Help with BiPaP settings

[steveko23]

So I’m 10 months into my CPAP journey with 0 results at present. I started with CPAP with a 5-20 range and over the next 9 months tried any sort of variation from EPR of 0 to 3, v-com, 4 different masks, fixed pressure at all sorts of different pressure, different variable pressure and per my apple watch (and how I feel in the morning I sleep exactly the same with the mask as without. I would generally wear the mask for 4-8 hours and sleep without it for 0-4 hours and looking at the apple data couldn’t tell a difference, I wake up 10-15 times a night without fail every single night.

So sleep doc gave me yet another sleep study (my 4th in total now) and now I’m on BiPAP. I’m 5 days in and the results are aren't great. I’m still waking up at exactly the same rate and I did with CPAP which is exactly the same rate as without. Is my sleep problem maybe something that PAP therapy isn’t designed to fix? Or do I need to practice some patience with the BiPAP and see if my body will get used to this therapy and I can finally get a good night sleep? I know there is a lot more adjustments I can do with BiPAP, but I’m not yet sure what I’d change as I’m not sure I understand what Respiratory Rate, Ti Min/Max, Trigger, Cycle, Rise Time so I do need some additional research now. I was just REALLY REALLY hoping BiPAP would be the winner and at the very least I would be able to see any sort of improvement with that vs nothing.

Link to see full history:
<not allowed to post>
Last night was pretty brutal, switched from EPAP = 8, IPAP = 15 to EPAP = 8, IPAP = 12 and changed Rise Time from Min to 250ms. Made these changes based on suggestion from sleephq forum, but looking at last night I slept MUCH better from 3am-5 when I had taken my mask off and was sleeping without therapy. Really not exactly sure what to try here.

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I'm not sure exactly how to share my data since I am not allowed to post a link to my sleephq dataset.  Basically I had a TON of hypopnea's last night though after making the switch.  I can post some screen shots, but an actual link to my data would be super helpful for me to be able to post. 

[SarcasticDave94]

Basics of adding OSCAR daily detail charts, with creating a new post, below the text box is an area called New Attachment then the Choose file box.

Read the wiki on attachments HERE.

This will allow you to attach OSCAR charts screenshot images not just links.

So why are you on the specialized ST? This isn't just a bilevel, but for those with lung disease. If this isn't you, you're going to be much better off with VAuto.

PS get your detailed sleep study report. You need to know the info on that. You can post screenshots of that with the personal info redacted. This will help you to know what you really need. Bonus is it may negate the request by a doctor to retest later. Here's the report can be your answer to a retest. And things happen when you don't have your own report. HIPAA law gives you the right to request and receive it.

[steveko23]

           

So why are you on the specialized ST? This isn't just a bilevel, but for those with lung disease. If this isn't you, you're going to be much better off with VAuto.

This is what the doc gave me...I had been on CPAP for the past 9 month, but continued to have many CA so did a 4th sleep study with bilevel and ended up with this machine.  I do not have lung disease, am a healthy 47 male, slightly overweight.

I will post the OSCAR screenshots I just thought the sleephq data would be easier to look at and zoom into rather than a screenshot which is why I was attempting to share the link.

[steveko23]

   
Sleep study:

[SarcasticDave94]

My take on a few things:

Doc didn't help you very much giving a higher level machine than needed. You can see yourself ST just goes EPAP to IPAP, square wave down up down up. No variation at all. You didn't need this.

You'd be much better off with VAuto.

Note the clustered events. You have some Positional Apnea. Either you have a high or thick pillow, or you are more susceptible to chin tuck. Take a look in the wiki for this. If the pillow isn't causing it, you might want to invest in a soft cervical collar.

Probably don't adjust timing on the ST.

If this were me, I'd demand a VAuto. The price for ST is more and unnecessary for you. Price, not just extra money but it cost you better therapy.

[steveko23]

   

Note the clustered events. You have some Positional Apnea. Either you have a high or thick pillow, or you are more susceptible to chin tuck. Take a look in the wiki for this. If the pillow isn't causing it, you might want to invest in a soft cervical collar.

If this were me, I'd demand a VAuto. The price for ST is more and unnecessary for you. Price, not just extra money but it cost you better therapy.

Are you saying the AirCurve 10 VAuto?  So still a bilevel device just the VAUTO vs the ST that I have?  What exactly is the ST giving me the VAuto isn't and vice versa?

With respect to the positional apnea.  I do have a flat pillow and generally start on my back but move all around.  I will try to switch to my cpap pillow (thicker for side sleeping) and lay on my side tonight to see if that make any difference.  I do have a cervical collar as well that I can put back on.

Also super frustrated with my doc at this point.  I was really not expecting to be 10 months into this journey and have nothing positive to show for it.  I lived with this quality of sleep for at least 15 years now I'm kinda ready to throw in the towel.  The 2 hours I slept without my mask last night (from 3-5 in the attached image) were the best 2 hours of sleep I had.    And really the only (and obviously the best) advice is what I get from message forums, I'm not sure why my doc can't be an active participant in helping find settings that work.

I do really appreciate you're advice and everyone who's helped me, I'd still be using a CPAP with a range of 5-20 otherwise.

[SarcasticDave94]

Yes you're correct, ResMed AirCurve 10 VAuto, and is a bilevel but where you set a range. The ST has 1 exhale and 1 inhale pressure. No variable.

What does ST do different than VAuto? Timed breath for those that need it. You've already told me you likely don't by answering lung disease but being present.

Think of any of your doctors that you see now. Would any support a script change to VAuto? Any doctor can do it, not just "sleep specialist" doctors. If one of your other doctors is willing to take on the small bit of CPAP discussion, and script your VAuto, that's all that's needed. This doc doesn't even really need to know much about settings. We can guide you on that. Consider firing the quack that gave a high priced, not needed ST for more common bilevel VAuto needs.