[Treatment] CPAP to Bilevel advice

[kkjacks]

I'm a 70 yo female, 5'2" 130, no health issues other than sleep apnea, physically active. I had a sleep test last fall due to insomnia: AHI 78, OA 2.5, Mixed 1.6, CA 5.3, Hypopneas 69.3. I didn't sleep long enough for them to be able to titrate a CPAP but in November I started using a ResMed Airsense 11 at 4-8 and was getting an AHI up to 13. I talked my sleep center into changing the pressure to 6-11 and was getting a pretty consistent AHI under 5, but with lots of CAs. In the meantime my titration study in January showed I "failed CPAP" and needed a bilevel. AHI 6.6, OA .4, Mixed 0, CA .2 and hypopnea 6.2.

I picked up my ResMed 10 VAuto on Friday. Dr.'s initial order was for EPAP 9, PS 4, IPAP 13. Seemed high to me since most of my events were controlled with pressure under 11 on the Airsense but I gave it a go. I couldn't handle the pressure. My ears felt like I was on a 747 descending for landing and the pressure of the air in my mouth broke the tape seal I use to prevent mouth leakage - even after adding another layer. I gave up after 2 hours and slept without a machine.

I've learned lots from following this board and the excellent advice of knowledgeable members so I decided to be brave and adjust my settings and try again. I started with EPAP 7, PS 3.6, IPAP 13, trigger high. My AHI was 5.4 with mostly CAs probably around periodic awakenings.

I would really appreciate it if someone could advise me on how to adjust for tonight. I hope to have good results before my doc blows up at me. 

[attachment=60185][attachment=60184][attachment=60183]

[Sleeprider]

Your doctor's recommended pressure does not allow the Vauto to held you to self-titrate. We can get you on some pressures that are more comfortable and and we will take care of the centrals as well. I see you have already dropped your PS back to 3.6 with high trigger sensitivity, and your pressure range is 7.0 to 13.0. I think we can drop your EPAP m in back to 5.0 and observe the results there to see if you actually need more. We will keep your maximum pressure at 12.0 which seems to prevent any obstruction.

Let's try this:
Mode: Vauto
EPAP min 5.0
IPAP max 12.0
PS: 3.0
Trigger: Very-High
Ti Max: 2.4
Ramp Off.

[OpalRose]

Try moving the Trigger setting to Very High. If that doesn't bring the CA's down, then try a lower Pressure Support, maybe set at 3. But try one thing at a time and give it a couple days to gauge results.

Insurance requires that you try and fail Cpap (which you did fail). The next step is a BiLevel, (which you are now trying). If that fails to tackle CA's, then you may be eligible for an ASV. Let's hope we can get you dialed in on the BiLevel.

[kkjacks]

I’ll give those settings a try tonight. Thanks so much!

[kkjacks]

       

I tried Sleeprider's settings last night and here are the results. I had a difficult time getting to sleep so all of the events before the mask removal are awake breathing. I was awake again between 5 and 6 so those events are also awake breathing. Except for one OA the sleep time looks pretty good. What do you think?

Very grateful for your help!

[kkjacks]

Another screenshot - the "normal" breathing.



   

[Sleeprider]

Hang in there and keep these settings through a normal night.

[kkjacks]

       

Good morning Sleeprider! I'm afraid my normal night might look something like this until I can resolve my problem with mask leakage. It's not really mask leakage it's leakage from my taped mouth. I wear an N20 and tape my mouth. I started taping a month or so ago, not because I'm a mouth breather, but because of air bubbling out my mouth waking me up. The tape resolved the issue and I've had very little mask leakage since (using the Airsense 11).

With the new Aircurve VAuto this problem has come back in a big way. Both nights I've struggled to get to sleep because my cheeks suddenly puff out and the only way to release the air is to break the seal of the tape. So I was awake struggling with this for those early night events. It started again at my 4 am wakeup until I finally took off the tape resulting in a steady flow of air out my mouth.

I was trying to figure out if it was happening on the inspiration or the expiration and it seems like maybe it was during the transition. 

Any recommendations? Thank you in advance!

[Sleeprider]

This is a bit counter-intuitive, but I'd like to see what happens with PS 4.0.

[kkjacks]

I will give that a try. Thanks!