Inconsistent Sleep Quality with BiPAP Titration - Seeking Advice

[Gettingbetter33]

Hi everyone,

I’m looking for some advice on my BiPAP titration. Recently, I’ve had a few nights where I slept exceptionally well, waking up refreshed and feeling great all day. I’ve attached screenshots of two of these good nights (June 15th & 16th) where I slept for about 8.5 hours and felt fantastic the next day.

However, I also have a few nights each week where my sleep quality is terrible. On these nights, I wake up extremely tired, need a 45-minute nap after work just to function, and generally feel awful. I've attached screenshots of two of these bad nights (June 17th) as well.

After comparing the data in OSCAR, the only significant difference I noticed between the good and bad nights is that my flow rate is lower on the good nights. I’m trying to understand what might be causing these fluctuations in my sleep quality and how I can achieve consistently good sleep every night.

Here are my current BiPAP settings:

Device Settings
 
Mode
VPAPauto
Min EPAP
6.00 cmH2O
Max IPAP
11.00 cmH2O
PS
4.60 cmH2O
Antibacterial Filter
No
Climate Control
Manual
Cycle
Med
Essentials
On
Humidifier Status
On
Humidity Level
6 
Mask
Pillows
Ramp
On
Ramp Pressure
5 cmH2O
Ramp Time
45.00 Minutes
Smart Start
On
Temperature
30 ºC
Temperature Enable
On
TiMax
3.50 Seconds
TiMin
0.30 Seconds
Trigger
Very High

Does anyone have any insights or suggestions on how I can adjust my therapy to improve my sleep consistency? Any tips or similar experiences would be greatly appreciated.

[SarcasticDave94]

A few things can be made better.

Ramp at 45 minutes and holding it below your therapy pressure both are working against you. Ramp activated every time therapy is turned on, your case twice per night. So you lose 90 minutes of therapy per night. Solution is turn it off.

Your PS may be too high. 3.0 or 4.0 should be OK.

[Gettingbetter33]

Thanks for the advice. The problem is that without the ramp time, I have trouble falling asleep most nights with the higher pressure. If the ramp time was an issue, why am I still getting a few good nights a week?

Also, any lower PS than what I am using right now leads to consistently unrefreshing sleep. I’ve been slowly titrating up by around 0.5 in PS and 0.5 in EPAP each week, and it's only in the past couple of weeks, where I found success with these few very restful nights, that I’ve stuck at 4.6 PS and 6.0 EPAP.

[OpalRose]

Is there a reason the Trigger is set to Very High? I would move it to the default setting of Med. as long as there isn't a clear airway issue.

Also, raise your maximum IPAP setting a bit, maybe to 12 or 13cm.

So, summary:

Ramp off.
PS set to 4.
Keep Epap the same at 6.
Set IPAP to 13.

So your setting will equal 10-13.

Hopefully, this should equal better sleep quality.