[Pressure] Optimizing BiPap - Sleep Issues in spite of decent AHI

[BradA12345]

Hello – Thank you for those that help on this forum. I just discovered this after 6 years or so of being diagnosed. 

I can’t find my first sleep study right now but it was mixed apnea and I believe the events per hour were:

OSA = 12-14 ish?
CA = 3 or 4?
 
I tried a CPAP which seemed to be on a really high pressure - I do have mild controlled asthma - 6'1" 250ish.    I couldn’t breathe back out against the pressure and was not successful using it at all.  I gave up on it.  Then I had another sleep study and they put me on Resmed AirCurve 10 Bipap in setting S at 16/12. I can provide that report if it helps. I have used it for about 4 years now with 99%+ compliance.  

I’ve been having progressively worse cardiovascular symptoms over the last few years – dyspnea on exertion, lightheaded etc.  That lead me to dig further on my sleeping. 

I’ve not slept well with the Bipap, though it does show mostly correcting my apnea.  When I say slept well, I mean woken up refreshed or slept all the way through the night.  I seem to wake up repetitively and the pressure seems overwhelming and my heart will race.  I wouldn’t say it’s all night long that I notice, but at least 3-4 times a night.  My brain has been trained to restart the machine so I go back to ramp up mode to fall back asleep.  I’ve never really felt more rested or better since using the machine - but trusted that it was good for my health as my AHI was usually okay.  It's been going up some recently.  I get very small amounts of deep sleep according to my Apple Watch - Maybe 20 minutes a night and 45 min to an hour of REM.  Not sure if that's accurate from the watch at all but I'm possibly attributing it to my apnea therapy.

Based on what I’m reading on this forum, I assume I need to set it to Auto mode with a max IPAP pressure of 16 and minimum EPAP pressure of 8 or 10 ish? Maybe start at 10 and work my way down?  I assume I should turn off "Ramp Up"? 

I tried to talk to my primary and cardiology doctor about it but they blew me off saying my AHI was under control.   

I haven't imported O2Ring data to Oscar yet so included a crude screenshot from a point of interest as well as 2 nights of Bipap data.   

Aircurve 10
Airfit F30
IPAP = 16/EPAP = 12 (Tried moving it just a little down last night to see what would happen by 0.4 on both)
Mode =  S
Easy Breathe = On
Ti Max = 2.0s
Ti Min = 0.3s
Rise Time = Min
Trigger = Med
Cycle = Med
Ramp = 15min
Start Epap = 7.0
Climate Control = Auto
Tube Temp = 71

Again, much appreciated.   

Brad

[staceyburke]

Welcome to the board.  I also have the VAUTO and have had great success using it in VAUTO mode.

I would suggest the following setting and see how it helps you.

Min 6
Max 18
ps 4
Trigger high
turn off ramp

That should make the sleep better and the trigger setting will help your centrals. If there are still a lot of central apnea try very high trigger..

[BradA12345]

Thank you, I will see how it goes.

It’s odd that they put me on S mode. I ignorantly thought it was set to adjust pressure through the night until I logged in to the clinical mode. Frustrated with myself and them.

Does it seem like my CAs are from the pressure or just me? Or any way to know from the data?

-Brad

[staceyburke]

Central apnea is you just not breathing.  All of us do a little bit of that, we hold our breath when we roll over in bed, pick up a blanket, take a sip of water...

[BradA12345]

I do understand, but I was questioning whether it was treatment induced CAs possibly? 

So I tried the new settings last night.  The report looks somewhat similar actually but I feel more tired and have a little bit of a headache.   1 night is not a big enough sample size to say that is related.  Attached is the report from last night.  I was thinking of moving it to Trigger = Very High? 

Adding O2Ring info - seems like I had more drops in O2 Saturation.  

Thanks

[staceyburke]

your oxygen looks fine.  I can NOT see the trigger setting.  So if it is set to HIGH the move it to very high and we will see if that helps.  Did you have central apnea during your sleep study?

[BradA12345]

I'm trying to find the original sleep study pre-machine, but can't. The only one I still have is where I was moving from cpap to bipap. It did show centrals there, but seems like it was more than the original sleep study. Though I know for sure I at least had a few centrals before treatment.  I'll see if I can find it, because I'm curious as well.  

I'll try moving from high to very high tonight and see how it goes. 


Thank you for the replies! 

-Brad

[BradA12345]

Happy Holidays! 

So these changes definitely tuned things in from an apnea perspective.  This report from last night seems pretty great - very much appreciated! 

There's two other things I need to figure out - one is the mask. I'll take a look at the resources here about that. This one almost shuts off my nose from breathing and it's mostly mouth breathing.  

The second thing is that I wake up a lot still.  Is there anything I can take from this report to understand that part? 

Thanks

[staceyburke]

I don't see much to change, looks very good.  Looking at the pressure chart, it is almost flat which means that your sleep should be better.  It just might be you need a little while to get back to feeling better.  Most people don't just wake up the next morning and feel great - in a while you will just notice the difference...