[Pressure] Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV?

[SarcasticDave94]

Possibly in both the oxygen charts, especially the left one in light blue, you're holding evidence that you should be on supplemental oxygen. It lists time under 90%, but it appears that your at or below 88% for quite a bit of time. That means supplemental oxygen is indicated. This to me means a health concern.

[chrisj]

That's interesting thanks Dave - it is something I'd considered as a possibility if PAP therapy alone wasn't enough, but my sp02 levels when on the ASV do typically come up to a basal 96-97 so apart from these intital desats when falling asleep the ASV keeps it relatively well under control.   It sounds like from the differences between the ResMed and Philips devices this may be where the ResMed would help.

My daytime basal is around 96% so I suspect the NHS here in the UK would just say oxygen isn't quite necessary in my case - the problem is I've got to wait at least another 6 months before I can see a sleep (i.e. respiratory) specialist again here as it's a total nightmare with covid 

On the basis of what you've said though I will do some more (no pap) overnight tests with the more hospital grade equipment I now have access to, so I've got more detailed data when I do see a sleep specialist again. If my current therapy can be tuned further on the basis of these graphs it would at least put me in a better health position until that time  

I actually lived in the US for a few years back around 9-11 time  (I was in NYC on that fateful day and lived just opposite the twin towers)...   I certainly do miss the group health insurance which was a whole lot better than here!

[Sleeprider]

Most of the zoomed graphs you posted showed significant flow limitations or flattening of the inspiratory flow. You certainly don't have any apparent need for higher EPAP than the 8.0 your are currently using. Your therapy by the numbers is fine. What do you think you need to improve it? My inclination is to start over with titration and just try to optimize one thing at a time. I would start by reducing EPAP min and then looking at the PS min, which might need to be higher for the flow limitation. I just don't know quite where to go from here with your results showing low AHI, but a lot of inconsistency in flow and spontaneous breathing.

[chrisj]

Hi Sleeprider,

I lowered by EPAP min to 6 last night and as an experiment used a cervical neck brace (thanks to the link in your sig)  we had lying around to see if any of my lower basal spo2 / flow limitation was positional apnea / hypopnea.  My IPAP was left at 4 - one lower than I'd normally have had it set at before.  In all very easy  to breathe naturally with and easy to get to sleep, no ramps needed.

The result was impressive - the best overall spo2 I've had (only 2% of the time below 95%) with a basal of 96.7.  The number of triggered breaths more than halved from 540 to 220, however I did have 5 OAs which is less normal for me - I believe it was possibly down to the neck brace being a bit too big for me and folding in on my throat when I was in certain positions, I've purchased a better fitting one today to see if it helps.

I'll upload the graphs shortly - I've not pullled everything into OSCAR yet to see if the neck brace is actually helping with the flow limitations.

I've also managed to find a low hours and low cost S9 asv with humidifier which I can afford to have on hand as a backup, so it'll be interesting to see if I get even more stablility with the ResMed machine but if not it's there in case one breaks down. 

It's really quite amazing looking at the graphs on the neck brace page how much difference it seems to make for some people... such a straightforward solution!

[Sleeprider]

That sounds encouraging, and your willingness to try some new things and judge how well they work for you will pay off with improvements to your comfort and efficacy. I can't ask for more than that!

[SarcasticDave94]

Yes agreed. That sounds like it may be helpful.

[chrisj]

Thanks again both It's certainly given me a direction to try and optimise the results. The symptoms of sleep apnea have had a devastating impact on my life for many years so I want to ensure I'm getting the best possible treatment during the (expectedly slow!) recovery process.

Your comments have been invaluable!