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+--- Thread: [CPAP] Just bought a second hand bilevel, hoping for some help with titration? (/Thread-CPAP-Just-bought-a-second-hand-bilevel-hoping-for-some-help-with-titration)
Just bought a second hand bilevel, hoping for some help with titration? - JohnnyLarueBathrobe - 02-29-2024
Hi All,
I have been struggling with feeling exhausted for a few years now and this is finally the year where I have decided to tackle it.
First sleep study in hospital was 2011 (AHI of 35) and started on APAP in 2012 (titration night in the hospital showed CPAP at 15 cm of pressure was most helpful). I didn't look into the data too much since the worst effects of my sleep apnea seemed to be handled with this new machine and I felt a real "kick" of energy for the time immediately following starting to the device to sleep. I got approved for an APAP because I was struggling going directly to 15 right away and would take the mask off in my sleep.
I went from Philips One APAP to Airsense 10 in 2018. Had another sleep study (with device on), was told my machine was managing my apnea. But i still felt exhausted.
Long story long, in 2023, I started really looking into my sleep data and realized quite quickly that my APAP was not really helping as much as I had assumed. Since then, I've fixed my leak (new machine and new mask, F&P Evora), jaw drop (tape my mouth), etc but still feel exhausted. Doctor tells me my AHI is low so therefore I am fine and going to a higher pressure would just worsen aerophagia I sometimes got at anything over 17 cm of pressure even with various EPR settings. They would not give me a prescription for a bilevel. I had most recently been on an APAP 16.4-20 with EPR off and a VCOM in the tubing chain.
This week, I purchased an AirCurve 10 VAuto from facebook marketplace with low usage hours because I am determined to get to the bottom of this and to start sleeping well. I know SleepHQ is likely not super popular here, but I will try this first sharing it as it includes my sp02 data, the machine data and the apple watch data in one place and it is where I have been tracking it myself.
Any ideas or advice would be very welcome. Thank you again.
Here is last night on the AirCurve 10 with 25/16 and pressure support of 4: https://sleephq.com/public/c925d58f-42e2-455f-ba8e-4a0beb77255e
RE: Just bought a second hand bilevel, hoping for some help with titration? - Sleeprider - 02-29-2024
I would prefer to see your charts in Oscar rather than SleepHQ if you have that capability. As you know, your AHI is very good with EPAP min 16, max pressure 25 and PS 4.0. I'm going to ask you to significantly dial back your pressure so we can see if we can relieve your aerophagia, and to determine the efficacy of lower pressure with PS from your new Vauto. I'll note that you were at nearly fixed pressure all night at your current settings, and I'm certain we can get you to a lower, effective pressure. With that, if you're game, lets do this:
Mode Vauto
EPAP min 10.0
IPAP max 20.0
PS 4.0
Ti Min 0.3
Ti Max 2.6
Trigger sensitivity: High
Cycle sensitivity: Medium
Ramp Off, or if you can't go directly to pressure On with Minimum 7.0 on Auto
I think this will improve things pretty quickly. Please try to post with Oscar
RE: Just bought a second hand bilevel, hoping for some help with titration? - JohnnyLarueBathrobe - 02-29-2024
Thank you for your reply, I really appreciate it.
Just want to clarify that so far, in the first three nights of using the bilevel instead of an airsense, not much aerophagia to speak of.
Is there a good way to get my Sp02 data from my wellue oximeter into OSCAR? I feel this may be quite helpful, I tend to see it fluctuate quite a bit throughout the night with seemingly a lot of dips.
I’ll make those settings changes you outlined for tonight. Thank you again!
RE: Just bought a second hand bilevel, hoping for some help with titration? - Sleeprider - 02-29-2024
Our Oximeters wiki has information on your using your oximeter with Oscar. I'm not the expert in that area, but many members do import SpO2 and pulse data. https://www.apneaboard.com/wiki/index.php?title=Pulse_oximeters
RE: Just bought a second hand bilevel, hoping for some help with titration? - JohnnyLarueBathrobe - 03-01-2024
Hello,
Please see last night's stats attached. My oximeter fell off in the night and for whatever reason, when I woke and put it back on, it won't import the second half of the night into OSCAR for me so I will include the SleepHQ link as well that has it all.
Sleep HQ: https://sleephq.com/public/42da58cf-f04f-4c14-b8cd-25978207c60c
RE: Just bought a second hand bilevel, hoping for some help with titration? - Sleeprider - 03-01-2024
We probably only need the main detail chart. What would help most is to track whether you're starting to feel any positive effects from the use of Vauto. So far, this looks pretty good and the good news is the significant reduction in pressure looks fine from here. Your subective feedback is actually equally important, or more-so than the data.
RE: Just bought a second hand bilevel, hoping for some help with titration? - JohnnyLarueBathrobe - 03-01-2024
Ah ok, thank you for letting me know.
To be honest, that was likely the worst night on the VAuto so far even though I may have technically slept more time. I feel very tired.
I guess that’s where I get lost in all of this - the delta between the numbers and how tired I feel.
RE: Just bought a second hand bilevel, hoping for some help with titration? - JohnnyLarueBathrobe - 03-01-2024
I appreciate your help with this - is there something I should change tonight in the settings given how poorly I feel I slept?
RE: Just bought a second hand bilevel, hoping for some help with titration? - Sleeprider - 03-01-2024
Your therapy is great, but if you want to try PS 5, I think you can keep the lower EPAP min and see if that helps. Sometimes a higher PS helps with the feelings you are describing, and we have no concerns at this point of triggering centrals.