New BiPAP User - Self Treating - Advice Greatly Appreciated

[MX117]

I'll try to give a brief summary of my profile and symptoms:

- 30/m
- 6'1", 205lb, 14% bf (very active, weightlifting, martial arts, etc.)

For the last few years I've really struggled with crappy sleep. Had legit insomnia for about 2-3 years but finally got over that. However, no matter how much sleep i get, i never wake up feeling refreshed. Sometimes, the longer i sleep, the worse i feel when i wake up. Summary of my symptoms below:

- Daytime drowsiness/fatigue
- Snoring
- High blood plessure
- Clinch my teeth during my sleep
- Jolts of adrenaline when i'm on the brink of falling asleep
- Chronic congestion and previous deviated septum which was surgically repaired in 2018 but then broke my nose again early this year
- Never feel refreshed when waking up
- Wake up with headaches, brain fog, etc.

I went to the ENT about 6 months ago and he ordered an at home sleep test with one of those Wellu2 o2 rings or whatever you call it. Results came back inconclusive, said he could refer me to a sleep lab but i really don't have the money to pay for it.

After lurking through this board for a while as well other online research, i believe i have OSA as well as possibly UARS. Based on these assumptions, I got a ResMed AirCurve 10 VAuto and decided i would try to treat myself.

I've attached my OSCAR chart from last night. This is the 2nd night I've ever used the BiPAP machine, but was the first night i felt like i actually got a accurate representative night of sleep to analyze.

I would honestly appreciate any sort of insight or advice any of you have to offer. I'm kind of just jumping in head first because i'm absolutely at my wits end with the quality of sleep i'm getting. I just know i shouldn't feel like this at my age and fitness level.

Thanks in advance!

[PeaceLoveAndPizza]

You have done an excellent job with your settings. Also, congratulations for taking the first steps to self help. Bravo!

To help clear up what is left, try the following settings:

EPAP min 8
IPAP max 14
PS 4
Trigger high

Adding some sensitivity to the trigger should help with the CA’s. Give that a few days and if needed you could move the trigger setting from high to very high. 

As to UARS, I am not seeing it in this chart, but others may see something I am missing.

Once you post some more charts we can offer more advice if needed.

Again, well done!

[OpalRose]

I would change the Trigger setting to High. It's been known to tame and CA's.

Also, you may need a bit higher EPAP. (this sprints the airway open to keep Obstructives at bay).

But let's make one change at a time and look at the results.

Looks like I was posting same timing as PLAP. I think we agree!

[MX117]

You have done an excellent job with your settings. Also, congratulations for taking the first steps to self help. Bravo!

To help clear up what is left, try the following settings:

EPAP min 8
IPAP max 14
PS 4
Trigger high

Adding some sensitivity to the trigger should help with the CA’s. Give that a few days and if needed you could move the trigger setting from high to very high. 

As to UARS, I am not seeing it in this chart, but others may see something I am missing.

Once you post some more charts we can offer more advice if needed.

Again, well done!

Thank you for the advice. Can you provide some context as to why 8/14 may be more advantageous over my current 6/20 setting? I’ll set my trigger to high and see if that helps the CA’s. 

Also based on this data, is it safe to say I have OSA and that at-home test was junk?

---

I would change the Trigger setting to High.  It's been known to tame and CA's.

Also, you may need a bit higher EPAP. (this sprints the airway open to keep Obstructives at bay).  

But let's make one change at a time and look at the results.

Looks like I was posting same timing as PLAP.  I think we agree!

Thank you for the response! Will set my trigger to high tonight.

[PeaceLoveAndPizza]

I cannot comment on the home sleep study without seeing the results. When the ENT said the results were “inconclusive”, they may have meant you were borderline mild AHI, possibly 5 or less. It is quite possible to have a low AHI, but have a high RDI. Many docs only care about AHI, but RERA (arousals) are equally sleep disturbing. 

Adding a wee bit more pressure will help with the hypopnoea and obstructive events. Given that your median was almost 7 and per the chart it took more pressure to resolve those events, I recommended starting a bit higher to try and keep them from occurring in the first place.

Using a more sensitive trigger helps with central events by having the machine transition from EPAP to IPAP with less flow, helping reduce CA’s.

[MX117]

Thank you for the help. I’ve adjusted my settings based on your recommendations and will report back in a few days!