[Treatment] OSCAR BiLevel Adjustments

[sstoddard0512]

Good morning and happy New Year!

I have been using a ResMed Aircurve 10 ST-A for the past month and was previously using a Aircurve 10 ST for about 6 months prior to that with a 3 month. I sleep pretty well now that I've found a good mask, no pounding headaches in the morning anymore, still having a hard time getting up early in the morning though and maybe it's just me catching up on much needed rest, but can someone please advise on what, if any adjustments are needed? It's been a few days, but there are times where it seems like I'm not really sleeping at all and just kind of laying there throughout the night. I used to wake up multiple times a night (4+), that's improving. AHI is usually under 4, around 2 on great nights. I've had issues with getting proper sleep studies done when I was first diagnosed with sleep apnea and had central apnea events then, so don't really trust what the Drs had provided and would like a second look.

Dr Recommended Settings -  BIPAP - ST at 11/7 cmH2O, back up rate of 12, timed inspiration of .3 - 2.0 seconds, rise time of 300, trigger medium.

   
   

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Here's some data from the 30th, the 31st only recorded a few hours for some reason.

   
   

[Jay51]

The 1st 2 charts look pretty good IMO.  The 2nd two had some Hypopneas (H's.  You can try raising both epap and ipap by 1 to help stop the H's.  Also, it may help to try sleeping on a lower pillow height, side sleeping vs. back sleeping (and keeping something between you chin and chest to prevent chin tucking, and even using a soft cervical collar).  

There are other comfort settings that can be tweaked as well.  But try the above 2 plus the positional apnea techniques 1st.  Actually, try the positional apnea techniques 1st - it may enable you to keep the same settings as you have now.  Then if that doesn't work, try raising epap and ipap by one.  And later, the comfort settings can be tweaked as well. 

Here is some reading from our wiki on it:    

• 5.3Positional Apnea
  

[sstoddard0512]

Thanks. I already use a ergonomic CPAP memory foam pillow and usually sleep on my back, only time I switch to side sleeping is when I wake up and don't fall asleep right away. Do the graphs show positional data anywhere?

[Jay51]

Not technically.  The only reason I mentioned it was because you have a lot of H's; and a few of them tend to be clustered together.  When a group of clustered H's (and even more dangerous would be clusters of OA's) appear, it could point to your airway getting "kinked" or from your chin dropping to your chest and inhibiting your breathing. 

You can try a test.  Sit upright in a chair.  Let your chin fall to your chest (touch it).  See if that inhibits your breathing in any way.

[SarcasticDave94]

The 30th and 31st do show the possibility of Positional Apnea patterns with the clusters in Hypopnea.

I'm wondering if the Ti Min being shortened might be somewhat beneficial, unless you've tried it and it didn't help. Also just maybe using the smarter aspect of the ST-A in iVAPS mode might open up some further treatment options. ST is much more basic in static EPAP, PS, and IPAP as I recall.