Looking for some advice on Bipap settings (not sleeping good)

[Isacariah]

I started using a Bipap machine a little over 4 years ago and have never really gotten 'used to it'.  Previous to my sleep study I was trying to figure out why I had headaches every day and it turned out I was having I believe ~34 AHI (or times stopping breathing per hour).  Ended up on a Bipap SV and worked up to 8 hours a night keeping the mask on and the headaches improved dramatically.

I've never really gotten to the point of sleeping through the night, I wake up many times (at least that's how it feels) and hit the ramp and try to get back to sleep.  Tried a few different masks, I'm currently using the Phlips Dreamwear full face mask because for the life of me I can't do the nasal-only masks without waking myself up with air out of my mouth.  I'm reluctant to go back again to my sleep doctor, I get about a visit a year and tell them this stuff and they have me try a different mask because they say the pressures all look fine and my episodes are low (~4 AHI) and each visit is costly.

Sleep isn't good and I still have some headaches and feel tired, but it's definitely helped some in that the headaches aren't as bad as when I first started.  I would love to get some restful sleep though and if I was able to sleep through the night, then that would be awesome.  I'm to the point where I was going to experiment with some slightly different pressures and stumbled onto this forum while researching how to do that and wondered if anyone might be able to offer some advice.  I've never downloaded the data off my machine other than using the app which doesn't seem to give that much information, I'm willing to do that though if that helps.

Thanks for any advice or recommendations, I would be happy to answer any questions or upload any info if it would be beneficial.

[Sleeprider]

Let's start by looking at the details of why you might be aroused by your current settings. You will need to download the free OSCAR Software https://www.sleepfiles.com/OSCAR and post a daily details chart. Instructions for formatting and posting charts are in my signature links. https://www.sleepfiles.com/OSCAR

[Isacariah]

Great, thanks for taking a look!  I believe I got the right charts in this screenshot but let me know if I missed anything.


   

[Isacariah]

I'm gonna try just lowering the pressure a little bit and then monitor my AHI and see if it goes up and whether it makes a difference in how much I wake up. Does that sound reasonable?

[Sleeprider]

Do you actually have central apnea, or is it your intent to use this as a bilevel machine to resolve obstruction and flow limitation and to make breathing easier? We can greatly limit the servo ventilation component if you're not prone to centrals.

[Isacariah]

After the first sleep study, the doctor said I was having both central and obstructive. I ended up switching to another doctor and he was skeptical of the first study because of how it was done and doubted that I was having central apneas. (My throat is pretty small and he was looking at it and thinking that I'm mainly dealing with obstructive apneas.). Is there a way outside of another sleep study of figuring out which type I'm having or is that the way to do it?

I'm willing to give some new settings a try and see what happens. Would I be able to tell from the data afterwards if there were more central apneas happening?

[Sleeprider]

My thought is that we can block out most of the CA therapy and leave you with bilevel. That would potentially leave you with less disruptive therapy with much steadier pressure. If CA is present, it should become more clear what we need to do. I'm a bit distracted after seeing Damar Hamlin removed from the Monday Night Football field in Cincinnati, so I'll pick this up again tomorrow.

[Isacariah]

Hey there, question on this, if we do block out the CA therapy like you mentioned and the CA is still happening, does that then show up as increased AHI or would that be seen more in the graphs?  

Whenever you have time if you have some settings you think might work, I am definitely interested in trying some out and seeing what happens, but seriously no rush.  I appreciate the time you've taken already and looking at my graph!

[Isacariah]

I'm gonna be heading into my sleep doctor in a few weeks to see what he suggests, but if anyone wants to take a look at the report I uploaded earlier and has any suggestions, I would definitely take them and give them a shot.

I'm just not sleeping well, waking up multiple times per night, but my API is low so the doctor in the past has been hesitant to change any settings.  I'm seeing a new doctor (for the last year and a half) who was a little suspicious about the central apneas from my sleep study and isn't totally convinced I'm having those so gonna chat with him about that when I meet.

My full face mask isn't perfect, but I don't feel like it's leaking a whole bunch.  Have tried a few of them and the Dreamwear is the most comfortable that I've found but if anyone has any mask that has worked really well for them, I'd definitely be willing to try another.

I'm open to any suggestions if anyone has any.

Thanks for taking the time to read!