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Switched from APAP to BIPAP
RE: Switched from APAP to BIPAP
The report recommends the higher CPAP pressure and also higher bilevel pressure, it doesn't comment if bilevel was better than CPAP though or give any data for us to interpret beyond that. You are already pretty much using the recommended titration so nothing really supports making any changes at this time.

The one thing you could consider doing is trying fixed bilevel pressures (13/9 or 14/10) for a few nights and then try a lower or higher setting to compare it to. With auto EPAP the data gets muddied depending on if it was a good or bad night, if you collect multiple days you might be able to determine what works better and then can either increase pressure or set a max if you find too high of pressure is an issue.

Otherwise you could try low pressure just to see what it does but as you noted the titration study doesn't support doing that.
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RE: Switched from APAP to BIPAP
I used settings of 14/10 last night, and there is clearly room for improvement but I'm not sure whether PS or IPAP should be changed. 

To let you know, I went through the whole night and these were my findings:
  • I excluded any respiratory events until 1:45 am, the time I fell asleep.
  • Out of the 18 remaining CA's, 7 were preceded by obvious, erratic flow rate's which indicate some form of movement. 
  • While flow limit is shown to have never occurred during the night, there are periods of time with an abundance of double-peaked waveforms. 

Here are my results from last night:


Flow limit Example (Lasted from 7:58 - 8:21 and ended in erratic flow rates and me waking up briefly.):


As my current Trigger levels are on High, I believe changing them to Very - High may help to manage issues with Central Apnea events. It is also important to note that despite the leak rate being small, they are mostly in line with some form of OA / CA cluster. I will make adjustments to my mask to avoid this issue.  

Another symptom of my sleep to include is that without any alarm or external factor to wake me up, I naturally wake up in the middle of dreaming and can remember the majority of the dream.
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RE: Switched from APAP to BIPAP
Interesting little peak early on in those breaths but not sure it is caused by flow limitation as it happens too quickly imo. Even if related to flow limitation it isn't clear if it is an issue or worth trying to treat, not all flow limitation need to be treated. Potentially that breathing is related to rem sleep, PLM or a myriad of other things that can all affect flow rate graph.

These settings are very similar to the previous night but results look quite different because your data varies significantly night to night and not related to the settings. The only thing I really see in this data is a bunch of falsely flagged apnea both central and obstructive. I interpret that as poor sleep quality not related to breathing issues. It will be interesting to see more detailed titration study data to see how well they say your breathing and sleep quality were that night and to see if there were any other explanations of poor sleep quality (they say you responded well to CPAP indicating it should be helping you). 

My recommendation is the exact same as yesterday. The only thing you can do now is collect multiple nights data at a setting, change setting, collect multiple nights data at the new setting and then try to decide which was better and slowly titrate yourself. Avoid APAP so you know exactly what settings you are using and can draw a conclusion based on how you feel (not necessarily the data) about which settings are better. Reviewing the data each night and then trying a different setting is only useful in situations where there are obvious issues to be treated, those don't exist in your case and your nightly variations are making more of a change on data than your setting changes. You need to slow down, focus on how you feel and titrate slowly and methodically otherwise you will not find ideal settings.
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RE: Switched from APAP to BIPAP
Here are my detailed titration results:

.pdf   Cropped Titration results compressed.pdf (Size: 601.49 KB / Downloads: 13)
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RE: Switched from APAP to BIPAP
Here are my results from last night to add to that. I haven't noticed any improvement and still feel absolutely miserable and out of touch with myself.

Let me know if there are any additional screenshots I should take. I'm going to see a neurologist in the next 2 weeks to examine any possible neurological issues since my Brain Fog is coupled with a constant 'feeling off' and vision issues.

Bipap results:


Thank you
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RE: Switched from APAP to BIPAP
A few comments about the titration data.

1) On both CPAP and bilevel you slept well and had effectively no breathing issues (RDI of 1.4 on CPAP, 0 on bilevel).

2) 8-12 cm CPAP I assume is fixed pressure (no EPR or PS). If untreated UARS/RERAs was your issue you should have had higher RDI on CPAP that improved with bilevel.

3) I don't agree with the recommendation that higher pressure is best. You had over an hour at CPAP of 8 and 9 without a single breathing issue. You had a handful of events at CPAP of 10 and then next to no events at 11 and 12. I would say the data is inconclusive and more data would be required to draw a conclusion. Were you just sleeping in a bad position on edge of pillow or something when trying CPAP of 10? Who knows.

4) Their arousal count appears low, only 6 arousals but 17 awakenings doesn't make much sense. I assume the 11 unscored arousals would be spontaneous though.

5) Your SPO2 stayed very good throughout the night and didn't change when settings were changed. 

6) Your sleep efficiency with the bilevel was lower than with CPAP even before you failed to sleep the last 2 hours. I am not sold higher PS is helping you.

Everything in this titration study supports that even low pressure fixed CPAP treats your breathing issues effectively.

Your original watchpat study had an RDI of 9.4 indicating mild UARS at worst and imo that is a questionable diagnosis considering watchpat does not actually monitor breathing. Your known nasal congestion could explain that RDI easily imo.

Frankly I do not believe you have a significant breathing issue and I believe any breathing issues you do have are treated even at basic settings. If I were you I would return to a lower pressure and pressure support (say 8 cm pressure and 2 cm PS) and give that a try for a while to see how it feels after having been at a high pressure and PS for quite a while now. A change like that and then letting it run for a few days should offer some level of obvious improvement or worsening in your sleep quality.

I found myself in a similar situation after two in clinic sleep studies indicate no apnea. It sucks because it isn't an easy fix but imo it is a good reason to change focus and look elsewhere for the issues that are plaguing you. Reduce stress, try to figure out what is causing the nasal congestion etc. I would strongly recommend trying food elimination diets and see if food intolerances are an issue, dairy and gluten in particular can screw a person up royally if you are intolerant to them (or worse have celiac etc).
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RE: Switched from APAP to BIPAP
I will try your recommended settings tonight on S mode. My nasal congestion seems to have cleared up and I can finally notice a significant improvement in nasal breathing. Consequentially, I believe that I don't mouth breathe anymore during sleep which is great. 

I have the p10 nasal mask ready to use, as well as a chin strap to avoid mouth breathing so I will likely try that tomorrow night. 

For the transition, are there any recommendations to change my breathing habits so that a chin strap is eventually unnecessary? 

PS: I have also received my custom MAD from my dentist and will be adjusting that once I can zero in my BIPAP settings.
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RE: Switched from APAP to BIPAP
Good to know nasal breathing is improving.

Regarding pressure changes and switching to a nasal mask I would only make one change at a time and would probably try pressure changes first because adapting to a new mask may take a while (or you might end up realizing you still need or prefer the FFM).

When you switch to a nasal mask the main thing I am curious about is if it will get rid of or reduce the times where you have what looks like positional apnea.
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RE: Switched from APAP to BIPAP
Here are my results from last night. I ended up using an IPAP of 9 and an EPAP of 7 since while laying down awake I noticed that it felt like I was struggling to get air. While positional flow limitation was an issue, it seems that flow limitations were an issue (which can be demonstrated by multiple close-up screenshots). 

I feel worse than I did at higher pressures, but at least I don't wake up with a painful, bloated stomach. 

PS: If able, can my allocated attachment usage be increased? I've been having to delete old attachments every new post I make. 

Whole Night:


Close up 1 (lasted from 2:15 - 3:00):


Close up 2 (4:37 - 5:10):


There are many more periods of flow limitation which I can upload but I think the point is made. My tidal volume is still very low for someone of my height/gender.
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RE: Switched from APAP to BIPAP
Can anyone help me? I'm fairly desperate to try and resolve my sleep-related issues.
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