Spetzal's therapy thread (Help needed with DreamStation BiPap)

[spetzal]

Historically, BiPAP IPAP 19/EPAP 14 for many years.  Multiple procedures done as one sinus surgery June 2022.  Updated titration study August 2022 recommended CPAP 13 with CFLEX 3 (CPAP 13 evaluated for 67.8 minutes with 95% average 02, 92% lowest 02, sleep associated heart rate of 55.5pm with highest of 94bpm.)  Used this setting at home for 3-ish weeks, looking back to OSCAR data it was therapeutic then.

As my sinuses continued to heal/change, there were complications.  The pressure setting was now causing severe sinus head/ear pain.  Doctor lowered script to 11 (same prob), then again to 9.

Here is what I have observed from the doctor's changes plus my own methodical fiddling the past few weeks.  incidently, just finally able to buy the necessary equipment to make more intelligent decisions!

CPAP 10 is minimum needed to keep from waking up choking.
CPAP 10.5 is maxiumum constant pressure i can tolerate without intolerable sinus pain.
Seemed to be constantly fighting the machine, so switching back to BiPAP was much more pleasant.
Using a sleep/anti snore collar significantly cut down on OA.
Can tolerate IPAP 12/EPAP 10 well, with minimal sinus pain that quickly dissipates upon waking.
Any BiPAP IPAP over 12 causes severe pain.
Have a heated tube being shipped and will arrive soon; not sure how this will affect pressure tolerances.  Typically, start stomach sleep and then flip flop onto back.  Cant side sleep due to nerve damage issues.  Joined gym 4 months ago and radically changed my diet, lost 35 lbs so far.  

Hard to say what, in terms of PERCEIVED sleep apnea treatment, is "good".  I stopped opioids in Summer 2020, and havent had a good nights sleep since due to spondylosis over length of spine and associated back musculature pain.  So primarily am going off of data results.

Observations and data driven help is needed!

[spetzal]

Additional history on heart rate:

Diagnosed with CHF in 2020 due to "slight thickening of heart wall" and reduced ejection fraction of 48%.  I got that fraction up to 55 (55 considered minimum normal) as of 2021 without mediation and just lifestyle changes.  I made doctor aware my heart rate sometimes was observed at 43 or 44bpm during daytime, although its commonly 55-70 sitting up and resting.  He said as long as I feel ok it was nothing to worry.  I see its infrequently dropping to the high 30's though the night....hmm..It looks like it drops below low 40’s after 12:30 am, which is hen im fairly sure i turned onto my back. I have some random previous data that shows when i attempt to side sleep, my HR stays around 44. I also see my 02 is periodically dropping, although its consistently above 92% and Wellue says time under 90% for last night was 2 min 24 sec

[spetzal]

My BiPAP machine is capable of Auto BiPAP, although i have never used it.

[Crimson Nape]

Does anyone have knowledge of this model to help this member???

- Red

[Gideon]

Can you post your OSCAR charts

I read that you are in CPAP mode and I suspect you will do better in BiLevel mode and utilize PS to manage your condition.

[spetzal]

I understand there might be confusion.

As indicated by my initial statement “ Can tolerate IPAP 12/EPAP 10 well, with minimal sinus pain that quickly dissipates upon waking.” I am currently on BiPAP IPAP 12/EPAP 10. This is also reflected in the two screenshots i posted.

[spetzal]

Gideon, you referenced “PS” in your previous comment. That would be pressure setting i believe, which is when utilizing Auto BiPAP. I am on regular BiPAP with fixed settings as described. I am willing to use Auto BiPAP as it seems many others rave about how great Auto CPAP is, however i never have.

[Crimson Nape]

When someone mentions PS, even if you are in the static pressure mode, think of it as the difference between the EPAP and IPAP pressures.

- Red

[spetzal]

Ah, ok….i understand. There is currently a PS difference of 2 on my current setting then. I dont want to adjust the setting without:

A) logical input from the forum
B) me understanding and concurring
C) using my new heated tubing which still hasnt arrived, lol

[spetzal]

Here is a snapshot of OSCAR for last weekend using a slightly diff setting of BiPAP IPAP 12/EPAP 10.5

There is no 02/HR info associated here, but I recall that on this night and previous nights at higher pressure BiPAP IPAP 13, which i cnt tolerate due to sinus pain, my heart rate was fairly consistent and never dropped below 44.  this is normal for me.  at the current BiPAP IPAP 12/EPAP 10, my hear rate drops down into the high 30's and my 02 is dropping quite a bit as you can see.  I actually feel better at the slightly higher 10.5 EPAP.  a setting of EPAP 10 seems a bit lacking in support as i breathe.