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[Pressure] Didn't sleep at all my first night with BiPAP. What should I do?
#1
Didn't sleep at all my first night with BiPAP. What should I do?
Hi all,

Well, I got my AirCurve 10 VAuto yesterday and was excited to try it last night. The device actually felt more comfortable than I was expecting. However... I tossed and turned until nearly 8am when I finally pulled off the mask and slept for a few hours. I'm not sure if I was just anxious, or if my settings were way off.

I started with EPAP at 5 and IPAP at 10, and quickly felt like I was not getting enough air. I did a search online and someone suggested to bump the pressure up, which did seem to help slightly. 

The other thing I noticed is that on a PS of 4, I felt really uncomfortable. I eventually lowered it to 3, then 2 and finally 1.2. Do most people feel this sensitive to the PS? I am considering even trying just a regular CPAP mode for a few nights.

All in all, I'm feeling lost. If I slept at all I would upload my OSCAR data.

Any help would be greatly appreciated. Thanks!
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#2
RE: Didn't sleep at all my first night with BiPAP. What should I do?
The best way to adapt to CPAP therapy is to make a commitment to use it all the time you are sleeping. Changing the settings for the reasons you mentioned is not recommended. You need keep the settings the same for several days so you can adapt to them.

You may not feel you slept with the CPAP machine on, but perhaps you did, so collect the data anyway.

The sleep you think you are getting without the CPAP machine is an illusion. You never fall into the deeper levels of sleep because you keep waking up to breathe, even though you have no memory of it. Plus, it's increasing your chances of heart disease or stroke, and makes a negative contribution to your overall well being. Especially if you suffer from anxiety.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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: Didn't sleep at all my first night with BiPAP. What should I do?
sleepy,
Post a graph from the daily page of OSCAR.  This way we can see what affect the pressure settings you used had and be able to advise accordingly.

We would still like to see your data whether or not you slept that much.

Use this link to guide you in Organizing your chart and post it here in this thread.

http://www.apneaboard.com/wiki/index.php...ganization
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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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#4
RE: Didn't sleep at all my first night with BiPAP. What should I do?
(10-29-2020, 12:17 PM)sleepy331 Wrote: Hi all,

Well, I got my AirCurve 10 VAuto yesterday and was excited to try it last night. The device actually felt more comfortable than I was expecting. However... I tossed and turned until nearly 8am when I finally pulled off the mask and slept for a few hours. I'm not sure if I was just anxious, or if my settings were way off.

I started with EPAP at 5 and IPAP at 10, and quickly felt like I was not getting enough air. I did a search online and someone suggested to bump the pressure up, which did seem to help slightly. 

The other thing I noticed is that on a PS of 4, I felt really uncomfortable. I eventually lowered it to 3, then 2 and finally 1.2. Do most people feel this sensitive to the PS? I am considering even trying just a regular CPAP mode for a few nights.

All in all, I'm feeling lost. If I slept at all I would upload my OSCAR data.

Any help would be greatly appreciated. Thanks!

The EPAP at 5 is very low.  Most people need 8 or above to not feel air starved.  4 is the lowest the machine will put out so again 5 is to low.  And 10 seems quite low also.  Have you set it to VPAPauto?  I'm not saying yours should be set the same as mine but you did not put up OSCAR file to look at and I don't know how you have it set. 

Mine is set as follows and I will explain:
VPAPauto
PS 4.6 over 8.0-18(cmH2O)

The 18 is as high as the machine will go (it can be set to 25)
8 is the lowest it will go (it can be set to 4)
The PS=4.6 so my starting high pressure is 8+4.6=12.6 and it can go up to 18

now at the bottom I included my pressure graph...  Notice it got up to almost 16 never the high of 18, The min pressure was 8, and the starting high pressure was 12.6 and went up when I needed more pressure. Also note the 2 pressures stay the same distance apart... 4.6 As the top pressure raises the bottom pressure raises the same amount keeping the same distance and that is the PS number of 4.6

I don't know if this helps but I hope it does.


Attached Files Thumbnail(s)
   
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: Didn't sleep at all my first night with BiPAP. What should I do?
Sleepy, 
Sometimes I *think* I did not fall asleep after getting up in the night, but my charts clearly show that I did sleep. So it would still be helpful to post a few charts of your nights. The team here will be able to help you in the right direction.

You said you were only able to tolerate PS of 1.2, other machines like the Airsense have similar levels of equivalent pressure support of up to 3 cm H20: Were you previously able to tolerate that pressure difference?


(
@ Stacey

Thanks for posting that graph. I can't say I have looked too closely at charts of others on the Vauto, but what strikes me about yours is how little pressure variation there is, how few pressure swings over the night, with pretty constant pressures throughout the night: is this the norm for you or is this one of the benefits of the VAuto?

I am also impressed at how quickly the pressure comes down after it has spiked up.  

Is this  the norm? the sort pattern sleepy331 should be looking for?
)
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#6
RE: Didn't sleep at all my first night with BiPAP. What should I do?
I posted to you to explain the PS in the VAUTO and that it is different than the way it differs from a Resmed Cpap machine.  When I first started using it I could not quite grasp how it worked as I keep thinking of it in the same way I did when I had my cpap.  Then Sleeprider sent me a message that helped me get my mind around it: "we add PS to EPAP to get IPAP with the Vauto.  With the Airsense 10 CPAP we subtract EPR from IPAP to get EPAP.  We nearly always refer to the Airsense 10 in bilevel terms so it does get confusing."

Just trying to pay it forward.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#7
RE: Didn't sleep at all my first night with BiPAP. What should I do?
(10-29-2020, 12:34 PM)Sleepster Wrote: The best way to adapt to CPAP therapy is to make a commitment to use it all the time you are sleeping. Changing the settings for the reasons you mentioned is not recommended. You need keep the settings the same for several days so you can adapt to them.

You may not feel you slept with the CPAP machine on, but perhaps you did, so collect the data anyway.

The sleep you think you are getting without the CPAP machine is an illusion. You never fall into the deeper levels of sleep because you keep waking up to breathe, even though you have no memory of it. Plus, it's increasing your chances of heart disease or stroke, and makes a negative contribution to your overall well being. Especially if you suffer from anxiety.

Okay thanks! So last night I actually did get some sleep with the machine on. I also tried to use it a bit in the afternoon to get used to it, so you'll see it on for a few hours then.

I also put on the mask about an hour or two before bed while I was watching TV to get used to it. I got up to go to the bathroom a few times (and you'll see a huge jump in the leak rate).

I think I captured the right information in my screenshot. Please let me know if you need anything different!


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#8
RE: Didn't sleep at all my first night with BiPAP. What should I do?
With EPAP min 5.6, Max pressure 11.0 and PS 1.6, events are all central, although the rate is not too bad at 2.35/hour. I'm a little puzzled why you are using a Vauto when there appears to be no apparent flow limitation, even with minimal pressure support, and you are clearly sensitive to pressure support. Please refresh my memory what your sleep test results were or why you ended up starting on a bilevel.

I think we can continue with the current settings. The Vauto has a "Trigger Sensitivity" setting with a default value of Medium. If you change that to High, it may help reduce some of the central events. Give that a try, and if we don't see a reduction in CA events, we may ask you to reduce the PS to 1.0.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#9
RE: Didn't sleep at all my first night with BiPAP. What should I do?
If you’ve never used cpap before it takes some getting used to. Dropping you pressure (which wasn’t that high to begin with) means you won’t be getting any benefit
"Sometimes the magic works . . . and sometimes it doesn't" -- Chief Dan George in the movie Little Big Man
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