New to BiPAP, but AHI is fluctuating?

[sllama]

Hello everyone, I am new to the forum and overseeing my dad's OSA case. We did the sleep study 3 weeks ago with AHI of 40.3, Non-REM AHI of 39.2, and REM AHI of 48. According to the report, he was recommended a BiPAP titrated to 22/13 cm with AHI of 2.4. However, the doctor's prescription setting was 22/12cm so we follow this setting with ramp time of 15 minutes and a humidifier of level 4. We started the BiPAP for now a total of 11 days, but AHI keeps fluctuating between mild and moderate levels. We try to keep the mask as tight as possible but it seems to put too much pressure on his nose bridge and we are planning to use gel nasal pads to reduce the redness.

I saw the doctor 3 days ago when the AHI dropped to 1.26, but then, in the following days, it kept increasing. The doctor informed me that the fluctuating is normal as he gets used to the machine, but I am not so sure. Is there a way to keep the AHI as low as possible? Or is it still too early to tell?

Attached are some screenshots from last night's session and the overall stats.


           

[staceyburke]

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.

I can't see what you have set for trigger.  If it is not set to high please set it to high.  That will help with the central apnea.

[sllama]

Hello staceyburke, thank you for your reply. Regarding the sleep position my dad sleeps on his back, and the number of pillows depends on his position due to his bedridden state. Around 2-3 pillows and they are flat. I will keep in mind the collar suggestion. I posted below the device setting, but yes, the trigger was not at high.



Mode = VPAPauto
Min EPAP = 12.00 cmH2O
Max IPAP = 22.00 cmH2O
PS = 6.00 cmH2O
Antibacterial Filter = No
Climate Control = Auto
Cycle = Med
Essentials = On
Humidifier Status = On
Humidity Level = 4 
Mask = Full Face
Ramp = On
Ramp Pressure = 6 cmH2O
Ramp Time = 15.00 Minutes
Smart Start = Off
Temperature = 27 ºC
Temperature Enable = Auto
TiMax = 1.80 Seconds
TiMin = 0.50 Seconds
Trigger = Med