[Treatment] Persistent Hypopnea and Unclassified Apnea Issues with BiPap Settings

[behtaaash]

Greetings, everyone.

I have a problem with hypopnea that does not go away with minor adjustments to the pressure from my prescribed settings.
Additionally, I experience situational unclassified apnea during the night, and I can't identify any patterns that may correlate with it. I suspect the device may be tagging central or obstructive apneas as unclassified, which seems a bit odd, but I understand it could be due to the model.

Does anyone have any advice on what I should do about these hypopneas?

[Jay51]

You can try raising both your EPAP and IPAP to see if this helps get rid of all of your H's.  Start by raising both by 1.  Hopefully this will decrease them.  You can keep increasing both pressures also if you need to in order to get rid of any H's.

In looking at your charts, when you raised epap to 9 in the 3rd chart, it looks a little bit better than the first 2 charts when you were at 8 epap.  

Be sure to raise Ipap also though when you raise epap more.

[staceyburke]

You are having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

[cizagui]

    I agree that the position is significant. I had that problem early on. I have a barrel chest and no matter what side I started my sleep I would roll to my back creating issues with my mask and episodes of apnea. Eventually, I resolved the position issue by sleeping in a recliner in a recumbent position (about 60 degrees from the vertical) and  rotation to the side was impossible. While on auto CPAP I also used a neck brace to prevent my head from rolling down toward my chest and causing airway occlusion.  Recently,  I had problems with the auto mode (the algorithm went crazy recently) and sent the machine back for repairs. However, the loaner had a similar situation. After researching forums and YouTube "experts," I switch to CPAP mode only, and a nasal pillow mask (from full face). BTW I also use an oximeter to monitor my O2 levels, and like magic, my oxygen levels returned to normal.
Life on a respirator is not boring.

[behtaaash]

Thank you for all your comments.

Jay51, the problem is that the moment I raise the pressure above 12 or 13, I experience aerophagia, which wakes me up with panic or bloating. If I try to decrease EPAP below 6 while keeping IPAP at 12 to prevent hypopneas, I start experiencing obstructive events again. I'm also unsure whether the issue was caused by the high pressure swings or something else, but I couldn't manage to get 7 hours of sleep with a PS of 7.

[behtaaash]

I used a soft collar and a slim pillow last night to help with my positional apnea, but the results were disappointing. I tend to change positions frequently while sleeping, and it’s possible the collar forced me to sleep on my back, where my OSA tends to be worse. I’ve attached some data from both my sleep study and last night's sleep for reference.

[SeePak]

Hi behtaaash.

I am wondering if you are a mouth breather?

Also, have you tried straight CPAP, maybe a setting of 8, 9 or 10 cm ?
( not sure what your prescribed settings are?  8-13? )

Those pressure swings, whether due to positional or not, cause a lot of trouble.

Try a set pressure.

I notice you have a much longer exhalation time vs. inhalation.

For me, that is ideal.
I wish i had that !
I have much longer inhalation times, probably due to UARS and mouth breathing issues from childhood.


For me, straight CPAP, without EPR usually works best, though there are so many other factors from day to day that i try anything sometimes to get a good nights sleep!

[Jay51]

behtaaash, you have a very high number of PLMS (periodic limb movements) on your sleep study.  This is causing a lot of arousals from all of the position changes that you have to make during sleep.  Is your Dr. aware of this?  A good plan would be to talk this over with your Dr. and maybe get on medication to help stop it.   I hope this helps.  

Some members have had success by using magnesium glycinate, etc. to help stop muscle cramps during sleep.  Your PLMS may be neurological in origin though, and your Dr. should be able to help with this.