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BiPAP Settings?
#1
BiPAP Settings?
Hi everyone!

After asking on reddit, a kind soul named beerdujour recommended me to post here for further questions.
So, a bit of history: I got prescribed a DreamStation Auto for general use, which in general works OK, but still leaves me with AHI somewhere between 5-10 most nights. I seem to be tucking my chin in during my sleep. Apart from the soft collar, the recommendation was to try ResMed/BiPAP (IIRC), so I dusted out my ResMed BiPAP which I had acquired second hand a few years ago, but which reeked so much of smoke that I could never use it. Took it apart, left it to air out, and cleaned it with soap. It seems to have helped, and together with a sponge with essential oil in front of the air intake, seems to be tolerable. (Plus I learned a lot about how those machines work, yay!)

The results of the first night are attached to this post, hopefully in the right way.

Would you have any recommendations how to adjust the settings? (Feeling mostly exhausted today, like it didn't work very well)

The DreamStation was reporting around 30L/min leak rate, which is what is specified for this mask, but the ResMed now is reporting 0, with two short ~10L leaks during the night, is this to be expected?

Also interestingly, the SpO2 drops fit quite well over the tidal volume "noisy" bits.
And sadly I had to sleep without a soft collar as the one I have is still damp from washing (how do you deal with this? Keep 2? More? Other solutions?)


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#2
RE: BiPAP Settings?
On your Aircurve 10 Vauto, with EPAP min 9.0, max pressure 20, PS 4.0, results look really good, and your CA events will likely diminish as you become more accustomed to the pressure support. I don't think this level of CA is a problem. Your pressure is is only fluctuating less than 2 cm between 13/9 and 14/10 (IPAP/EPAP) which is excellent. You can probably reduce pressure slightly with EPAP min 8.6, max pressure 16.0, PS 3.6.

If you still have smoke odors, you can buy a new humidifier chamber and the outlet silicone seal where the tube attaches. Of course I assume you installed new tubing. I treated a contaminated machine with Ozium that can be found in most auto-parts stores. It is used to deodorize cars and as a room deodorizer. Just spray a cloth or cotton ball with a small amount and let it be drawn into the machine for a while. Do not spray into the machine itself. It seems to take out most of the odor, and it will diminish in time as well.

Welcome to the forum. Fred should be along shortly.
Sleeprider
Apnea Board Moderator
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#3
RE: BiPAP Settings?
Thank you!

Will try and locate some Ozium, or something similar.
And yes, it's a pity as the smoke-smelling tubing was a climateline heated tube.

Where does the source of the exhaustion come from then? I don't understand it.

For reference, or in case it is interesting to anyone, DreamStation graphs attached (OSCAR is SO useful!)


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#4
RE: BiPAP Settings?
Just curious: you seem to be going to bed around 3 or 4 a.m. and getting up around 10 or 11. Is that your usual schedule? Is it necessitated by work?

When you were using your PR machine, did you usually feel rested the next day?

Small bit of housekeeping: could you change your profile to show you have an AirCurve 10 VAuto, rather than an S model?
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#5
RE: BiPAP Settings?
(10-31-2020, 11:10 AM)Dormeo Wrote: Just curious: you seem to be going to bed around 3 or 4 a.m. and getting up around 10 or 11.  Is that your usual schedule?  Is it necessitated by work?

When you were using your PR machine, did you usually feel rested the next day?  

Small bit of housekeeping: could you change your profile to show you have an AirCurve 10 VAuto, rather than an S model?

Oops, not sure how that S snuck in there, should be corrected now.
My ideal schedule is around midnight to 8, this homeoffice thing and my lack of discipline make it hard for me to go to bed early.
And yes, somehow even with the higher AHI I would feel more rested.
Actually the same thing happened when wearing the soft collar with the PR machine, AHI would drop to around 2-3, and I would feel exhausted, not rested at all.
Hoping it will go away somehow, but it makes it hard to keep on living, keeping a job, etc.
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#6
RE: BiPAP Settings?
One night is way to little to go on for any hypothesizing, and it is quite possible the different feel of this machine and the settings kept you from sleeping well. It can take a few nights to get used to something new, even if it the difference is fairly minor.

In general you'd do yourself a favor if you tried to work on your sleep schedule. I'm doing the work-from-home thing too, and I know what a complete drag it is, but think how much better you'll be able to cope if you feel rested!

While we're at it, here's the full list of things to do to improve your sleep. I ignored these for quite a while, thinking they looked too mickey mouse, but eventually in desperation I tried them, and lo/behold, they helped.

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

To this I would add the advice to get out in the sunshine for 20-30 minutes every day. It helps your biological clock to work better for you.
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#7
RE: BiPAP Settings?
Yes this is a good list!
(Following pretty much all of it, just that my schedule is delayed by a few hours. That will correct itself automatically once my better half comes back and forces me to wake up at ungodly hours to eat breakfast with her.)

The exhaustion is consistent with the AHI somehow. Whether soft collar, different pillow, or different machine, AHI goes down to around 2, but I feel exhausted to the point of barely being able to drive. Dark rings under the eyes.
Asked my doctor about it and he had no clue, just said "Well, let's just keep your AHI around 10 then".
I hope hope hope somebody here reads this and recognizes it somehow Smile
or has an idea what to try to find out what it could be?
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#8
RE: BiPAP Settings?
Glad to see you made it. To be clear I am BeerDuJour on Reddit. I was on the road today but I see the best of the best has chimed in to help you. That is one of the things I love about the ApneaBoard.

You are doing pretty well, I would hold these settings for a day or two then, as my friend Sleeprider said " You can probably reduce pressure slightly with EPAP min 8.6, max pressure 16.0, PS 3.6."

You are in good territory with your numbers, your obstructive numbers are in very good shape whish suggests a lower Min EPAP, and the Central Apnea you see should drop some as you reduce the PS.

Most important, and the reason to wait to make the change is I want you to make a critical evaluation of how you feel, not the numbers, but how you feel.

Then after the change repeat and then choose which settings make you feel better.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#9
RE: BiPAP Settings?
Thank you very much! Smile
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#10
RE: BiPAP Settings?
As for the last question in the first post, collars are generally inexpensive. If you love the one you have, buy another. If it’s ok, but could be better, read some reviews and try another you might like better. I’m trying one that’s new to me (not to the forum) and sleeping much better than I have for awhile.

In general, I keep backups for everything CPAP-related. You never know when a hose is going to tear, or a mask will stop sealing, or a collar will need to be washed, etc.
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