[Treatment] New Bipap user

[SleepezCRNA]

New to sleep apnea and bipap use...My initial sleep study showed AHI of 77 with lots of obstructions and CA's...My sleep doctor prescribed Bipap 18/13 which dropped my AHI's to 25-30 with increased treatment-emergent CA's....Over the course of two months my bipap settings have settled at 13/10 and my AHIs have been less than 10 for 6 weeks now with an average AHI of 5-6 and CA's of 25-30/night for the last 4 weeks.....My sleep doctor says he is satisfied with less than 10....I feel much better with less daytime fatigue and am sleeping much more soundly....Is there anything you can suggest to get my AHI's and CA's even lower or should I be happy with AHI of 6? Thank you for your help....This forum has taught me so much    

[SarcasticDave94]

Welcome to Apnea Board,

Can you get your detailed sleep diagnostic report? If you could post a redacted version it'll be helpful.

In the meantime, has the Trigger setting been adjusted? You can try turning up trigger to high and see if it helps your CA, of which are most of your events.

I would also cancel Ramp entirely and consider turning PS 4 to 3. These edits may help Central events drop somewhat also.

[SleepezCRNA]

Thank you for your help and prompt reply. I have turned the trigger to high...My machine is the Resmed Aircurve 10 vAuto bipap set to 13/10...As such there is no setting to adjust the PS from 4 to 3 (I believe it sets the PS automatically)...Is there a suggestion of settings to lower my PS as suggested?

[Crimson Nape]

If it is set to the S-mode, then a setting of 13/10 would equal a PS of 3. There isn't a PS setting when it's in the S-mode, only when it's in the Auto-mode. OSCAR will still report a PS setting, though.

[Gideon]

Try dropping your IPAP by 1 to effectively set your PS = 2. Please critically describe the effects of the change and post your nightly charts.

Reducing the PS should result in some reduction of your central.

In addition to the normal, standard view, please include a 10 minute view so we can evaluate the character (origin) of your central events.

[SarcasticDave94]

My apology but I've never been on VAuto.

When it's time to try this, consider Trigger to Very High as you're on High now.

[Dormeo]

You're in S mode, as Crimson Nape suspected. One result is that you don't get any data for flow limitations, and those data could be of some use. So to follow up on Gideon's recommendation, I'd suggest you use VPAPauto mode, with PS of 2 over EPAP min = 10, setting your max IPAP max = 12.

[SleepezCRNA]

    Sorry I have been out of touch but appreciate everyone's feedback. Last night I turned my settings down to Ipap12/Epap10 for a PS of 2 and increased my Trigger to Very High as suggested....As seen, my AHI was 2.4 with CA's down to 15....The new settings were easily tolerated and I slept well....Will continue to monitor and post my nightly Oscar results...Any other advice is greatly appreciated

[SarcasticDave94]

OSCAR looks better than it was before. Since your sleeping well with this, just monitor and try to build a nice trend with it's settings as is.

[Dormeo]

As Dave says, stick with these settings for now. If the CAs get consistently below 1, try what I suggested for getting out of S mode so you can see flow limitations. If the FLs are heavy, you could try inching up your PS. I’m glad things are going better for you!