feel ok using the Bilevel. I've never really needed pressure settings above 16, and have no lung or heart problems.  Sleep Doctor constantly confused and just goes by the sleep study report that recommended a bilevel based on "Patient may have higher events on her back and may exceed a pressure of 20" which I never have.  So there's the underlying question of whether the Bilevel is best for me - she just keeps saying it should be more "comfortable", and to keep trying to make it work.

So.....just trying to improve things with changing some of the settings.  The IPAP/EPAP range seems ok, if maybe too wide.  PS of 5 that was prescribed was too high, and AHIs decreased when I went down to 2 - haven't tried to go lower.

I saw somewhere that my I:E ratio should be around 1:2.  I did increase the Ti Max to 2.5s but it usually doesn't get above 2.0s. Otherwise the Ti Min, Trigger, and Cycle are the Factory Settings.

I wanted to get any observations from the knowledgeable folks on this forum of things that may be happening or adjustments I could try - my sleep doctor is of no help, and the DME tech knows about 1% of what she should.






I never used to have so many CAs, and most days they are occurring from 6 a.m. on, but I need to sleep until 8 or 9 to get enough sleep.

Thanks for any assistance you might give me.

[Hojo]

Yes, there are a lot of CA events and it doens't appear to be treated, you may need a different machine, ASV perhaps.  I failed my BiPAP sleep study; it didn't take care of the CA events and ultimately ended up on ASV and I'm sleeping better and feeling so much better.  How long have you been on your new machine?

[Walla Walla]

You don't hardly have any flow limitations to go along with those obstructive events. I'm wondering if the machine is misreading them and they're actually CA events also. Someone smarter than me will need to look into it.

[bluemom51]

I have used the Aircurve since mid-November 2017.  Upon further thought, the Centrals weren't too bad until about 2 months ago when I had to start taking Cymbalta.  I am on the lowest dose possible, and have to take it, as it has eliminated constant panic attacks and anxiety and ER visits.  I have tried taking it at night and then tried only in the morning, but the charts look pretty much the same....And it seems they are happening in my deepest sleep with lots of dreaming.

Obviously it messes with my sleep results I guess - that's the main thing that changed.  My AHIs on the the S9 Autoset were about 6-8 with very few centrals (before Cymbalta).  I was hoping the Bilevel would improve that and it did, sort of, with the AHIs about 3-4 at first. I was also hoping I would feel better - actually feel worse.

But the problem that has not changed is that both before and after Cymbalta I feel horrible - like I haven't slept at all.  Within one hour of waking up, I can go straight back to sleep - feel completely exhausted. I've changed pillows, mattresses, black-out curtains, reduced caffeine, etc.

If I could live on 4-5 hours of sleep and get out of bed before 6 (before the CAs increase a lot), my numbers would be better I guess, but I can't even function with the current 8-9 hours of "sleep".

[bluemom51]

I forgot - during my titration with the bilevel, they got my events down to zero between about 13-15. The doctor just "assumed" I would need a Bilevel because I never slept on my back during the study. 

But that was in October before the Cymbalta - don't know what it would have been with the new medicine.  I have never needed really high pressure and really never had many centrals either, and no medical issue like lung or heart problems.

[Sleeprider]

The very long expiratory time is somewhat responsible for some of the hypopnea, but your respiratory statistics show a relatively high tidal volume and minute vent. Of course that slow expiration may just be what is normal for you. We would have to look at a close up of the respiratory flow rate to see if that is just a long pause before inhale, or if your exhale phase actually takes that long. This is more common in people with chronic obstructive pulmonary disease where it can be hard to breath out. Most events are central and are concentrated later at night and in the morning. Whether they are serious depends more on their length than the frequency that AHI measures.

Other than suggesting a discussion with your doctor on the possible complications of Cymbalta, it's not very easy to suggest a path forward to improve the AHI due to the fact both obstructive and central events are present in a complex pattern. You might try 11-15 with PS 1 and see if that improves anything, but I certainly can't say with any certainty that it will.