Switched to BIPAP

[JRTO808]

I have struggled with OSA for 3 years now. I started with APAP with pressure setting of 7-10 then changed to 7-12. After second sleep test I was switched to CPAP starting with a pressure of 4 and gradually increased to a pressure of 9 every couple of months. I have not seen any improvements in my sleep no matter what changes my doctors made so I switch to BIPAP (AirCurve10). This is my first night with BIPAP with a IPAP/EPAP of 9/4. I don't really feel different but that's expected, just want help to optimized my therapy and make any necessary changes. 

I have had 2 sleep test, the first test diagnosed me with moderate OSA (RDI: 19.1, AHI 2, apnea:0, hypopnea:3, RERA: 25) and the second sleep test and year later diagnosed me with mild OSA ( RDI: 5.2, AHI 5.2, just hypopnea:29)


       

[PeaceLoveAndPizza]

I suggest titrating with the new machine and seeing where it lands. Things look good where they are, but it never hurts to double-check.

Mode VPAPauto
EPAPmin 5
IPAPmax 15
PS 4
No ramp

From there we can help adjust to something more to your liking.

[Phaleronic]

Welcome to the forum JRTO808!

Those charts look very good, I like that they put you on s-mode. I'd stay with that and not move to vauto unless you need to have EPAP pressure jump up to compensate for oa/h/rera events which aren't showing up in these charts. I would keep the settings you have for now besides turning off ramp. Your 99.5 percent pressure is 9cm and your ipap max is 10cm and your waveform looks good too, so keep if for now and let yourself become adjusted for a week or two then check back and post charts unless major issues crop up.

[JRTO808]

Thank you PeaceLoveAndPizza and Phaleronic for looking at my data, good to know I'm off to a good start. I did take PeaceLoveAndPizza suggestion and set my machine to VPAPauto with IPAP/EPAP of 15/5 with a PS of 4. I was curious to see how the machine would titrate throughout the night. 

Should I make any adjustments or should I just keep my normal pressure settings?

[PeaceLoveAndPizza]

How do you feel? That is the important thing. If it was me I would leave it as is for a few days and see how things go. Easy enough to change it up.

One thing that stands out to me is the pressure swing in response to flow limitations. When you were in BIPAP-S mode you do not get flow limitation data, so those were likely hiding.

[JRTO808]

I feel the same, no real difference between yesterday and today. Still very tired throughout the day and still wake several times throughout the night and can't fully fall back to sleep.

[Phaleronic]

Those charts look good too JRTO808, if you feel the same I'd keep it as it is then, but if you start to feel worse and the charts are showing 0 you may want to go back to s-mode for a bit.

[PeaceLoveAndPizza]

That is most common. Something to try is increasing EPAPmin by 1 and seeing how you feel. Sometimes a bit more pressure can help. 

You are still having arousals that are the likely culprit rousing you from a deeper sleep state. It is not doubt there when you don’t use a CPAP, so it will take time to find what can help reduce them.

Also, set your trigger to high. Not that you need it to deal with CA’s, but to see if a bit easier transition from inspiration to expiration will help.

[JRTO808]

Hello, I've been following your advise and trying Vauto mode with IPAP/EPAP OF 15/5 and PS of 4 for about a week now. I still don't feel better; I think its because I have a hard time keeping the mask on for more than 4 hours. Also PAP therapy has given me really bad insomnia and its still persisting; it's either I waking up constantly or I wake up once and can't fully fall back asleep for the rest of the night. I think maybe switching to S mode may help with the insomnia but I need help figuring what my IPAP/EPAP should be? 

I've attached last nights data

[JRTO808]

Here is the data of the only night I was able to use the machine for about 8 hours. I woke up after 4 hours and couldn't fully fall back asleep for the rest of the night.