[Treatment] First PAP usage (BiPAP) for treating UARS + Maybe OSA - Feel like hyperventilating?

[OneShleepyBoi]

Hello guys, I hope you can help me. I'm absolutely desperate.

I just had my first night with my ResMed 10 AirCurve VAUTO which I reflashed with ASV firmware (37113-SX567-0401) because the consensus of the internet was, that you should use ASV if you want to treat UARS. I have IT background, so flashing wasn't much of an issue.

I had a sleep lab diagnosis around 2 weeks ago which was absoluteley negative, eventhough my daily symptoms feel like sleep apnea/UARS. The ENTs and sleep lab docs don't want to help me and dismiss me for beeing healthy and not showing anything on paper (AHIs below 1). Questions about UARS are not getting answered, because they never heard of it. Just getting sent from one doc to the other.

I feel completely devastated throughout the morning and day, permanent fatigue, brainfog, depression, insomnia, hypersomnia, no inner circadian rhytm - EVER, constant nose congestion and dust mite allergy, daily heavy constipation probably through heavy mouth breathing through the night - getting completely dehydrated. Extreme dry mouth in the morning. All of these symptoms are with me since I was a child. I was not aware of my problems except constipation until 5 months ago. Turned 30 and my state got even worse. Researched more in to mouthbreathing and constipation and landed at OSA/UARS, which exactly match with all the other symptoms as well. I'm at my lowest point ever when it comes to tiredness, fatigue, brain fog and energy levels. Luckily I have a partner helping me with the household, else I would completely drown. My workplace is also understanding and luckily I can work at my own speed and time. It would be a disaster if it wouldn't be possible, because I can only leave the house or start to work remotely by around 2-3pm.

My septum is extremely deviated to the left side, which was diagnosed by an ENT 2 weeks ago which actually took his time for once. His statement was, that I could do septoplasty and maybe slight turbine reduction if I wanted (I pushed him a little bit) but his guess is it won't fix my breathing problems and sleeping issues in general. He thinks my condition is not OSA or UARS (he never heard of it) but a neurological issue. He also mentioned that by doing septoplasty, I would switch from breathing 10% left side and 90% right side to 50/50 and so I wouldn't feel much of a difference. I told him that I respect his view but I feel else. I feel like my body is not getting enough oxygen at night and it feels like I partied all night including a lot of alcohol and only slept 1-2 hours. Every morning, ever day. It seems like my body is working overtime every night. And it feels like my body doesn't want to go to sleep at all because it's always a huge struggle and fight to survive. My nose is congested most of the time throughout the day and night. If I do some phisical activity, my nose unclogs slightly. Different sprays help slightly at times to remove mucus and some swelling, but not always (saline, xylitol, steroid). I managed my dust mite poop allergy with bedsheet encasings an Xyzall antihistamines. It's basically non-existent now. No change from that exept that it doesn't clogg up my nose and face even further by swelling and itching. My heart also always felt a bit off at times - not permanently but now and then there is pressure on my chest and some slight weird flickering until it beats the right way again. This doesn't happen always but I'm a little bit worried. I also looked into what the maxilla or problematic jaw can do, but so far I'm not sure if this is the culprit. My jaw isn't that small, neither is it big, I only have a slight, minimal overbite and my teeth are mostly straight except one and normally looking. Of course, that's only from my non-expert POV.

I thought it was normal to feel like sh*t. I thought it was normal to only have a certain amount of energy levels and I thought it is genetically how people can sleep only 5-6 hours and burst throughout the day with constant energy.

Well, anyhow: I'm currently 30, male with a BMI of 25.4. I also had those symptoms when I was slender with a BMI of 21.5 for most of my life until 24ish, so it's not about my weight.

Now to the issue I had the first night using my self-bought BiPAP: I feel like I'm hyperventilating. I'm using a ResMed Q30i Nose Pillow mask. I also bought a ResMed N20 Nose mask and a Fisher & Paykel Brevida. The Q30i felt the best, because I like to sleep on the side (left because of my septum).

I could only wear it for around 1h until I ripped it of by waking up from some irritation/pain on my nostrils and a claustrophobic feeling, mixed with some hyperventilation feeling. The algorhytm also doesn't feel that nice to me, it makes me breathe way to quick and doesn't feel natural. I started tritrating with ASVAuto default settings as recommended by the ResMed guidelines.

Min EPAP 4cm
Max EPAP 15cm
Min PS 3cm
Max PS 15cm

I hover around 4-10cm when breathing.

The SD card didn't show any data in OSCAR when I was sleeping unfortunately, I have to check on that and see if I can fix it for the upcoming night.
Any idea, any suggestions?

Sorry about the chaotic order of all the stuff I wrote, my brainfog is immense.

Thank you very much in advance.

[Sleeprider]

I think you'd better off starting in Vauto mode which normally resolves flow limitation. The variable pressure support in ASV mode is often disruptive and is meant to treat central and complex apnea. I think starting in Vauto mode with EPAP min 6.0, IPAP max 12.0 and PS 4.0 will give us a base line to decide where to go with therapy. Give it a try and post an Oscar chart. Don't believe everything you see on the internet about using ASV to treat flow limits or UARS. I have coached a lot of users and the Vauto mode is generally more successful and comfortable. If it turns out you need ASV, we'll get there.

[OneShleepyBoi]

Thanks for your quick reply. I will need to reflash the firmware then, as the current firmware only let's me choose between CPAP, ASV and ASVAuto.

I will report back when I will be able to reflash my device. Probably tomorrow. I will then start with your recommended settings.

I can also attach my redacted sleep study if it might give more indications but to me it doesn't look particularly helpful.

Thank you, I appreciate your effort a lot!

[OneShleepyBoi]

Part 2 of my sleep study as I somehow can't attach all 3 pages in one post? (Mobile user)

[OneShleepyBoi]

Part 3 of my sleep study attached.

[OneShleepyBoi]

Received another ResMed 10 APAP with less runtime today and modified it to VAUTO. Just testing it right now with your parameters. The only thing I've lowered is Min EPAP to 4, as it is really hard for me to breathe against 5. Should I still use 5 and try to train my lungs/airways like that? I could combine it with the Ramp feature and start with a EPAP of 4? But I can already notice a big difference to ASV mode. It's much more pleasant to me. It feels awesome to just lie in bed breathing and have more oxygen than before! Also ordered a ClimateLine hose to prevent condensation. Works perfectly.

I will see how this night will go and if I change it to the N20 because of nasal irritation. Fingers crossed that there will be some good chunk of data for Oscar tomorrow. Which graphs are the most relevant for my case?

Thank you so much!

[Sleeprider]

We use EPAP pressure to resolve obstructive events, and PS to help with hypopnea, snores, RERA and flow limits. Without seeing a chart in Oscar it's kind of hard to really know what's going on. You probably don't need ASV, and we don't know what pressure range resolves your issues.

[OneShleepyBoi]

Went to bed around 6am, as my insomnia is currently really strong. I slept with my mask for only 2:45h. I woke up with my mask dangling next to me and I can't recall what I did or what happened around 8am. Probably ripped it off? Don't know. This time I purposely left my nose pillow mask somewhat loose to prevent irritation/pain in my nostrils, so maybe it came off. Other users mentioned that nose pillows should only be tightened very loose and it should be like a hovercraft on your nostrils. I really don't know, but I can't recall that the mask bothered me this time or that I had hyperventilation or a claustrophobic panic attack.


Screenshots:
https://nx38421.your-storageshare.de/s/p6z5fT8s3Z2zrMe

If you need more screenshots, let me know.

[OneShleepyBoi]

BTW: I've ordered a "Wellue/Viatom O2 oxygen ring" which is compatible with OSCAR. Maybe it helps us to further analyze upcoming events. I know its not the most precise ring, but it seems to be better than the built-in sensors from a smartwatch anyways.

[Sleeprider]

Your Oscar screenshots show that you are using your Vauto at EPAP min 5.0, max IPAP at 12 and PS 4 with a ramp from 4.0 at 15 minutes. This results in what appears to be very good breathing, but with occasional clusters of CA events. There is no flow limitation or obstruction and pressure does not rise from the minimum. Leaks are actually very good as long as you wear the mask. The central apnea you zoomed in on appear to be actually centrals.

To resolve the occasional central events, I'm going to suggest we lower PS by 1-cm and increase trigger sensitivity to high. The new settings are:
EPAP min 5.0,
Max IPAP 12.0
PS 3.0
Trigger sensitivity: High (not all Vauto machines have this feature, and seems to be missing from Airbreak and European models)

Removing the mask becomes a behavior that is difficult to break. You will need to find adjustments that are comfortable and keep the mask in place. I recently switched to the P30i and it seems to work will and stays in place better than the P10. I guess i't just a matter of accepting the interface and training yourself not to remove it. The restlessness or insomnia come from factors outside your apparently good therapy. You may want to consider sleep hygiene or asking your doctor for medications that can get you past this and help you fall asleep. For me, a lot of insomnia is actually anxiety as I know I'm not sleeping well and anticipate I won't sleep, then find I can't sleep. It is a self-fulfilling anxiety, and success is the best treatment.