r4robin - Therapy Thread (Help with BiLevel settings-post #5)

[PeaceLoveAndPizza]

As OpalRose said, we need to see the entire evenings chart to offer advise. Don't worry about zooming into any specific areas. If anyone wants to see a zoom they will ask.

[r4robin]

Here is the full graph from last night, for some reason, the last couple of hours didn't get included but it includes 5 hours.

Although the AHI is low, I still have issues with aerophagia, night sweats (which didn't happen on APAP), and also just in general feel unrefreshed when I wake up. 

Not sure what to tweak settings wise...

[PeaceLoveAndPizza]

How did you end up with those settings? Doctor? Self-titrate?

Also, please read the link in my signature on formatting OSCAR charts. Seeing the full left table is important.

[r4robin]

I picked the settings myself, I came from APAP and I found 8-13 with 3EPR worked well, so I tried putting something similar in Bilevel.

As I said, the AHI on both APAP and Bilevel seems to be low, but I still wake up feeling unrefreshed, and now newly on Bilevel also have night sweats, also I still wake up frequently, and most times when I wake up I feel like I am either breathing super lightly, or wake up because I am not breathing, so I am not sure if these settings are good for me.

Sorry, I forgot the left table, I attached it here.

[PeaceLoveAndPizza]

I think you may have too much pressure support, which is adding to the feeling of not enough air. You can have a low AHI with not enough pressure.  

Back to your settings. You said on your APAP the settings were 

Min pressure 8
Max pressure 13
EPR 3

To get those settings on a bilevel you need to use

EPAP min 5
IPAP max 13
PS 3

Which is not what you are currently using. I suggest you go to those settings and we tweak from there.

[r4robin]

Ok, I will try those settings tonight! 

Thank you.

[r4robin]

I tried those settings last night, and it felt slightly better, I had less / no aerophagia, but I still woke up feeling awful, I woke up maybe 3 times throughout the night, and each time I just felt so bad.

[PeaceLoveAndPizza]

The only thing I see in the latest chart is your tidal volume is a bit low, but upping the pressure should help with that. Other than that, it is a fairly clean.

Try the following settings. It is not much higher so should not add to any aerophagia concerns.

EPAP min 7
IPAP max 12
PS 4
Trigger high
No ramp

The extra pressure support will clean up most of the flow limitations and trigger on high will do the rest. There may still be some, but it should not be much.

[r4robin]

Hey, I've tried these settings for 2 nights now, it definitely is better than the previous settings, but I have issues with aerophagia, and still feel super awful when I wake up. I'm kinda confused, the AHI is low, and not a huge amount of flow limitation (I think), but I am still having issues.

I can better describe the feeling when I wake up - basically when I wake up feeling like I am not breathing / it feels like I haven't breathed (or have breathed very lightly) for a while before waking up, and I have to manually breathe deeply when I wake up to feel better. Because of this when I initially wake up, I feel kinda cold (not always), have head congestion, and sometimes night sweats. Also, kinda specific and might not have to do with anything, but usually the times I feel awful when I wake up, my tongue is pressed against the roof of my mouth and I have a dry mouth / bad taste in the throat.

Edit: I am also curious if having a high RDI / low high has to do with anything, and why I am not feeling better, I attached my sleep study for reference. 

Thank you!

[PeaceLoveAndPizza]

Nothing in your chart stands out. Some arousals, but not much. Look at the flow rate and respiration rate for the spikes, those are what get counted as arousals.

Do you have issues with GERD or other stomach issues? It sounds a lot like reflux by your description. Consider trying 20mg of famotidine about 30 mins before bed. You could be gulping air when you swallow due to reflux, so that is worth considering.