jakespeare65 - New to BIPAP - Set-up Help?

[jakespeare65]

Hi All,

I had an earlier thread, seeking advice on reading my OSCAR data and optimizing my CPAP therapy. The consensus was "get a bi-level." I also recently had a consult with lankylefty27 and he agreed. He shared a local listing for a used VAuto 10, which I picked up for a very reasonable price. Towards the end on CPAP, I switched to CPAP (not APAP) mode and upped the pressure to 18. That resulted in historically low AHIs and at least one restful night. But RERAs kept me from feeling rested most nights even with very low Central, Obstructive and Hypopnea events. The waveform was still showing some obstructions, collapsing from a nice sine wave due to RERAS. Also had more leakage from the higher pressures on CPAP. 

Some of my Apnea was positional - I use a CPAP pillow, and only side sleep now. I have this ball that attaches to your shirt and makes it uncomfortable to sleep on your back. I also use a cervical collar and nasal dilators for my chronically stuffy nose. Flow limitation no longer an issue. I'm due for a new mask/headgear order, which should help with the leakage. 

Here is last night's BIPAP report: 
   
I feel pretty rested today.

Here's two of my last CPAP reports for comparison - the one from 10/25 left me feeling noticeably rested. 10/26 AHI was super low, but I was not rested and sleep was interrupted with long waking stretches:
   
   

I've been on bi-level for about 5 nights, each day improving as I adjust - bi-level is really a different animal. My insurance, Kaiser just also agreed to let me try out bi-level. If they think I'm doing better, they'll get me a spanking new bi-level machine. Nothing like a back-up, and I can keep reporting data to them for compliance purposes. 

Please help me optimize my bi-level therapy, and reduce these centrals?


Thanks in advance!

[PeaceLoveAndPizza]

Overall things look smashing. Are you comfortable with the pressures? Have you tried lower bilevel pressures? If not, consider dropping back to something like 

Mode BIPAP-S
EPAPmin 12 
IPAPmax 16

and see how it feels. Or consider dropping back a bit more and let the machine titrate you to see where it lands.

Mode VPAPauto
EPAPmin 8
IPAPmax 16
PS 4

With the latter the machine will adjust pressure as it deems necessary. It may end up at a lower pressure that feels good, or maybe not.

Either way, I am glad Jason helped. He has his own take on things that work for many. I used him myself and found him helpful.

[jakespeare65]

PL&P,

Thanks for your informative response!

I can tolerate the higher pressures. Aerophagia is the only real issue there, but it's not bothering me that much.

Jason had me try these pressures:
17/12
17/13
18/13
18/14

I tried each one for a night - 18/14 got the best results, but could that also be a function of adapting to bilevel? It is a different feeling to CPAP.

This is really encouraging, PL&P!

I will try the settings you've suggested and will post updates.


Thanks!

[jakespeare65]

Here is last night's report:
   

I feel somewhat rested today, low events last night. Still seeing those pesky RERAs though. 

Should I stay the course with these settings for a few days, then try the auto mode?



Thanks!

[PeaceLoveAndPizza]

Up to you how to proceed. As long as you feel good, staying with it a few days will not hurt. 

Have you changed the trigger setting? If not consider setting it to “high” if those CA’s continue. 

I only see a few arousals of interest, but nothing that is a worry. Are there any specifically you are concerned about?

[jakespeare65]

I will change the trigger to high, and continue like that for a few days.

If you don't see any arousals of concern, I'm good - I'm definitely seeing less than on CPAP. 


Thanks again, your input has proven to be very helpful to me!