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On BiPAP but still tired in afternoon (OSA/UARS)
#1
On BiPAP but still tired in afternoon (OSA/UARS)
Hi,

I was recently diagnosed with OSA after my third (!) sleep study. This one finally caught what I believe started out as UARS and has progressed to sleep apnea. I have a very small recessed lower jaw and am getting double jaw surgery next summer. Multiple doctors have told me I am "basically breathing through a straw" and that my airway is extremely narrow/almost nonexistent.

Attended sleep study:
AHI 23.8
RDI 27.9

They started me on a ResMed AirSense 10, but I got a deal on an Aircurve 10 VAuto so I picked that up instead of continuing to rent.

I noticed improvement on both the machines, but I am still getting tired in the afternoon, and still seem to need 9-10 hours of sleep a night. I feel like I'm "70-80%" improved--I really feel great in the mornings, but by 3PM I'm basically collapsed like I used to be all day long before CPAP therapy.

Here is a typical night with the Aircurve. I had them set it up, but they just set a constant pressure of 9.0, which defeats the purpose of a BiPAP. I set it to 4-9. From the OSCAR charts, seems I may be hitting a ceiling with the max set to 9--so I'm open to suggestions here.

This night has an AHI of 1.72, which seems great (and gets me a score of 100 via My ResMed), but I have 30+ days full of 98-99-100s from My Resmed and I'm still tired. I'm hoping to get this tuned a little better so I can feel great throughout the entire day.


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#2
RE: On BiPAP but still tired in afternoon (OSA/UARS)
Erica, you got a great machine...the best. To help you we really need to see the left column information with settings, respiratory statistics and therapy summary. Please look at the tutorial linked in my signature, Organizing Your Oscar Chart. You appear to be doing okay with low pressure and PS at 3.0, but a bit more information should help.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: On BiPAP but still tired in afternoon (OSA/UARS)
Oh, okay, I read that but thought it said to turn off the right sidebar. Here you go!


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#4
RE: On BiPAP but still tired in afternoon (OSA/UARS)
Good looking chart. Your event rate is acceptable, but with obstructive apnea events, the pressure needs to go a bit higher. Flow limitation appears low, but the statistics are sometimes deceptive. When you get a chance, we should zoom in and look at the flow rate wave-form at about a 2-3 minute resolution. That lets us see if there is flattening that might benefit from pressure support. Some areas we might want to zoom in to are at about 01:15 and 02:15 ahead of the OA event, and the flow rate spikes around 3:30.

I think you need to move EPAP min to 6.0 and Max Pressure to 11.0. The PS 3 looks okay for now, but that is your tool to deal with flow limitation and respiratory event arousals. The 2-cm increased pressure should help avoid the OA events, but we do want therapy to be comfortable, so please let us know if higher pressure creates any issues for you.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: On BiPAP but still tired in afternoon (OSA/UARS)
Thank you so much for your advice! I will give that a shot. Here's a zoom right around the 1:15 OA, the 2:15 OA, and the 3:30 flow rate issue.


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#6
RE: On BiPAP but still tired in afternoon (OSA/UARS)
Good charts. In the first at 01:06 there is pretty obvious flow limit that resolves with an arousal at 01:07 (RERA), then fairly normal respiration leading into the OA at 01:09.
The chart at 02:13 is completely unremarkable leading into a random OA at 02:15:40. There is no indication this is coming, and no obstructive cause is visible.
the last chart shows a periodic series of normal breathing punctuated by arousal spikes. Movement is the suspect here based on small leaks that correspond to the spikes. Nothing here requires changes.

The only place where higher PS might be useful was in the first chart to deal with the flow limits. This is pretty subtle stuff, so just go with the increased pressure for now and we will defer PS until later.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: On BiPAP but still tired in afternoon (OSA/UARS)
Thanks for all your help! I've increased the pressures per your recommendation. I'm a bit more gassy, but I think it's helping with my afternoon tiredness. Still not 100%, but I think now it's just time as my body slowly heals from all the unintentional sleep deprivation it's had over the years!

I've made a donation. Appreciate the time you spent looking into this!
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#8
RE: On BiPAP but still tired in afternoon (OSA/UARS)
It would be interesting to see the results on your charts for increased pressure. We might be able to back off some if you are having some air ingestion. The main objective was to resolve the OA events. Thanks for the feedback and donation. The Forum is only supported by donations like yours.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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