Switched to BiPAP, now lots of central apneas

[Tom83]

Hi Everyone,

New guy on the apnea board - Just curious if anyone else has experienced a large uptick in the amount of central apneas after switching to bi-level from cpap.  I recently had another titration study done by a new doctor because after 15 years of compliant cpap therapy with low AHI (usually below 2) I never feel rested.  The results of this most recent study showed that "cpap was not adequate in providing proper treatment of the patient's sleep related breathing disturbance, and Bi-Level PAP therapy worked better."

So this made me very excited to try my shiny new bi-level machine.  I've used it for 3 nights now and feel even worse than usual.  I loaded the data in sleepyhead and seem to have mostly all clear airway events (screenshots attached).  I'm making an appointment to go back to the doc before my one month check in, but was just wondering if anyone else has had a similar experience and what they tried to fix it.

[Sleeprider]

It's common to have an increase in CA with bilevel therapy, and in this case it is easily fixed. You are currently at 13/7.0 pressure which is a pressure support (PS) of 6.0. The titration protocol is very clear on the response to this, just reduce IPAP until the CA is reduced. Your respiration is over stimulated by the PS 6.0, and you will almost certainly tolerate PS of 4.0 or 5.0. Just be patient and go through the fine tuning process, gradually dropping IPAP until this clears up. You may eventually be able to return to a higher PS after you have adapted to bilevel. One thing is certain, if I increase my PS above 4.0 my CA rate increases rapidly.

[Tom83]

Thanks the reply, Sleeprider. I'll give lowering the IPAP a try tonight and see how that goes.