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[Pressure] central sleep apnea because of high Bipap pressure??
#1
central sleep apnea because of high Bipap pressure??
Hi this is my first post.
I was diagnosed mild sleep apnea 12 years ago. Couldnt get accostomed to my cpap so i just lived with it. I did UPP and tonsilectomy in 2015 but the surgery didnt help.
I did my recent polysomnograph on feb 2021. Ive attached the screenshot. AHI was 66.5 with 186 obstructive and 164 hypopneas but only 2 central apneas.

Doctor asked for bipap titration since i mentioned him i have apap already which didnt work. The bipap titration was successful as with pressure of 11/18 the ahi was 0. screenshot is attached. AHI was 17.3 as i couldnt fall asleep most of the night. This time with 17 obstructive and 30 hypopneas and There was only 1 central apnea recorded.

I got by bipap and start treating with it. It was very hard for me from the day 1 i used the bipap. I keep waking at the middle of night with chocking and gasping for air. I thought it would take time to get accoustomed so i kept using the pap with great difficulty but each night obstructive and hypopneas were significantly down but the clear airway(central apnea) was very high so the AHI would fluctuate from 20-55 range for next three week i used bipap until i gave up because it was very very hard on me. I talked to doctor and he immediately asked me to stop as bipap was causing problem instead of helping me. He said he process for ASV for me.
I am crossing my finger that asv will work for me or i have no other option at this point. I am very very tired through out the day and i am mostly in my bed day and night beause of tiredness. I have very hard time sleeping at night. Has anyone gone though similar situiation? What was helpful for you and how are you managing now? your inputs will be very helpful.
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#2
RE: central sleep apnea because of high Bipap pressure??
Welcome to the forum

I strongly suspect Treatment-Emergent Central Apnea. Since you are on a BiLevel because APAP didn't work You may not need that much PS. High PS tends to cause Central Apnea.
If you don't mind would you like to try with lower values?

EPAP = 11
IPAP = 14

Try that and post your results.
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#3
RE: central sleep apnea because of high Bipap pressure??
That is the strangest titration study I have ever seen. the minimum PS was 6.0 cm and increased as EPAP pressure was increased.  This runs contrary to any protocol I have ever run across. Surprising you did not display the CA events during this study.  Anyway, please follow Gideon's suggestion. When you post the next chart, please minimize the monthly calendar by clicking the triangle in the date line. Lots of useful data is hidden because of the calendar.

[Image: attachment.php?aid=32182]
Sleeprider
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#4
RE: central sleep apnea because of high Bipap pressure??
Wow you only had 186 obstructive events on the diagnostic study. Smile
And it appears Blind Squirrel did your titration. Appears to be an idiot.
Dave

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#5
RE: central sleep apnea because of high Bipap pressure??
Hi
the VAuto-mode is not very beneficial for treating CAs. You should switch to S-mode and choose a backup rate of 10.

With best regards
Frank
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#6
RE: central sleep apnea because of high Bipap pressure??
Possibly S or VAuto mode will Avoid CA. Neither will treat the CA. Given low CA on both diagnostic and dopey excuse of titration, and high at home CA, we're dealing with treatment emergent. As was given by Gideon, settings need edited to reduce the too efficient flushing of CO2. And the doc doesn't have the evidence to script an ASV and get insurance to approve coverage payment. Trust me, it's not likely to go through.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: central sleep apnea because of high Bipap pressure??
Will try it and post as soon as i hear back from doctor in couple days. Thanks
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#8
RE: central sleep apnea because of high Bipap pressure??
I'll add, it's not the mode, it's the settings used with the mode.
Rest assured, should the charts so indicate, I'll tighten up on the settings to reflect the new data, possibly to the equivalent of a CPAP machine (IF needed).
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#9
RE: central sleep apnea because of high Bipap pressure??
(05-11-2021, 08:55 PM)Sleeprider Wrote: That is the strangest titration study I have ever seen. the minimum PS was 6.0 cm and increased as EPAP pressure was increased.  This runs contrary to any protocol I have ever run across. Surprising you did not display the CA events during this study.  Anyway, please follow Gideon's suggestion. When you post the next chart, please minimize the monthly calendar by clicking the triangle in the date line. Lots of useful data is hidden because of the calendar.

Hello sleeprider,
what are the protocol for the pressure support if i may ask? Couple fellow commenters also think the bad titration specially (bad?) PS might have provoked central apnea.
How do they find out the best pressure support for patients? trial and error only way to find out or is there a science behind it. 

Also gideon suggested the pressure support of 3 EPAP = 11 IPAP = 14. With my old apap machine i had use to set the pressure around the range (EPAP = 9 IPAP = 12) with pressure support of 3 as my old apap machine had that option. It worked a little bit to bring AHI down but wasn't substantial. my sleep apnea was mild anyways, but i just felt like i was choking and suffocating so i stopped the therapy.

If only i know what the best PS support for me is then i could test and try different pressure setting with my bipap.
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#10
RE: central sleep apnea because of high Bipap pressure??
(05-12-2021, 08:53 AM)Gideon Wrote: I'll add, it's not the mode, it's the settings used with the mode.
Rest assured, should the charts so indicate, I'll tighten up on the settings to reflect the new data, possibly to the equivalent of a CPAP machine (IF needed).

I do not understand this Gideon. can you please simplify.
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