srwilsn3's therapy thread | APAP -> BiPAP

[srwilsn3]

Hi all.

Based on recommendations from here, I have switched from a Resvent iBreeze APAP to a Resmed VAuto Bilevel. You can find my past posts here.

The long and short of it is this:

• Diagnosed OSA with an AHI of 5.
  
• Prescribed a Resvent iBreeze APAP with pressure 5 (min) to 20 (max).
  
• First year of treatment AHI was < 1 but with very little improvement of symptoms.
  
• The last six months or so AHI has been anywhere to 2 AHI on a good night and 10 on a bad night.
  
• Pulmonologist prescribed 16 (min) to 20 (max).
  
• No change in AHI. Significant aerophagia. Flow limits very, very frequent.
  
• Tried to fix positional apneas through side sleeping and collar. Though successfully using both, apnea clusters remained.
  
• Changed EPR to 3 to try to reduce FLs.
  
• On recent post, member PeaceLoveAndPizza reviewed my data and posts and recommended a BiPAP. Purchased one used. ResMed Aircurve S10 VAUTO, BIPAP.
  
• I set EPAP to 9. IPAP to 17. PS to 4.
  

It's only been one night with the BiPAP, but I got the best night's sleep that I've gotten in months. I haven't reviewed my OSCAR data yet, but the machine report showed a staggeringly low 0.6 AHI. This is the lowest it's been in a year on night one of the BiPAP. I feel like I actually slept for the first time in weeks and weeks.

The Resmed Aircurve VAuto is 100% better than the iBreeze. Whereas the iBreeze would set its own pace in breathing (sharp blasts of air that demanded inhalation followed by drop in pressure for exhalation), the Resmed follows what's essentially my normal unassisted breath. Whereas the iBreeze was blowing my mask off of my face at even 13 pressure, the Resmed does not at all. The increase in quality is incredible, which I suspect is a difference in both firmware and hardware.

I was a little scared to go "rogue" without my pulmonologist, but the advice I've gotten on this board is 100% more detailed, 100% more practice informed, and 100% more tailored to the person's experience. Many have helped me, but I want to shout-out to PeaceLoveAndPizza for his help and recommendation on my last thread.

I will continue to report my progress on this thread. It's only been one night and it'll be important to track my progress over several days' time to confirm the efficacy of my new treatment. That said, on a distribution of nightly AHIs, last nights' would fall in the ninety-ninth percentile.

[PeaceLoveAndPizza]

Most happy to hear it is working well for you. Give it a few days and post a chart. Folks may have other suggestions on tweaks that I missed.

[srwilsn3]

Therapy with the BiPAP has so far been a complete success. Three nights in a row I've gotten more restful sleep than I have in months. I can not understate how much BiPAP has changed my experience so far.

My AHI has also gone from a nightly mean of 6 (standard deviation ~4) to mean of 1 (SD ~0.2).

I am posting the OSCAR charts below. I've now gone 3 days, so I'm interested in what direction I can go for tweaks. I'm seeing that the majority of my apneas are now CA. Does this indicate a slightly too high of pressure? My OAs seem to be largely treated.

What does the board think next steps might be?

[srwilsn3]

Update: While treatment and symptoms are improved, I am still moderately tired most days. Constant headaches are gone, thankfully. Flow limits seem to be totally managed by PS of 4.

Looking my OSCAR data (all nights), about 50% to 66% of my apneas are CAs. What tweaks should I be working into my therapy?

See below. I have included summary statistics to give a snapshot of my OA/CA ratio. Thank you!

[UnicornRider]

Clear Airways are pretty high, Decrease PS by 1 (cmH2O), increase pressure min by 1.2 (cmH2O) to see if CA go away, and match your Press Med of OSCAR Report..

If the CA go away then gradually increase PS by 0,2 (cmH2O) to just start CA reappearance, after a couple of days with CAre emergence, you could reduce PS 0.2 (cmH2O).

If CA do not go away after reducing the PS by 1 (cmH2O) start reducing PS by 0.2 (cmH2O) until you are free of CA. You will want to adjust pressure min up, according to needs.

[PeaceLoveAndPizza]

UR is spot on regarding the relationship between PS and CA’s. Before you go that route, try setting your trigger to high or very high. That may be enough to clear up the CA’s.

Remember as well that CA’s are strange beasties. You can have crazy numbers for a few nights, followed by almost none for weeks. I don’t go bonkers when I get some CA’s, unless they are happening nightly and waking me up. I use a fixed pressure, so i don’t get pressure increases, but they still can cause arousals.

[srwilsn3]

Thank you both.

I'm going to increase trigger to High, since that seems like the most modest change. If that doesn't improve things after 3 days, I will begin the pressure change processes UnicornRider suggests.

Could someone explain what Press Med means, when UR says "match your Press Med of OSCAR Report"? This is the only part of the directions I don't understand.

[Crimson Nape]

I believe this is referring to the Median pressure in the Daily Screen statistics data.

- Red

[srwilsn3]

Thank you all.

A little unscientifically, I decided last night to split the difference on the recommendations. EPAP +0.2 and PS -0.2. Trigger from medium to high sensitivity.

Had zero CAs last night. Just one night, but trending well.

I still slept like crap last night, though, despite my AHI being 0.27. 

Very low restfulness; like actually worse than the night before, where my AHI was 2.5. I'm wondering whether flow limitations are a lingering problem here. I don't know what normal breathing patterns look like, but these are mine (one from a week ago and one from last night). Can anyone shed some insight?

[srwilsn3]

Two nights with low CAs and another with elevated AHI because I think I was chin tucking. My collar may have been too loose.

I'm still having headaches all day and tired eyes. Not so much fatigue though.

Charts below.

I'll continue to monitor since I had success eliminating CAs with a higher trigger. However, still interested in my breathing sinewaves since they look irregular to me, and I'm wondering if they are indicative of disturbed breathing. Just trying to chase down why I feel so crummy.