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Overall, things seem to be incrementally improving. I'm hoping that as I become more used to the extra pressure support that I have less awakenings during the night. As I started dreaming again I seem to be a bit clearer and more focused during the daytime.
The only settings I've changed from your recommendations were extending the TiMax time to 3.0s (now my breaths don't get cut off when I'm trying to fall asleep) and setting the trigger to High (this brought my CA events down from around 3 to less than 1).
What sort of settings changes would you have in mind if I end up hitting a wall?
If I would change anything, it would be to slowly increase EPAPmin and IPAPmax by 0.2 every few nights to see if some of the arousals will get smoothed out. Also, read the link in my signature on “sleep hygiene” to see if something there sounds like it would be useful.
One thing to remember is CPAP can solve your apnoea issues, but cannot solve sleep issues caused by other things.
07-30-2024, 02:25 PM (This post was last modified: 07-30-2024, 02:27 PM by cpapsisig.)
RE: UARS patient - advice on new BiPAP?
Thanks for the recommendation! Two quick questions:
1. What is the difference between raising minEPAP and maxIPAP by 0.2 versus keeping minEPAP level and increasing maxIPAP by 0.2 with an accompanying increase in PS of 0.2? Is raising minEPAP typically the first approach when trying to decrease arousals instead of raising PS?
I'm concerned about raising maxIPAP while keeping PS of 4 as I learned that I was prone to awakenings when using EPAP > 8 while I was titrating my CPAP. What do you think?
2. How many days should I trial the change in minEPAP and maxIPAP before coming to a conclusion about my results (whether to keep these settings, revert to prior settings, or continue increasing minEPAP and maxIPAP)?
1. My thinking is that the arousals appear to be on both inhale and exhale. Add more EPAPmin raises the inhale pressure, but I like to keep the delta from min to max the same. What we want to see is if adding a bit more pressure on both helps resolve the arousals.
2. Trying it for 2-3 days is plenty. If it totally goes bonkers after the first night, then revert back to the last known settings that work.
Mode VPAPauto
EPAPmin 5.2
IPAPmax 12.2
PS 4
No ramp
Go with that for a few days, then increase again by 0.2 cmH2O if the arousals (spikes in flow rate) do not look a bit better. There are other settings you could also tweak, particularly trigger to high, but for now one change at a time.
Note that you will likely never completely resolve the arousals, but we want to see if they may become less disrupting to your sleep quality.
08-05-2024, 11:24 PM (This post was last modified: 08-05-2024, 11:26 PM by cpapsisig.)
RE: UARS patient - advice on new BiPAP?
Hi Pizza,
I postponed changing my EPAP settings as I was having continued issues with mask fit causing me arousals at night. I have since returned to using a F20 AirFit mask, but sized down to a medium, and my sleep seems markedly better over the last 4 days.
Reason I was using large AirFit and Vitera masks was my nose would be pressed closed by a medium mask after I got my nose surgery in March. It seems my nose has healed enough now for me to tolerate a medium size again.
Before I make any changes to EPAPmin, I just want to hear your opinion on a few flow rate snapshots from my sleep last night (from 8/5/24). These tend to be pretty representative of what I've been seeing lately from a full night of sleep results.
The waveforms seem to range from a more rounded top, to a tooth-like top, to a flattened top depending on what part of the night I am looking at. There is also some visible interruption between breaths that I see every once in a while. My 95% flow limit still moves around between 0.0 and 0.2 depending on the night and I haven't been able to achieve a consistent 0.0.
Wouldn't trialling an increase in PS be more effective for my overall sleep and breathing quality than increasing EPAPmin, especially given the abnormal breathing waveforms? I was only able to try an increase of 0.2 cmH2O (to 5.2 minEPAP and 12.2 maxIPAP) for one night -- my OAs stayed pretty much the same and my flow rate did not seem to become any more level. I've attached my OSCAR sheet for that night for comparison with the previous charts I posted (from 8/1/24).
Just wanted to check with you on what you think would be more beneficial to my sleep. I am still experiencing significant symptoms such as anxiety, exhaustion, and decreased ability to focus (though they are better overall than before I started the BiPAP).
