New to BIPAP - Oscar Evaluation

[mikesj]

I really wanted to see if someone might be able to point me in the right direction to adjust my setting to reduce the number of CA and OA events i'm experiencing each night.  My provider has been unfortunately not very good to work with and they keep giving me bad information including their inability to read my SD card, but due to the great forum here I was able to utilize oscar and get my own records.

I've gone thru 3 sleep studies at this point and they determined that I needed 8/12 on a BIPAP machine, but still experiencing high frequency of events with the Resmed Aircurve V11 using pillows.

I'm attaching my last 3 days of results on OSCAR to see if anyone has any recommendations on how to better align my machine.  The Office wanted to just proceed with going to the auto-settings which I don't think would be ideal and I should just dial-in my setting to be more appropriate.

   
   
   

[staceyburke]

You have 2 problems that need to be addressed.  The first is Centrals.  I can't see what your trigger setting is but it has been shown to help Centrals to set trigger to high or very high if high is not enough.

The other is Positional apnea.  You are having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[mikesj]

First of all thank you so much for your assessment. 

I need to read more to understand what and how to set the trigger so that I can adjust accordingly and will share that back to you. 

As for positional, I always start by sleeping on my back but I'm always rolling around in my sleep.  I know I change positions without any thought thru the entire night rolling around on both sides,  back and even occasionally on my stomach which doesn't happen so much now with a machine attached to me.

I'll go ahead and purchase a new pillow to try,  any thoughts on if one of those cervical memory foam pillows might work as they appear like they could better prevent the chin from dropping. 

Next week I can also setup a camera that records me while sleeping so that I can figure out what position is causing it. 

Thank you so much and I'll post some updates!

[Phaleronic]

Welcome to the forum mikesj

Please turn ramp off, your leak rate as StaceyB mentioned is very high too, a nice flat pillow along with another one that is easily workable to move under your chin and shoulder is what helps me to keep from chin tucking.

There will be other members that will help you with titration on the vauto more than I can.  I'm also not sure why the pap mode is stating unknown either.

[mikesj]

Much appreciated your reply as well.

My mode is set to S with Easy-breathe on. Should I change that to vauto and set the max ro ipap 12 epap 8?

Changes from last night:
Used a different pillow, made things worse for me somehow my leak rate went up substantially and as did my OA.

I did find the trigger setting which was medium and increased to high which did decrease the central. I'll be raising that to very high to see if it further reduces the central.

New pillow comes tonight before I go to the neck pillow I'll try that.

[OpalRose]

Hi mikesj,

It would be helpful if you would post an updated chart after making adjustments.  

Do turn the Trigger setting to very high.  If that doesn't alleviate the CA's, then look at lowering the PS a bit.

When it comes to pillows, be sure it's not too tall, as this will cause your head to tilt forward into your chest and cut off your air.  Finding the right sleeping position that doesn't cause Positional Apnea is priority.  

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[Deborah K.]

You will probably find that you need a soft cervical neck collar, especially since you move around in your sleep a lot. Most drug stores offer a couple, and Amazon offers lots of them. When I needed one I found the Caldera Releaf Collar the most comfortable, and it worked as well as any of the others I tried. Good luck!

[mikesj]

Set trigger to very high. Should I leave the system at mode S or change to vauto?

Ordered the caldera, feel like I'm really gonna struggle to sleep with something in my neck but I'll start that next week and report back my updated results.

[OpalRose]

We can look at the Auto mode, but first post an updated graph with Trigger set to very high, when you get a chance.

[mikesj]

Updated for last night results.

My changes so far: Set to Very High Trigger.  Replaced my pillow with one of those cervical pillows and am waiting for the caldera to arrive today.