[Treatment] Auto BiPAP User December 2020

[VanWrinkle]

    I am desperate for any help that might be provided here. 

I've been a CPAP user without insurance for a long time. This means that I have been self-paid for everything. That also means I need to mostly self-guide my treatment. 

I am a 36 year old male, with a BMI of 51.4. Late last year, a family member was unable to wake me when I was using  my Auto-cpap machine and said I was not breathing. This lead me to acquire an Auto-BiPAP in hopes that the upper pressure levels might treat my apnea better. It started out great and I was feeling good on lower pressures. As the months passed, however, I found I had to up the pressure levels to fight off the brain fog and other symptoms that had returned. 

Also, as a means of fighting the apneas with tips I've read on the internet, I have used a soft cervical collar for a while as well as sleep on a wedge pillow, though I am a side sleeper. I am a homebound agoraphobic which makes getting a new sleep test nearly impossible. I am desperate for any help on my pressures. I don't want to keep upping pressures if I do not have to. I am hoping if someone looks at my OSCAR data they might see something that provides a glimpse as to my optimal settings. My leaks are fairly large and I have always struggled with that. Replacing the mask cushions and straps at normal intervals is not within my financial means. I am hoping, however, to replace them within the next few weeks.

[SarcasticDave94]

Welcome to the Apnea Board,

Let's get a standard view OSCAR chart with from top down, Events, Flow Rate, Pressure, Leaks, Flow Limit. This is from the Daily chart tab like you posted last but with the data on the left panel showing AHI, etc.

I see and hear positional Apnea from your description and OSCAR showing events for very high pressure.

The soft collar you have needs to be worn by you to benefit, but you need to review the positional Apnea wiki. Make sure your chin can't duck past the collar or you'll need to tighten it but not uncomfortably so. Or you need a different collar, one that fits better and prevents chin tuck.

Masks and all other PAP parts last longer than the DME tells. These parts do not need replaced monthly or similar. Several months is a minimum lifetime. It will be longer if you keep them clean. Wash your mask regularly, but daily isn't necessary. Wash the humidifier tub, hose, change filters. Wipe the external areas of the PAP down at times to take the dust off, but not inside it. Mask cushions need replaced if damaged or if it no longer seals easily.

[VanWrinkle]

The soft collar you have needs to be worn by you to benefit, but you need to review the positional Apnea wiki. Make sure your chin can't duck past the collar or you'll need to tighten it but not uncomfortably so. Or you need a different collar, one that fits better and prevents chin tuck.

hmm, i'll have to look into this. It mostly seemed to serve the purpose of A)not having my head fall forward closing off my airway + keeping my mouth from opening up. I tried chinstraps and all for that but it did not seem to work well.

[SarcasticDave94]

OK, as you said leaks are a bit high. Your DreamStation's going to show 2 trace lines on the leaks chart. The upper one is total and can be mostly ignored. The lower one though is your unintentional leak as I understand it. This is mask and mouth leaks as applicable. This lower one has been high, but I'm not certain in Respironics what number represents too high, but I'm under the impression you're there.

The middle session showed Apnea clusters IMO. This indicates to me either a collar didn't work well or you were in a position to cause the cluster.

Your sleep is too fragmented into several little sessions. Unless it can't be helped, one 6-8 hour session may be better than 3 3-ish got naps.

Last one from me, flow limit is more useful than snore. I'd reconfigure OSCAR to show FL instead.

[VanWrinkle]

Your sleep is too fragmented into several little sessions. Unless it can't be helped, one 6-8 hour session may be better than 3 3-ish got naps.

Yeah this has been an ongoing issue for years. My sleep cycles around the clock on about a 31 day month. I can show you old charts that follow the same exact pattern for a year or two. I've tried interventions but I also have limitations as far as sleep hygiene goes (I eat, live, work and sleep in the same room). 

Here's a chart with a more steady sleep: