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New BIPAP - Higher CA's than when on APAP
#11
RE: New BIPAP - Higher CA's than when on APAP
(05-20-2018, 07:40 AM)Kosoku Wrote:
(05-20-2018, 07:07 AM)tedvpap Wrote: Your OSA is well controlled.  The only question I have is why your minimum epap is set to 14.  You may have it set higher than needed.  Have you tried 12, 10, ...???
The CA could be due to discomfort caused by your injury, gas pain, ....  or they could be real.  I suggest getting your OSA properly treated and give it time before trying to address the CA.

Minimum epap was set to 14 by the DME. I believe she set it at this pressure to reduce snores. This is only my 2nd night on Bipap so no, I have not had a chance to lower the EPAP pressure yet. I will start the reverse titrating as per sleeprider and see how I fair.

Thanks guys.

It looks like she set your new machine without much thought.  
Your old machine (RemStar) was set to a range of 14-17 (IPAP) and FLEX was 2.  So your EPAP was essentially set to 12-15 which is lower than your new lower limit (14).  
Keep us posted.  I am optimistic.
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#12
RE: New BIPAP - Higher CA's than when on APAP
Here is what I figure is the lowest EPAP pressure I can achieve. I did try one night at 11 and OA's and H's made came back. CA's tend to stay the same. thought around 30 events in the course of the night.
I am still waking a lot. Not sure if the CA's are the cause or if the waking is the cause of the CA's.
Since I literally just bought this machine, should I still give it more time to see if the CA's will settle, maybe try "S" mode, or should I see about seeing if I can try the ST machine. I don't think I would need a ASV, I hope.
After jumping through the hoops to get a BIPAP and now to see all these centrals is very disheartening. I guess I had it in my mind that the BIPAP would fix all of my sleeping issues. Sigh!
What I hate most is using the Myair App and it still scores this night as a 98/100. Go figure.
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#13
RE: New BIPAP - Higher CA's than when on APAP
Your events are very well controlled and I think CA will decline in time. We can't know the reasons for the CA events, but they are distributed through the night rather than clustered, so this is atypical for true central apnea, and points more to transitions and movement. Hang in there and give it time. Let's hear about your comfort level.
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#14
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RE: New BIPAP - Higher CA's than when on APAP
Thanks Sleeprider.

Events do look a lot better for sure then when I was on the CPAP. This is the first time ever in eleven years that I have had no OA's recorded at all and that few H's and all in one night.. That was unbelievable to me.
As far as comfort goes, there is no comparison. The BIPAP just feels natural. My mask feels like it seals better, my max pressure, even though set to 20, has dropped by about 4 cmH20 overall. Breathing is natural and not feeling like I need to force the breath out or feeling like I am having air rammed down my throat. Comfort is incredible. 
Perhaps I should keep it at this setting for a while, avoid looking at the numbers for a bit as I am most likely stressing myself out about them, which could be a factor in my sleep disruption.
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#15
RE: New BIPAP - Higher CA's than when on APAP
I think if you just focus on the positive, extremely useful observations of your last post, that you can only conclude things are great! We do tend to get obsessed with the data, and in your case, HOW YOU FEEL is much more relevant. The CA event are inconsequential, and I do think taking a break from watching them tick away will be better for you. I am certain that in time they will just go away.
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#16
RE: New BIPAP - Higher CA's than when on APAP
So here is an update on my new BIPAP usage. I am pretty happy in the direction my therapy is going. Still needs a little tweaking, but overall, I am liking it.
So, the only changes I have made are.
1.) Set the trigger to very high. CA's dropped to 5 the first night. Thinking about starting to work it back to medium just to see if it is controlling the CA's or if I just adjusted to the the BIPAP.
2.) Started taking a magnesium supplement before bed.
3.) Last night I finally convinced my wife to make me a tennis ball shirt. Much better than using a body pillow or large pillow behind back. I know I never rolled on my back for sure, and it allows me to sleep more natural on my side the way I like. highly recommend this or at least try it. Cost is practically nil. Also scored the lowest AHI yet on the BIPAP.

Still thinking about raising my EPAP in small increments just to see if it knocks out the remainders.

Oh yes - Tennis ball shirt = Zero snores. Hope that trend keeps up.


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#17
RE: New BIPAP - Higher CA's than when on APAP
Looks great. I'll have to remember the increase in trigger sensitivity trick as a possible solution. Good job working through it.
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