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During the first part of the night, OAs pushed your pressure up; during the second part of the night, flow limitations were responsible. A higher minimum might help with the OAs, and higher pressure support might help with the FLs.
The goal is to tweak your settings so you keep your AHI nice and low, reduce your FLs, and keep your pressures from going high enough to cause aerophagia.
Ideally, you'd make one change at a time, and then wait several nights before considering additional changes. I'd recommend raising your PS first, to 3. We can probably see pretty quickly whether that helps with the FLs. (It might also help with the hypopneas.) Your OA index is low, so I don't think you need to focus on that first.
Just curious: why do you have a VAuto? It's a great machine, but it's usually prescribed for some specific reason.
As I mentioned in my post I struggle with aerophagia a lot, and my doctor thought having more options with a BiPAP could help, but it's been very challenging getting a hold of him to change things which led to me changing things on my own and just fiddling with things before realizing that wasn't helping, and that should join up here and optimize based on the input of the folks here.
It's a whole thing.
I try not to have any ill will because I'm sure he's managing hundreds of patients because of understaffing.
Sorry that's probably more information than you needed.
So some interesting developments, that I'm not entirely sure what to make of.
While looking through my oscar history I noticed that anytime in the past I had used a set bilevel pressure, aka not an autoset one, I had no flow limitations. I've messed around with this and combined with a cervical collar (which I find pretty uncomfortable to sleep with) my apneas seems to be mostly replaced by hypopneas.
However, I'm still struggling with the aerophagia even at low pressures, and a lot of awakenings (some of which I believe are caused by stress and discomfort due to the soft cervical collar, which is fitted correctly I'm just sensitive).
Ideally I'd have it set to auto-adjust to deal with any latent hypopneas, but I'm confused by the fact that autoset seems to somehow induce flow limits.
I suppose what I'm asking is, can this information, or any I can provide further, be used to reduce the leftover hypopneas in autoset while also managing the flow limitations?
Thanks!
Also as I've seen it mentioned as being helpful, I'll attach some redacted sleep study results of mine in another post.
Interestingly during the sleep study, without titration as it was a second study to evaluate progress, I had almost exclusively hyponeas as well, with limited Sp02 drop.
If anyone has any insight, it would be tremendously appreciated!
The machine doesn't report flow limitations in the mode you're using, so switch back to VAuto mode. If you like an unvarying IPAP and EPAP, that's easy to do in VAuto mode. For example:
min EPAP = 6
PS = 3
max IPAP = 9.
I'd suggest you try increasing your PS (and thus also your max IPAP). See how you feel with PS of 3.6 and max IPAP of 9.6. If that feels OK, then try PS of 4 and max IPAP of 10. What we'll be looking for are signs that your FLs and Hs are coming down.
In your sleep reports, I'm struck by the number of leg movements you experienced. Did your doctor discuss that with you?
Attached is the segment of last night where I trialed these settings.
The good news is that I had no events at this pressure, the bad news is I suffered terrible aerophagia and such painful bloating I haven't been able to do much this morning as it's still ongoing.
I suppose at this point adjusting the ipap until I reach a level with no or tolerable aerophagia is the best plan?
For a note, I do not believe I have gerd, only once in a blue moon do I get heartburn and a 2021 upper gi endoscopy showed no esophagal abnormalities, and I am also sleeping with a wedge pillow as some folks have said that helps with aerophagia.
Your FLs are looking great with the PS of 3.6, and of course your AHI couldn't be better. But you need to find the settings that will make the aerophagia manageable.
So set your max IPAP to 7.6, with your PS at 3.6 and your min EPAP at 4. This maintains the pressure differential that seems to be helping with FLs while moving the IPAP and EPAP down. Moving that pair of pressures down is worth trying because you're getting good treatment for OAs at relatively low pressures.
I know someone who got horrible aerophagia with one pressure and none with a pressure just .2 lower. So I hope there's a good sweet spot for you too.
Yes I do indeed seem to be very sensitive to small pressure differences so I count my lucky stars that my apnea responds well at low pressures.
I do believe we are narrowing down what the sweet spot may be, and I really appreciate your help with this.
I'll try for a few days at the 7.6 iPAP and 4 ePAP. And if I'm not having any aerophagia and still having some events, I will increase incrementally to find what my aerophagia threshold is.
