Bipap fine tuning

[CrispyPork]

Hello Sleep Apnea Board,

I'm seeking your help in order to fine tune by Bipap settings. I have the feeling that I'm not far to find the recipe that works for me, but I'm in need of advice from more expert eyes.

39 y.o male, 184cm, 86-87kg, not smoking, not drinking, no drugs, diet on the healthy side. Had septoplasty and turbinates reduction in 2022. Was very active before.

I have been diagnosed with sleep apnea in June 2024: AHI 21 average, Off-supine AHI 15 (REM 20), Supine AHI 29 (REM 76).

I started CPAP right after the sleep study, with limited results, never feeling refreshed, some heavy brain fog somedays, difficulties to work or train or somedays to just to get out of my house. Used CPAP and APAP with EPR, pressure around 13. Higher pressures lead to aerophagia.

Testosterone, mineral deficiencies checked recently. Body checked from head to toe in 2023 due to major surgery (100% recovered). 

Switched to Bipap (Aircurve 10 Vauto) 1st of March, and since it's improving in the good direction, but far from perfect.

Last night was what I called a "good night" (after three awful foggy days), giving me enough energy to write and ask for your help today. 
My O² steadiness levels are a good indicator of my sleep quality.

My equipment: Aircurve 10 Vauto + Climate air line (26°C), humidifier (level 5), P30i mask, Resmed chin strap (I tried mouth tape but I don't really like it.), Wellue 02 ring, Earplugs, and since last night, pregnancy pillow to try to prevent me rolling on my back. Room temperature 19°C (aircon). Brand new mask two nights ago. Trying nasal strips for two nights now.

My settings:

ModeVpapauto
MaskPillows
Max IPAP16.0 cmH₂O
Humidity level5
RampOn
Ramp pressure8 cmH₂O
Ramp time10.0
Antibacterial filterNo
Climate controlManual
CycleMed
EssentialsPlus
HumidifierOn
Min epap10.0
Ps4.0
Smart startOn
Temperature26 ºc
Temperature enableOn
Ti max1.60 seconds
Ti min1.40 seconds
TriggerVery high


My impressions: 

My AHI got very low. I used to have quite a lot of central apneas with the CPAP/APAP and at the beginning of BIPAP, and they are now gone. 
I can see my breathing patterns have gotten more regular, but I still see a lot of disordered breathing which I suspect create a lot of arousals. Also a lot of events not flagged by OSCAR.

I had to reduce the pressure due to aerophagia. It is getting better now, so I plan to gradually raise the pressure again to IPAP min 11 in order to match my 95% pressures and try to reduce the flow limitations.

I plan to try Resmed F30i and Philips Dreamwear nasal pillow soon. A cervical collar (Velpeau VP0201) will arrive soon. 
I should get a DISE soon in order to know the root cause(s) of my problems).

My Sleep HQ chart for last night: https://[REMOVE THIS]sleephq.com/public/2d421189-3bd2-404e-a572-86a248d11f7b

I'm sorry if my message is not very clear or broke any rules, hopefully not.

Thank you for your time and your help.

G.

[CrispyPork]

I add screenshots of what I call disordered breathing to illustrate.

[Deborah K.]

Your chart looks pretty good. Raise your ramp pressure to 9; hoping to turn it off later.

The chart setup could use some help.  Use the fn key to copy the chart.  That usually shows what we need to see.  Ensure that we can read to the very bottom of the flow limits.

Again, welcome, and best wishes for achieving great therapy and comfort!  

[jdougc]

Your apnea events are well controlled, but as you saw the flow limitations are underscored and need addressed.
As a test up your PS to 4.2 to fight flow limitations.
Try a lower epap of 8cm and ipap of 12.2 cm for a few nights.
You might be more comfortable.
Raise the epap and ipap if much worse.