BIPAP therapy help

[dpiela]

I've been using BIPAP for 6 months and I am still dealing with brain fog and fatigue. What adjustments could I make to my BIPAP to solve this.

[PeaceLoveAndPizza]

How did you end up with those settings? Dr prescribed, self-titrated, or quessing? Are you taking any medications? Any use of recreational drugs, CBD/N/G, or alcohol?

Also, please read the link in my signature on “Formatting OSCAR Charts”. I would also like to see your respiration rate chart if you can get them all to fit on a single screen.

Low AHI does not necessarily equate to quality sleep. There are many factors that affect getting a quality nights rest. I’ve noticed in my case brain fog comes from any of not getting enough rest, use of CBD or THC and their derivatives, and pressure/pressure support being too much or too little.

Depending on how you respond we may take different paths to try and find something that allows you to get a better nights rest. 

In the meantime, here is an article on sleep hygiene worth reading.

https://www.sleepfoundation.org/sleep-hygiene

[dpiela]

Self-titrated. I am not taking any medications. No use of recreational drugs, CBD/N/G, or alcohol. 

[G. Szabo]

Considering your pressure statistics, you are overpressurized. Most of the time, you are running 12.4 cm EPAP and 18 cm IPAP. The Auto function could not interfere. I suggest lowering your pressure while keeping the same PS so you will see the effect one parameter at a time. 

Your HR variation is concerning: 48-164!

[PeaceLoveAndPizza]

I prefer a more structured approach. Let’s take a step back and do another titration. For now, ignore the last chart and let’s move forward.

Mode VPAPauto
EPAPmin 5
IPAPmax 20
PS 4
No ramp

That should provide enough of a range to see where things settle in. Give it a go for a few nights and let us know how it goes.

[dpiela]

Here's the night using the suggested settings, still no improvement in brain fog or fatigue. The flow rate after the gap is me attempting to go back to sleep but failing. 

Let me know if there are any further adjustments I need to make.

Thanks.

[G. Szabo]

As you can see, the instrument settled to 10.14 (95%) cm pressure, and you used a setting that resulted in 18 cm (95%) pressure. You were extremely overpressurized.
I let PeaceLoveAndPizza advise you about the suggested lower-pressure setting.

Your HR spike, which lasted for 20 minutes, is concerning, and it is a mystery.

[PeaceLoveAndPizza]

I agree with G about the heart rate being worth looking into with your doctor. Your median is 67 which is fine, the 95% is 102 which is not an issue, but the time at 167 is a bit concerning and worth looking into. It may just be a remnant of dreaming, but let’s keep a close eye on things.

For your overall chart things look much more relaxed. How do you feel?

I suggest for the next few days locking into a narrower range.

Mode VPAPauto
EPAPmin 6
IPAPmax 11
PS 4
No ramp

That is right in your sweet spot and close to using a fixed pressure, but with an extra 1 cmH2O if it is needed on the high end. I think you are a good candidate for fixed pressure depending on how well you tolerate the new settings. Even so, have a bit of headroom is not a bad idea.

[BuzzaJim]

Any possibility of a heart arrhythmia?  I’ve been managing Afib for ten years and heart rate variability measurements from my smartwatch are a reliable indicator for an impending episode. Sleep apnea and arrhythmias can go hand in hand. I’m sure others will suggest a cardiologist.

[Phaleronic]

Hi BuzzaJim, your min epap was too high but if you're suffering from arrhythmias and your CAs won't increase dramatically by using CPAP I'd give it a shot for a night, set the machine to cpap mode @ 13.6cm with EPR @ 1.

Have you tried cpap mode before?

I have titrated my mother off of bipap to cpap mode to help her issues with nightly arrhythmias and it's curtailed her events completely.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7306230/