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+--- Thread: Still extremely tired after almost 4 years of Bipap (/Thread-Still-extremely-tired-after-almost-4-years-of-Bipap)
RE: Still extremely tired after almost 4 years of Bipap - topdba7 - 01-02-2025
Hi Dave,
Here is my chart from last night. For some reason, the flow limitation has increased.
Thank you for your help!
RE: Still extremely tired after almost 4 years of Bipap - DaveSkvn - 01-02-2025
Happy new year to you too!
I wouldn't say the flow limitations were worse. The numbers are very close so I'd say they were pretty much the same.
On Tuesday your base inspiration pressure was 13 which the machine nudged up to 14 a number of times. So last night we set the base inspiration pressure to 14 which the machine ended up nudging up to 15 a number of times. Flow limitations - much the same.
[attachment=73691]
From the last week's data, I wouldn't say the PS (difference between exhale and inhale pressure) is giving you much additional benefit. Your best night was with a PS of 2 and a high pressure. It was not that much better than the others.
Your AHI on all nights was excellent so I don't really think your issue is classic OSA. Its those pesky flow limitations (which I personally think are more UARS-ey than obstructive which means the machines "under score" them in importance). The CPAP treatment for OSA and UARS is the same: ramp the pressure up until the airway is open - which you (and I) have difficulty dealing with due to the arrival of aerophagia. There is also the question of whether there is a practical pressure that would open the airway (c.f. positional apnea).
Re nose congestion. My nose also works fine when awake. It also gets congested using CPAP which is resolved by walking around and breathing normally.
CPAP doesn't seem to be doing me much good either. The biggest improvements I've had recently were the soft collar (which you already use) - a marked reduction in flow limitations - and a positional device stopping me from sleeping on my back (sadly not an option open to you) - OSA pretty much eliminated. I still have daytime sleepiness and UARS-ey breathing. I'm also considering surgery but wouldn't really consider making the decision without doing a "drug induced sleep endoscopy" to find out what is actually the trouble (https://www.youtube.com/watch?v=r9R_IwafDMo). I was once put forward for a UPPP - it never happened because the private surgeon disappeared back to France - but it seems to be frowned up now (https://www.youtube.com/watch?v=1hZPlL-6mxI).
I'm not sure what you can try next. Perhaps min EPAP 12, PS 2, Max IPAP 15. I expect the results would be much the same as 26 Dec.
RE: Still extremely tired after almost 4 years of Bipap - topdba7 - 01-02-2025
Thank you so much, David!
I truly feel like you’ve helped me tremendously. I think I’ll keep the settings at Min EPAP 9, PS 5, and Max IPAP 15 for a while to monitor the results. I’ve noticed a significant improvement over the past two days. Although I still feel a bit sleepy, I haven't had the need to take a nap, which is something that’s never happened before.
One of my ENTs examined my airway and diagnosed that an unusually large tongue base is the main obstruction to my breathing. Another ENT believes I need to correct my deviated septum and reduce my turbinates, but I'm concerned about the risk of empty nose syndrome if the turbinate reduction doesn’t go as planned. I’ve been considering an ASV, as several people have shared that it has greatly helped with their UARS.
Thanks again for all your help!
RE: Still extremely tired after almost 4 years of Bipap - DaveSkvn - 01-02-2025
"I haven't had the need to take a nap" - that's what we like to hear!
If you feel improvement, ignore the graphs.
Best of luck on your journey...