Switched from APAP to BIPAP

[AmirKas]

I'm mainly concerned that a higher EPR, especially in tandem with a higher range in pressure, will increase central apneas and not do much to address my fairly high flow limitation. Would you recommend I keep my change my settings back to 9cmH2O to 14cmH20 with an EPR of 2, or use my doctor's settings of 8cmH2O to 15cmH20 with an EPR of 3?

[SarcasticDave94]

They're pretty close to each other. Yes I understand the concern about centrals. I think what I've seen in the past is the EPR affects CA more than raw pressures. It's a variable issue, what I call pressure swings. EPR will probably more likely to be the issue.

Have you tried both setting groups? Whichever was more comfortable is how I'd choose it.

[AmirKas]

I've also been thinking of upping my minimum pressure to 10cmH2O to minimize the effect on sleep quality from raising the pressure as seen on both starting periods of yesterday's (06-28-2021) night sleep. I feel like the rapid change from a lower to higher pressure is causing a lot of my treatment-emergent central apneas (my study showed no central apneas). What do you guys think about this change based on my results? I will also be getting a deviated septum diagnosis next week, and will hopefully book a septoplasty and possible turbinate reduction to address my apparently high flow limitations.

[SarcasticDave94]

It's easy enough to try and go with it then if it's got good results. I don't think it'll hurt a bit to at least try it.

[AmirKas]

Used my new settings of 10cmH2O - 14cmH2O with an EPR of 2 yesterday. Still woke up feeling groggy and had bouts of waking up frequently during the last part of the night. Cause of sleep fragmentation, I'm in a state of derealization and depersonalization that's all too familiar after a poor night's sleep. 


Thing is, is that my numbers aren't terrible, but still feel pretty awful. Here are my results:


Part 1:

[attachment=33328]

Part 2:

[attachment=33329]

Part 3:

[attachment=33330]



I think my flow limitations are the cause of my sleep fragmentation, but some analysis and advice from you guys would be appreciated. This is using the Resmed F20 full face mask, which is kind of uncomfortable on the face, but relatively comfortable for breathing with a deviated septum.

[AmirKas]

I've also been thinking of switching my Autoset to CPAP mode since flow limitations increase as my pressure increases, which I believe is what's causing most of my symptoms of brain fog, daytime fatigue, and feeling of detachment from the world. What do you guys think?

[Geer1]

Per your request I took a look through and it seems like things are headed in the right direction and that your results are getting better. I would stick with these settings for a while and let them work and allow your body to adapt. Nothing about CPAP treatment is immediate especially in cases like this where other issues (disturbed sleep cycle, insomnia, anxiety etc) are at play, it may take weeks or even months to get your full benefits.

I would try EPR of 3 again but I don't think you are ready for it yet, maybe in a couple weeks. I would leave it in APAP mode , your pressures aren't fluctuating too badly now.

The main issue I see now is the disturbed circadian rhythm, perhaps some lack of use (or sleep) and your comments about issues with anxiety. Researching good sleep hygiene and CBT for insomnia will teach you some tricks to try and improve sleep quality and try to get back into rhythm. Using melatonin might help with circadian rhythm too, if trying it I would start at 3 mg.

[SarcasticDave94]

I too would continue with APAP. You say flow limits are the reason to go straight CPAP, but I think it's the wrong direction.

[AmirKas]

Yeah, my circadian rhythm is completely off. Taking frequent naps because of my symptoms has ultimately shifted my sleep schedule to much later at night. As well as that, my brain fog and feelings of detachment fade away the longer I stay up, which means that I complete most of my responsibilities later at night when I can actually function, and end up sleeping later.

My daytime symptoms, in my opinion, are too severe to even think about fixing my schedule. 

I woke up way too many times during the last part of my sleep while I was dreaming, which I attribute to flow limitations, ultimately resulting in feeling terribly spaced out and anxious.  - I didn't have issues with anxiety till all these symptoms came about. 

I'm pretty sure treating my OSA / UARS will ultimately make fixing my sleep schedule significantly easier, and ease anxiety symptoms.

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I'll continue using the APAP mode, but I'm mostly concerned that 2 weeks in and I've been feeling worse than before. I need to feel better soon since I have a lot of stressors, which I don't want to get into, that I need to be functional to deal with.

[Geer1]

What I meant is it appears that your CPAP settings are on the right track and things should start to improve because of it. You need to be positive and try to improve the other aspects that CPAP doesn't treat (like the sleep schedule, not worrying about sleep, being positive and completing your other obligations in life etc).

CPAP often makes thins worse before it gets better. Many want to give up during their first week or two and I was one of them. I slept far worse and was barely functional my first couple weeks. It gets better but it takes time for both your mind and body to adapt.