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I'm back, tired, and hopeless. But is Bilevel the answer ?? - weuw - 04-25-2023
Hello, I am back here after a few months.
Reminder : man 52 years old, no risk factor but anxiety disorder, diagnosed with moderate sleep apnea (AHI 27) few years ago, on CPAP machine for about 3 years. Whatever I tried with CPAP machines until now, I feel exhausted (and depressed) minimum 50% of times.
Last six month I was under dental appliance instead of CPAP with exactly the same results : exhausted most of the time. I am using Sleep Analyzer (which does claim to have medical-grade sleep apnea detection) for 2 years, it says nearly no apnea, even with dental appliance...
So last week I made a reboot !! I retried the CPAP with EPR 3, and I feel better for a few days. It works better but far from perfect... Always very random sleep with a lot of arousals (detected in polysomnography).
Here are some Oscar screens of last nights for advice :
[attachment=50090]
[attachment=50091]
[attachment=50092]
Last days I jumped from my chair when I red this article : Flow Limitation/UARS and BiPAP - Apnea Board Wiki
Is that the solution for me ??? Because on Oscar the only bad parameters are Flow Limits... And sometimes spo2 drops under 90% for a few minutes max.
Especially when I red the chapter Can You Feel Anxiety in your Sleep?
And particulary Is Bilevel the Answer?
Maybe I am on the wrong way, but it is a way! Do I need to use a Bilevel CPAP?
What do you think ?
Thanks
Serge from Paris
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - Sleeprider - 04-25-2023
Your pressure moves higher of flow limitation, and so the initial response is to suggest a higher minimum pressure and to turn off ramp if you can tolerate that. There is some indication that you may have infrequent positional issues (chin-tucking) as indicated by sharp spikes in flow limitation and small apnea clusters. Just protect your head/neck position and avoid pillows or sleeping positions that increase airway obstruction. Bilevel pressure support would eliminate most of the residual flow limitation, and with a device like the Resmed Aircurve 10 Vauto, we could work with some trigger settings to knock out the centrals as well. As to your question, I'm certain we could reduce respiratory event related arousals with a bilevel device, but without sleep data, we don't really know how much of your sleep disruption that represents.
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - weuw - 04-25-2023
[attachment=50097 Wrote:Sleeprider pid='473954' dateline='1682425225']Your pressure moves higher of flow limitation, and so the initial response is to suggest a higher minimum pressure and to turn off ramp if you can tolerate that. There is some indication that you may have infrequent positional issues (chin-tucking) as indicated by sharp spikes in flow limitation and small apnea clusters. Just protect your head/neck position and avoid pillows or sleeping positions that increase airway obstruction. Bilevel pressure support would eliminate most of the residual flow limitation, and with a device like the Resmed Aircurve 10 Vauto, we could work with some trigger settings to knock out the centrals as well. As to your question, I'm certain we could reduce respiratory event related arousals with a bilevel device, but without sleep data, we don't really know how much of your sleep disruption that represents.
Thanks ! Here are some results of my last exam in september 2022 (you asked for sleep data ?) ->
Note : it was an exam with my dental appliance. Sorry for bad translation (automatic but good in fact).
[attachment=50097]
[attachment=50098]
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - Sleeprider - 04-25-2023
Your diagnostic AHI was relatively low at 14/hour, and both apnea and hypopnea are biased to more central than obstructive. The diagnostic shows mild complex apnea, so it's hard to predict whether bilevel therapy with additional pressure support might increase the central events or not. Your treated AHI with CPAP is s significant improvement over the baseline diagnostic condition, and there is not overwhelming evidence of a need to change to bilevel. It's up to you whether you want to take the risk of changing that therapy as neither one is really designed to target central events, however we gain some flexibility with bilevel. Sorry I can't be more definitive than to say, the chances for improvement with bilevel is uncertain.
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - weuw - 04-25-2023
(04-25-2023, 08:21 AM)Sleeprider Wrote: Your diagnostic AHI was relatively low at 14/hour, and both apnea and hypopnea are biased to more central than obstructive. The diagnostic shows mild complex apnea, so it's hard to predict whether bilevel therapy with additional pressure support might increase the central events or not. Your treated AHI with CPAP is s significant improvement over the baseline diagnostic condition, and there is not overwhelming evidence of a need to change to bilevel. It's up to you whether you want to take the risk of changing that therapy as neither one is really designed to target central events, however we gain some flexibility with bilevel. Sorry I can't be more definitive than to say, the chances for improvement with bilevel is uncertain.
Ok, I just want to recall you that exam I posted in the PDF was taken with my dental appliance, so what we see are residual apneas.
In 2019 my initial exam showed AHI of 24 (27 with limitations) / Arousals 19.
But what I think is important is my anxiety disorder which can benefit of Bilevel beliving the article I quoted. Or maybe not...
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - weuw - 04-25-2023
(04-25-2023, 07:20 AM)Sleeprider Wrote: Your pressure moves higher of flow limitation, and so the initial response is to suggest a higher minimum pressure and to turn off ramp if you can tolerate that. There is some indication that you may have infrequent positional issues (chin-tucking) as indicated by sharp spikes in flow limitation and small apnea clusters. Just protect your head/neck position and avoid pillows or sleeping positions that increase airway obstruction. Bilevel pressure support would eliminate most of the residual flow limitation, and with a device like the Resmed Aircurve 10 Vauto, we could work with some trigger settings to knock out the centrals as well. As to your question, I'm certain we could reduce respiratory event related arousals with a bilevel device, but without sleep data, we don't really know how much of your sleep disruption that represents.
If I stay with my Redmed Airsense 10 you think it is better to set min pressure around 9 for example as a conclusion ?
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - Sleeprider - 04-25-2023
A minimum pressure of 9.0 with EPR 3 results in a 9/6 pressure. The best bet is to try it and decide if the results and comfort meet your needs better. I prefer to see a pressure that is high enough not to cause a lot of variation, and a minimum pressure of 8 or 9 gets you closer to that. I would also consider capping pressure at 11 cm because higher pressure does not seem to offer much help.
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - weuw - 04-26-2023
Hi
Last night I used 9-12 pressure EPR 3.
Here is the Oscar results :
[attachment=50136]
As you can see my Flow limits are higher.
I feel really tired.
But I had many wake up that night, a bit of insomnia...
Oddly my Apple Watch found 1h06 of deep sleep against 30 min the night before.
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - Sleeprider - 04-26-2023
Let's take a closeup look (3-minute segment) of the flow rate during that high flow limitation, and maybe also take a look at how a CA event evolves out of that at 00:38
RE: I'm back, tired, and hopeless. But is Bilevel the answer ?? - weuw - 04-26-2023
(04-26-2023, 07:37 AM)Sleeprider Wrote: Let's take a closeup look (3-minute segment) of the flow rate during that high flow limitation, and maybe also take a look at how a CA event evolves out of that at 00:38
Of course here they are :
[attachment=50140]
[attachment=50141]
Thanks
