Help analyzing OSCAR data - CA's?

[alemon]

Yess! Thank you Dave, I was thinking something like that as well, I'm so hopeful - even with the awfully short night I've felt oddly almost completely fine today! 

[alemon]

All right, continued mostly good news - effective AHI of 0 on the bilevel! Definitely was up again with stomach pains/horrible GERD - I imagine it's because my CPAP is about 9.8-3EPR, but my bilevel is going significantly higher - and I have been wearing it as I get arranged in bed, which is I think sending the auto-pressure skyrocketing. I tried turning things down a little, but I'll probably go with the PS of 3 and try even lower, see if I can start at 7 and cap the IPAP lower, and hope it remains as effective - I DO know, though, that even on the APAP I started with I never had scores this low, (nor could I stay asleep haha).

I also have a direct comparison, I switched machines halfway due to the stomach problems:
   

CPAP:
   

Can see the places I might have been having CA's, still present, but:

[alemon]

Got through a full night last night with the following settings:

PS 3 / EPAP 7 / IPAP 11 - for the moment just trying to keep the airflow from causing pain. Unfortunately I'm tired today - I could feel myself waking up all through that early morning, I'm not sure if it was the breathing or pressure changes. Still seeing that periodic breathing, though I think that's the same as with the CPAP. On Vauto is there a way to set a more 'fixed' pressure?

   

[alemon]

Hmm ok. Back at it again. Few very rough days again - I'm tending to get up at 3A with that same aerophagia, and my card is acting up inasfar as getting last night's data. My charts still look FAR better, all told, but I'm exhausted today as I couldn't fall asleep after the wakeup (no chart  ) , yesterday pretty tired too. I feel like I need my EPAP/PS higher, but I just can't quite stand it yet.

On the 24th I felt amazing.
   

25th, I wound up up at 3A with aerophagia (same settings), tried turning down the pressure so I could get back to sleep, and then felt awful the next AM:

   

I know it's early on, but one thing I'm noticing is my minute vent and tidal volume have all noticeably dropped since starting BiPAP fully, (see 21, and then 22/25th). I know it has been suggested those were already low for me, is there a way to potentially fix this? I'm wondering it's not helping matters.

   

[alemon]

So I managed to work back up to 8EPAP-12IPAP, and my inspiration-time chart looks much steadier! Don't mind the CA's, the very-high trigger was disrupting my usual breathing patterns so I tried just 'high' - definitely a mistake, I'm switching it back tonight.

I still feel pretty bad, even the other nights where I didn't have the CA's. I'm getting lots of periodic breathing in REM sleep, and trying to figure out which settings might help - would that be EPAP or IPAP or something else. Any thoughts? I don't think it's positional, though it's possible, I'm a side sleeper, still using low-pillow and cervical collar.

   

Here's last night:

   

The other day I'd run a full reset to get a decent night of sleep, 7EPAP/10IPAP PS 3, honestly I felt pretty good with it, though still lots of that instability:

   

[SarcasticDave94]

OK, sorry I didn't tune in much for a few days. The stats look decent to very good if that helps.

Whichever setting group helps you sleep gaining the most rest is what I'd go with.

[alemon]

Thanks Dave. 

I appear to have a bit of a devil's deal - I need slightly higher pressures than I can stand. I think 8-12 seems like the sweet spot, but I just cannot quite deal with those pressures. Moving PS down just by that .2 means I think I'm not quite getting the PS I need, though I've had a couple good days - but having it 4/+ means quite bad aerophagia, even though I think those are the pressures I require. I admit it's difficult to parse how effective that range is vs, if I'm tired in the morning from being up with aerophagia, OR if I would have been tired anyway. 

Reducing EPAP seems to cause issues as well, I think I really don't want to go below 8 - it seems to cause more issues, THOUGH, I don't have obstructives even at 7, and I've heard PS is the way to deal with the hypopneas/RERA's? But 7-11 just doesn't steady my breathing as much, I get into these cycles of periodic breathing that I think aren't helping me.

It's funny, I can FEEL my cognitive capacity returning a little since starting bilevel, and the same few VERY good days, but still a lot of tired ones, and how I'll wake up on any given day seems a mystery - save FOR, any of the days I managed to stay asleep through 8-12 I felt amazing. Unfortunately very few! Weirdly I've started waking up an hour earlier - my hope is this is some adjustment period from moderately-better sleep-breathing, even if I don't feel it.

I already have my bed elevated and generally side-sleep (left), though have noticed rolling on my back a bit lately due to how low my pillow is, which I'm fixing - I do deal with some GERD, my only thought is attacking that aggressively is the answer here? 

I'm also using the VAUTO mode because I've noticed it has a quicker rise time than S, which suits me better. I received the advice that adjusting rise time to be even quicker can help aerophagia - but when  I use this setting, I have issues with the mask expanding and contracting too quickly, like a vacuum, which is very distracting (true anywhere from 400-600ms). Don't know if anyone has thoughts here, I can't find what the approximate 'standard rise time' is in either mode.

I was hoping that giving it a couple weeks would help me adjust to that 8-12 range, but it seems it just isn't working. Sleep trackers say my deep sleep is wrecked since starting bilevel, though my heart rate has been much steadier while sleeping. I've tried PS 5 (8-13, was recommended to me to help with the hypopneas) on naps, and I do feel quite good afterwards - but I think trying that all night is asking for trouble.

[Please note, screenshot with the numbers 5/8-13 was not that, that was simply for my nap, I tried a slightly lower PS 8-11.6 that night in the hopes of not needing a nap, it was not successful, but it WAS in letting me sleep through the night, even though I didn't feel great]

[alemon]

Good news, some interesting data - I've been wearing a fitness tracker now for long enough to have trends. My resting heart rate is down by 10% over the past 6 weeks, which is wild and VERY cool to see. I do feel more relaxed physically.

   

Bad news, I continue to have the same issues - how I feel day-to-day is just unknown, still getting many wakeups at night in spite of the AHI being now regularly below 1, brain fog on most days so bad I can hardly function. I think that number is incorrect in terms of respiratory disturbances, they're still all over my chart (my User Flag 1 is set to a 70% reduction for over 6 seconds). I've been able to manage the 8-12 range for the past week though, and I think it's a step in the right direction, even though I'm so tired at this very moment - congestion has been messing with my breathing lately, and it's usually at the start of the night, and leaks have sprung up, I think the mask is so soft it's getting a little bent out of shape.

   


Even with the good news, I'm so exhausted and tired of being tired. Fitness tracker says I had a huge dip in deep/REM after starting bilevel, but it might be starting to improve now - but I just strongly suspect I'm still not at the right pressures, the amount of times I appear to be waking up from poor breathing is still quite high. I think the next move is trying to move PS to 13.

If anyone has insights I'd be super grateful, as ever.

[SarcasticDave94]

You probably mean Max pressure to 13, not PS, I hope.

Have you tried Ti Min less than the 1 second listed? Then Cycle on High, maybe try medium again.

Unless you edited those intentionally and it changed for the better, they may need edited. Ti Min 1 means you'll always have at least a one second IPAP. High Cycle will require higher flow decrease to cycle or switch back to EPAP/exhale than medium.

[alemon]

Aaah sorry Dave yes you're right, you can see how tired I am haha. PS4/IPAP to max 13 haha.

Shoot, I don't know if I changed those values... I'll try setting Ti Min to default, I was hoping it might help with the quite-short breaths. The high cycle felt like it felt my normal breathing pattern better, but it wasn't a change I'd done outside of that reasoning, and frankly I don't know if I noticed any major differences one way or another in terms of day-after comfort or events - but in the absence of change I'd kept it. I'll try setting 'em back to see.