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Need advice with BiPAP, no OSCAR data yet - Printable Version

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Need advice with BiPAP, no OSCAR data yet - weiss27md - 04-08-2020

Self treating for suspected UARS.  Sleep studies  I am seeing a sleep specialist but as you know this process can take a long time.  Might be months with the current situation to get more sleep studies.  Had sinus surgery 3 months ago.  I go in tomorrow for my final post op evaluation.  I had balloon sinuplasty, turbinate reduction and septoplasty.  My nose is more clear but sleep had not improved.  I have a history of reflux, anxiety, bruxism, sinus infections, headaches, fatigue and nasal congestion.  Allergy tests all came back negative.

Last night was my first night using a cpap.  Was very anxious from the resistance when first exhaling.  Took about an hour to get to sleep and that included making some adjustments.  I did  a lot of research and set it up as:

Mode VAuto
Max IPAP 20
Min EPAP 6
PS 4
Ti max 2s
Ti min 0.3s
Trigger Med
Cycle Med
Mask Pillows
Ramp Time 10 min
Start EPAP 4

I ended up lowering the numbers to:

Max EPAP 14
Min EPAP 4
PS 2


Not able to download OSCAR yet, had a lot of issues because I'm running an old Ubuntu.  I have ordered a new Windows laptop that will be here next week, don't have time to mess with installing OSs right now.  I do have the MyAir app and a Garmin Vivosmart 4 for now.  I slept 2-3 hours with the machine with no issues but then woke up to anxious and had to sleep the rest of the night without it.  But those 2-3 hours with it I think I slept pretty good.  Considering how bad I slept overall I did wake up pretty refreshed so that must mean those 2-3 hours with the machine did quite a bit for me.  

Here are the results from my fitness tracker.  For the month I have had this tracker, last night was the most deep sleep that has been recorded and very low movement.  The MyAir info wasn't very useful.  20/20 good mask seal, 4 hours of usage, 9.2 events per hour. 

So I'm wondering what should I look into adjusting till I get OSCAR next week?


RE: Need advice with BiPAP, no OSCAR data yet - Sleeprider - 04-08-2020

The 9.2 events per hour are a concern. We need to sort out what kind of events you are dealing with and mitigate that. MyAir simply doesn't help in that regard. In the absence of data, we can raise your EPAP min and see if events drop. If higher minimum EPAP decreases evetns, we might be dealing with obstruction. If not they are likely central. The gray area remains pressure support. What was going on before surgery?


RE: Need advice with BiPAP, no OSCAR data yet - weiss27md - 04-08-2020

I got the surgery for lack of airflow through nostrils and sinus infection that would not go away with antibiotics. My sleep has slowly been getting worse over the past 5+ years. Had an in-lab sleep study 5 years ago that pretty much showed nothing but sleep continued to get worse. Had an at-home study 4 months ago that showed 5.5 AHI. I think the 9.2 events an hour by the MyAir app are probably just all the adjustments I was doing before I fell asleep and once I woke up. But when I was asleep with it my sleep tracker shows very good data.


RE: Need advice with BiPAP, no OSCAR data yet - Sleeprider - 04-08-2020

We just need to know whether we are trying to treat obstructive apnea, hypopnea or a central issue. Nothing in MyAir helps us to know. What made you reduce pressure support form 4 to 2?


RE: Need advice with BiPAP, no OSCAR data yet - weiss27md - 04-08-2020

My at-home sleep study measured 1.9/hr central, 1.2/hr central, 0.4/hr mixed, 2/hr hypopnea. It wasn't setup to measure RERAs which I'm thinking are probably the highest. I lowered my PS from 4 to 2 just because the higher pressure was just giving me too much anxiety.


RE: Need advice with BiPAP, no OSCAR data yet - DeepBreathing - 04-08-2020

weiss27md Wrote:My at-home sleep study measured 1.9/hr central, 1.2/hr central, 0.4/hr mixed, 2/hr hypopnea.

I think there must be a typo in there - central is mentioned twice but obstructive is not mentioned.


RE: Need advice with BiPAP, no OSCAR data yet - weiss27md - 04-09-2020

Fixed. 1.9/hr central, 1.2/hr obstructive, 0.4/hr mixed, 2/hr hypopnea.

I did sleep much longer with my mask last night. 6:29 versus 4:01 the night before. But my sleep was actually worse based on how I feel and my fitness tracker. Woke up more often. The first night I did have the humidifier and heated hose on, on auto. Thought I would try with them both off since I read that humidity can make nasal congestion worse. Kept waking up with a dry mouth last night and nasal congestion the same. MyAir app had more events. 21.4/hour.

My settings last night were:
Max IPAP: 14
Min EPEP: 6
PS: 4


RE: Need advice with BiPAP, no OSCAR data yet - Sleeprider - 04-09-2020

With 21.4 AHI, it's pretty clear that your therapy is actually worse than your sleep test baseline of 5.5. My suspicion is that the problem is central apnea. Since you do not have access to data, and can only summarize the total AHI, I'd like to propose using a titration technique to help you find effective therapy. Normally with a bilevel, we would start with settings like you are using with a low starting EPAP, PS 4.0 and let the machine titrate the pressure. In this case, because we suspect centrals, we are going to start with CPAP mode at a pressure of 7.0. This is a typical pressure that can treat mild obstructive apnea, and without using pressure support will not trigger more centrals than you normally have. If these settings bring your AHI back to 6 or less, we will have a pretty good idea what is happening. When your new computer arrives, we will be able to confirm and work to optimize therapy.


RE: Need advice with BiPAP, no OSCAR data yet - weiss27md - 04-09-2020

Thank you.  I will try that tonight.  Bonjour suspected I might have Central apnea too.  I guess we'll know for sure later on.  Central apnea was really the last thing I thought it might be.  I suspected UARS (sinus issues) and then maybe Obstructive (large tongue).

Fitness tracker data from last night.


RE: Need advice with BiPAP, no OSCAR data yet - SarcasticDave94 - 04-09-2020

It will be interesting to see the results after setting edits Sleeprider suggests. FWIW keep in mind the CA attribute of consistently inconsistent.