UARS patient - advice on new BiPAP?

[cpapsisig]

Hello,


I am a 30 year old male with around 15 years of bad sleep.  Started CPAP therapy in late Dec 2023, but symptoms only improved about 20%.  After reading through the forums here on Apnea Board and Reddit, I took a second look at my sleep study and confirmed my suspicion that I may have UARS in addition to mild apnea (AHI 8.5) with mostly hypopneas.

I am coming off of a rhinoseptoplasty in early March and have mostly healed.  But most benefits have been in daytime hours, while I have continued to struggle with small awakenings throughout the night that leave me exhausted during the day.  Thinking I was being aroused by the effort it took to exhale, I modified my settings to include an EPR of 3.  I have used these settings for around a week and a half and I am already seeing a benefit in my energy and focus.  However, based on what I've read here and other OSCAR graphs I've seen from users, it appears my breathing (flow rate shape) and flow limits levels could use a lot more work.  I am still experiencing arousals that disrupt my sleep throughout the night, but they are less than before I began using EPR 3.  I have tried lesser levels of pressure support (EPR 2 and 1) and I experience a rebound in my symptoms.  

On the advice of members here, I used Supplier #2 to purchase a refurbished ResMed AirCurve Auto.  I have been tweaking my CPAP settings for over half a year now and know that I have gotten the absolute most I can out of it.  I don't have very much knowledge of how to set up a BiPAP and was looking for some guidance from any members who have experience doing so.  I will post my latest night of sleep results from OSCAR (this is pretty average statistically for me on these settings).  I am grateful for any advice and wisdom any of you may have.  Please let me know if it would help to post any more data!


Many thanks,

cpapsisig

[Deborah K.]

Your Oscar report says you are still using your Autoset.  If this report is from your AirCurve, you need to change it on Oscar so that we can see your settings, in order to offer advice on setting changes.  Good luck with your new machine.  The ResMed AirCurve Vautos are great!  

[cpapsisig]

Thanks for the good wishes, Deborah!  

Right now I do not have the AirCurve yet, it is currently shipping.  Just trying to get a jump on things so that I can set it up correctly out of the box when it arrives!

Very excited.

[PeaceLoveAndPizza]

Try starting with these settings. It is close to what you use now with a bit more pressure support.

Mode VPAPauto
EPAP min 5
IPAP max 12
PS 4
Trigger med
No ramp

That should get you started and hopefully feel comfortable.

[cpapsisig]

Many thanks for the recommendations, this is very helpful!  Hopefully a pressure support of 4 can knock some of those flow limits out and keep me asleep longer.

[Fares otb]

When I read your post I thought you talking about me same story hop you find the solution with bipap any update?

[CPAPfriend]

Go with the settings that PeaceLoveAndPizza recommends. The clinical recommendation for starting on BIPAP is to simply place your EPAP at the pressure at which your obstructive apneas were best treated with CPAP, and then to put IPAP 4cm above it. Increase IPAP by 1cm until hypopneas, FL, residual snoring, etc. is cleared. I go over this flow chart in one of the videos on my channel: https://youtu.be/-IIZdru6vus

Although it's a generalized protocol, I find it works well for the majority of patients. From there, if things are not resolved, there are some more bells and whistles that can be adjusted to optimize therapy, but only cross that bridge when it's time to do so.

[cpapsisig]

Thank you for offering your advice, CPAPFriend!  I have used both static pressure and auto pressure in the past with CPAP and have noticed that my events have been lower and flow pattern has been more consistent and less interrupted with auto settings.  From a subjective standpoint, I also find I am more refreshed and awake using auto pressure.

Keeping this in mind, if I need additional pressure to minimise hypopneas and flow limits, would I raise the minEPAP and maxIPAP by 1?  Or would you recommend that I keep the minEPAP the same and raise the maxEPAP and maxIPAP by 1?  I was thinkin of going with the former  in order to keep the pressure range tighter for less disruptions when the algorithm is responding to my events.

I'll be taking a look at the video you linked as well.

---

Hi Fares, no updates yet.  I just received my BiPAP in the mail, but am waiting on my ClimateLine tubing to arrive in a few days before beginning use.  I can only tolerate PAP with humidity and don't want to experience any rainout.  I'll be updating this thread with my initial thoughts and results.

[cpapsisig]

[attachment=67665]Hello everyone,


I'm looking for some feedback on how my sleep is looking now that I've been using my new AirCurve 10 V-Auto BiPAP for the last week and a half.  

I've noticed that I've been waking up less during the night, though I still tend to awaken around 3 or 4 times -- particularly from small sounds or changes in light entering my room.  I've observed that I seem to be dreaming again, where I had stopped dreaming after using my CPAP for a few months.  

I have also changed the mask I was using because the old one (Resmed F20 Airfit) was pinching my nose closed as I slept (felt like I was being smothered).  For the last 4 days I have been using a F&P Vitera mask that no longer gives me these problems, though the leaks have been a little harder to manage so far with it.

Based on my Oscar charts below, would anyone recommend a change in settings?  Or should I continue to go steady with the ones I currently have?  Please let me know what you think.


Best,

cpapsisig

[PeaceLoveAndPizza]

Overall how do you feel you are sleeping? From a numbers perspective things look rather good, but there are always things to tweak a bit.

Sometimes it takes a while to get used to things. If you feel like things are getting better than stick with the current settings a bit longer. If things go off the rails, we can try changing a few things depending on the concern.