[Treatment] BiPAP: Great Numbers, Super Dizzy-ASV Pending

[churras]

First, thank you guys! This forum is a gold mine. I'm learning a lot here. After reading many posts and making several adjustments, my therapy, at least in terms of the numbers, appears to be great.

But during the last two nights, when the great numbers finally appeared, I was extremely dizzy in the morning—about 7.5 on a 1-to-10 scale. On the other nights, I always felt like "I didn't sleep well," so I kept reading the forum and making adjustments. Now that I finally have great numbers, I feel so dizzy that I'm almost ready to quit PAP therapy.

Last two nights: (flow limitation does not show in OSCAR for Bipap S mode, but manualy zooming it's very low)

   

   


So, very low numbers.

For context:
In 2010, I did a sleep study when I was 23 years old:

• 0 AHI, RERA 10.8, and they had a different metric for "brief awakenings per hour": 33.4/h
  
• SpO2 min 97%, SpO2 max 98%, PML 13.5
  

No PAP therapy was given.
After 14 difficult years...

In 2024, I had another sleep study:

• 17.8 AHI, with 35.8 AHI during REM and 13 in non-REM
  
• SpO2 min 91%, SpO2 median 94%, PLMS 3.3, Bruxism 8.5/h (14.7/h in REM)
  

Current Settings:

• BiPAP-S mode
  
• EPAP: 3
  
• IPAP: 6.6
  
• PS: 3.6
  

I found that EPAP 3 just solves my apneas and hypopneas.

• With PS 4, I started having lots of Clear Airways events.
  
• With PS 3.6, using a medium trigger and cycle, I still had many clear airways.
  
• With PS 3.6, trigger set to "Very High" and cycle to "Medium," the clear airways seemed to be resolved.
  

I started with APAP and was experiencing lots of flow limitations. EPR 3 helped a lot, but didn't completely solve the problem, so I moved to BiPAP. PS levels of 2.2, 2.8, and 3 didn't resolve the flow limitations either.

I'm thinking I might be experiencing a mix of hyperventilation and hypoventilation at different times, and I'm unsure what else to do...


I'm posting a zoomed-in view of the last 30 minutes of my night:

   

Does anyone have any suggestions? I'm really feeling hopeless about what to do next. I actually feel better without any PAP device than with it. I would be very grateful for any help—I'm almost giving up.

---

If you guys want, I can post more zoomed-in screenshots for 10 minutes and 40 seconds to show the waveform. I didn't do it before because I reached the maximum number of attachments.

[Deborah K.]

Most people find the Vauto mode better. Try that.

[churras]

Hi Deborah! Thanks for the reply! I'm clueless about what to do next.

I tried VAuto mode for a few nights, but as you can see, it produced a lot of clear airways, as shown in the two attachments.

I was waking up feeling bad too. =/

Any new ideas are welcome 


If you’d like me to post a zoomed-in pic, just let me know and I’ll upload it!

   

   

[churras]

My ASV will arrive in about 1 to 2 months. Do you have any alternative solutions I can try while waiting for it to arrive?

When I use a regular CPAP, BiPAP, or BiPAP ST, with or without EERS, it feels like my brain loses about 40 IQ points, although my body feels fine.

Without using BiPAP, I can work normally, but I experience terrible nightmares and need to sleep 3 times a day to function.

Is there any other option, like a mandibular device or something else? I’m not looking for a complete solution, but at least something to help alleviate the effects until my ASV arrives.

[Sleeprider]

Churras, I merged this new thread with your bielvel therapy thread because advice on what to do while waiting for ASV cannot be answered without the background in your BiPAP thread. You do very well with fixed pressure VPAP S mode on your Vauto at pressure of 6.6/3.0. Using fixed pressure with central and mixed apnea is a good strategy. If you have a trigger sensitivity setting on your Vauto, set that to Very-High. If you don't see that setting in S-mode, then use Vauto mode with EPAP min 3.0 Max IPAP 6.0 and PS 3.6. That will result in fixed pressure in Vauto mode, and the very-high trigger will provide more inspiratory assist with less spontaneous effort to trigger IPAP. This is very similar to ASV which triggers IPAP based on your spontaneous rate. I think once ASV does arrive, you are going to find, you can use a relatively low range of PS to achieve very good results because you do respond to the stimulus of the machine triggering IPAP.

It may be helpful to look at some zoomed screenshots of your flow-rate to see if residual flow limitation is causing a problem. Zoom into a 3-4 minute segment of therapy where the shape of the flow wave is clearly visible over a period of several minutes.