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+--- Thread: Moved to BIPAP and need help! (/Thread-Moved-to-BIPAP-and-need-help)
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Moved to BIPAP and need help! - REMRICK - 10-29-2024
Good evening Everyone! I really appreciate the information that you are able to get on this site.
I have been through my own ups and downs trying to get my sleep apnea, periodic leg movements, allergic rhinitis, and the brain fog under control.
I initially was diagnosed with Sleep apnea in 2017 and could not tolerate the CPAP and I worked a 24 hour shift during that time. I used an oral appliance for years but was minimally controlling my sleep issues. I had to leave my career and don’t work the crazy hours and have worked significantly on controlling my allergic rhinitis with medication and saline rinse.
I recently moved down to Texas and had a sleep study in January 2024 and then a titration in April 2024.
Sleep study in Jan 2024 -
AHI 18.6/Hour
RDI 20.7/Hour
I was placed on APAP for approximately 1 month. Switched to a pressure of 12 cm on CPAP. Neither provided a significant improvement.
Titration study in April 2024.
AHI 18.6/Hour
RDI 20.7/Hour
PAP Tritration with a recommended pressure of 13cm H2O with EPR 3.
I still have not felt like I am getting any quality sleep. I still wake up tired with multiple arousals through the night.
I reached out to Sleep specialist to provide suggestion and look at my OSCAR data. He recommended a high pressure of 14cm for a couple days then 15cm for a couple days.
The data was reevaluated and was thought I would do much better on a BIPAP machine with my amount of sleep breathing events.
I received my ResMed AirCurve10 VAuto and was suggested to start with 15 IAP and 10 EAP.
I still am not getting good quality sleep. Im sure my sleep is very fragmented but I don’t get much help from my sleep Doc. My AHI is below 5 and I am not feeling better.
I have reviewed threads many times on the Sleep apnea board for something I might change.
I finally came that I just need to reach out and get some guidance from this awesome platform.
I provided to screen shots of two different days from OSCAR. One day is 10-14-2024 and the 2nd is 10-26-2024.
[attachment=71360]
[attachment=71361]
Thank you for your help!
REMRICK
RE: Moved to BIPAP and need help! - Schernenk - 10-29-2024
You are running with a pressure support of 5, which is essentially the difference between your IPAP and EPAP. Since you are in Auto mode you could try widening the gap between EPAP and IPAP and then increasing your pressure support by a bit incrementally, maybe by .4 or .6 this is in effect reducing your breathing effort.
Your machine is also showing basically no AHI in those two screen shots, you could possible get away with a lower IPAP.
You may run up against aerophagia with too much pressure support but you can increase PS until that becomes an issue to see if it helps. There is a helpful bi level video by the "LankyLefty" on settings and set up of Resmed Bi Level that goes into detail about that. Once you watch that video you could also try S Mode. The way your have your setting right now, with the difference between your IPAP and EPAP being the same as your pressure support you are essentially running in S mode (standard mode I think) but again, watch the video mentioned above for some very nice explanations.
At the end of the day your are basically get much better and nuanced pressure support with Bi Level, and it is quite possible you need more support.
RE: Moved to BIPAP and need help! - REMRICK - 10-29-2024
Thank you for your suggestions. I will definitely watch the video. I definitely don't entirely understand pressure support. I had one of my nights that had a bunch of Clear Apneas and I helped resolve them with raising the trigger to very high. I don't know if that was the proper correction. I am just trying to prevent from going the wrong direction on improving my treatment. The BIPAP is definitely more tolerable and recently started using mask liners which have helped with leaks.
RE: Moved to BIPAP and need help! - SarcasticDave94 - 10-30-2024
With CA/Clear Airway/Central Apnea, your PS 5 may be making them worse with this machine. I'd drop it back to 4 for now.
Both your Trigger and Cycle are edited. Trigger High or Very High can help CA, so that's OK. However, few need to edit Cycle away from the Medium setting.
The AHI looks very good regardless. Try those edits to PS and Cycle. Give feedback tomorrow if you're able.
By the way, did you get the detailed sleep study from your doctor? If not you need it for yourself. Important info will be in part the event table with count and type. Also the doctor's recommendations.
RE: Moved to BIPAP and need help! - REMRICK - 10-30-2024
I appreciate the suggestions. I do have the technical report for these recent sleep studies. I also have the periodic leg movements that were identified in both sleep studies.
I have tried to make working out and eating healthier a priority for the entire year. I lost 10lbs that put me to my normal weight. I just haven't felt any significant recovery in my sleep.
I worked as a Firefighter for 20 years. My sleep schedule was crazy for many years.
I have really worked on a healthy sleep hygiene over the last year. I did also have significant nasal breathing issues for many years. I did have nasal surgery because the sinus infections. I have made keeping my nasal passages clear a high priority over the last two years. I saw an ENT/Allergy Doctor. I have been completely away from the fires that caused the issues.
I started taking the medication for the periodic leg movement. I was trying to make sure they were not influenced by the sleep disordered breathing.
RE: Moved to BIPAP and need help! - SarcasticDave94 - 10-30-2024
Weight loss is never bad. I lost 100 lbs after a bariatric sleeve surgery due to comorbidity COPD, Apnea, heart condition called PVCs. I still need a machine, but my extra complex issue means they're not getting me onto the right machine after 10 years.
You will certainly not be as difficult to treat as I am.
Care to post the event table with type and count? Despite low to zero CA right now, maybe they're an issue after all.
PS periodic leg movement itself can ruin sleep.
RE: Moved to BIPAP and need help! - REMRICK - 10-30-2024
Yes I have been trying to improve the areas that I have control. I had some heart testing done 1-2 years ago and I had a large amount of PVC's also. The Heart Doctor felt my PVC's was being caused by my Sleep Apnea.
My Periodic Leg movements was 61/hour in Jan 2024 with sleep study. The titration study they reduced to 30/hour. So I saw the PAP helped the movements. It's hard to know if they are improving.
I can post the event table. I just want to make sure I am posting what you are wanting. The OSCAR Data with the Central Events?
I actually had moved the trigger back to High and the cycle to Med.
What type of machine are needing to get for yourself?
RE: Moved to BIPAP and need help! - SarcasticDave94 - 10-30-2024
Having Central Apnea and COPD, I should likely be on ResMed ST-A if I stay in the CPAP class. Otherwise it's full vent line the ResMed Astral 100 or 150.
Yes that's sounding like the correct table.
RE: Moved to BIPAP and need help! - REMRICK - 10-30-2024
This OSCAR data is from 10-25-2024.
[attachment=71372]
RE: Moved to BIPAP and need help! - SarcasticDave94 - 10-30-2024
That's not bad per the numbers. Trigger High or Very High will be a variable you can edit to see which is better overall. And again going back to PS 4. So far that's what it's looking like.
My CA on the ASV when doing well, the AHI would be between 0-3. Compare that to 124 CA on the test that got me onto ASV, which thus far isn't a machine indicated for you.