newbie with AHI~50 & a new dream station biPAP

[rbookman]

I'm new to this world, and need help.

Short Hx: radiation treatment for a salivary tumor triggered radiation fibrosis. Functional dysphagia also translates into postural obstructions of the airway.
Now, 28 months post-Tx, I've found out that I'm severely desaturating repeatedly during the night.
O2Sat levels transiently go down below 80% 15-50 times per night and average AHI from the dreamstation biPAP for the last 7 nights is ~50.
Last night, for example, DreamMapper reports CA=88; OA=124, total HA=164.
Maskfits (w/ nasal pillows) are typically poor ranging from 61% - 91%.
I'm using a Masimo MightySat to record O2 levels throughout the night.

We are now supplementing air with 3lpm of O2.

Too often, I feel like I'm fighting the bPAP.....I'm still slowly, relaxedly exhaling....and it starts to switch to the higher pressure. I think of it as a frequency mismatch....and when I ask how to slow the bPAP's rate, I'm told it doesn't have a rate.

Nasal pillows might need to be replaced by full face. I'll try a new variant of that tonight.

But meanwhile any and all suggestions or pointers would be most welcome.
Tonight, I will also try to take a look at the detailed data from my DreamStation with SleepyHead.....which I only learned about through this forum. Thanks!!

[Walla Walla]

Go to the Provider mode and under comfort settings there is a rise time setting. You can set it from zero to 3. zero is the shortest time it takes to go from exhale to inhale and 3 is the longest. You can try increasing the rise time number and see if that helps you.

[dmeRT]

well, first recommendation is to try wearing a soft cervical collar to prevent any positional/postural obstructions.

...you could ask for the "rise time" to be increased. this lengthens the time between exhalation and inhalation. that might help with your "frequency mismatch?" (oops....walla walla already covered this....)

But I think the main problem is keeping your airway in the proper position. solve that one first then we can move on to the settings. Probably should be in an auto bipap setting also....

good luck

[trish6hundred]

Hi rbookman,
WELCOME! to the forum.!
Hang in there for more responses to your post and good luck with CPAP therapy.

[Sleeprider]

rbookman, you are experiencing complex apnea based on the events your are reporting with CA at 88, OA at 124 and HA 164. Considering the event rates, and SpO2 denaturation, this is a serious condition that requires your doctor's immediate attention. Based on your profile I assume you are using fixed BiPAP at 15/10 pressure, and this is not helping. I need to know if you are using the Dreamstation BiPAP auto DSX700, or BiPAP-S DSX600 (fixed BiPAP).

I think you need your doctor's guidance. If you are using fixed BiPAP, my recommendation is to significantly lower EPAP to 6.0 cm, and only use 3-cm of pressure support for a setting of 9.0/6.0 fixed. If you have the BiPAP auto, then I would suggest EPAP min 5.0, IPAP max 10.0, and PS min 2.0 PS max 4.0. This will lower your event rate, however it is pretty clear you should be on an adaptive servo ventilator (ASV) which provides breath by breath pressure support to eliminate central apnea and hypopnea. I have found the best results are with the Resmed Aircurve 10 ASV rather than the Philips Dreamstation BiPAP Auto SV Advanced.

[Sleeprider]

One last thought. If you are using Opioid pain medication at this time, that can really affect your results. It does not change the fact you are not currently getting good treatment, but it would help to know.

[rbookman]

Thanks, Sleeprider!!

Rest assured that I am in contact with my sleep doc daily while we work towards a solution.
And, no opiods.

My machine is a DreamStation DSX700 with heater and humidifier, and we are now supplementing with 4 lpm of O2.

Here's an image from SleepyHead and the record of PO2 Sat & pulse rate from my Masimo PulseOx for last night. 
[Oh well.....as a newbie, I'm not allowed to post images yet. Darn!]

AHI = 45; Ob Index = 43; Hyp Index = 0.7; Clear Air Index = 0.8; Max EPAP/IPAP = 12/17.
Leaks are way down now with a ResMed fullface F20 mask.

Interested to hear your thoughts & suggestions.

[Sleeprider]

Thanks, Sleeprider!!

Rest assured that I am in contact with my sleep doc daily while we work towards a solution.
And, no opiods.

My machine is a DreamStation DSX700 with heater and humidifier, and we are now supplementing with 4 lpm of O2.

Here's an image from SleepyHead and the record of PO2 Sat & pulse rate from my Masimo PulseOx for last night. 
[Oh well.....as a newbie, I'm not allowed to post images yet. Darn!]

AHI = 45; Ob Index = 43; Hyp Index = 0.7; Clear Air Index = 0.8; Max EPAP/IPAP = 12/17.
Leaks are way down now with a ResMed fullface F20 mask.

Interested to hear your thoughts & suggestions.

You have made the member threshold and hope you will post  your results. I would love to see it, but start doing your research on ASV and make sure your doctor is up to speed on that topic, because that is probably what you need.

[rbookman]

Here are the SleepyHead/DreamStation and Masimo PulseOc data.....now that I can post images.

[Sleeprider]

Cool! Really glad you posted this. I'd almost bet your problem is positional apnea that could be mostly solved by using a soft cervical collar. That is a lot of obstructive apnea, and your pressure should be high enough to mitigate it. It is very likely you tuck your chin towards your chest and this cuts off your airway. The ideal chart is to see the Events, Flow Rate, Pressure, flow limitations and snores as shown in the first link in my signature. You are experiencing an extremely high rate of obstructive apnea, and this is usually caused by poor alignment of your head and neck which cuts off the airway. In some people sleeping on the back can cause it, but most likely it can be fixed regardless of sleep position.

Your oxygen desaturation in this image is mostly above 90% and the dips may be a poor connections (we hope). The supplemental oxygen is doing its job, but we really want to resolve the huge number of obstructive apnea. My recommendation is an inexpensive soft cervical collar from your pharmacy, Walmart or Amazon. It should be 2-inches larger than the circumference of your neck, and just shorter than the height between the bottom of your Adams's apple to the base of your chin.

In addition to the soft cervical collar, you should increase minimum CPAP pressure to 9 cm. This will improve oxygenation by raising the Positive End Expiration Pressure (PEEP). Enable your maximum CPAP pressure to go to 20 cm pressure. Your tidal volume is showing as 380 mL and I suspect you are not a small person. It would help a lot to see a more complete picture of the detailed Sleepyhead data. I hope you will stick around and let us help.