First night on Bi-level was a disaster

[Dogberry35]

Hi everyone,

I have UARS (AHI 3, RDI 28), so I purchased a Resmed Aircurve 11 to help treat my day-time fatigue, headaches, etc. This is my first time using any PAP therapy.

Initial settings: 

Max IPAP: 14
Min EPAP: 5
PS: 4

Just for a bit of background: I suspect I have a narrow airway + swollen turbinates, which are the cause of my issues (having a CBCT soon). Nasal congestion is an issue at night which I treat with an anithistamine & steroid nasal spray, which helps clear things up so I can breathe through my nose. The mask I'm using is a Resmed P30i.

However, I found that I could not tolerate the bi-level machine at all - I would wake immediately after falling asleep. I tried lowering the pressure a little (IPAP 10, EPAP 3, PS 3) but the issue seemed to persist. After what felt like a dozen arousals, I eventually gave up. I've plugged my data in Oscar and it appears to suggest that I was having a ton of CA events. I remember checking my phone at 12:40, after one specific awakening from sleep, and I have attached a closer look at my breathing during the episode.

I believe I was still awake during the cluster of CA events before 12:00, so this may be an error, but I can't say for sure.

Any help or insight you could provide would be great. I'm not sure where to go from here - a hybrid mask or to lower the pressure perhaps?

Thank you.

[Sleeprider]

Interesting. Try one more night but change trigger sensitivity to very-high.

[Dogberry35]

Sleeprider
Interesting. Try one more night but change trigger sensitivity to very-high.


Thanks for the tip. I'll give that a try tonight.

[Snoozyjinn]

… I would wake immediately after falling asleep. I tried lowering the pressure a little (IPAP 10, EPAP 3, PS 3) but the issue seemed to persist. After what felt like a dozen arousals, I eventually gave up. I've plugged my data in Oscar and it appears to suggest that I was having a ton of CA events.

This is exactly the worst of my problems. Every night I run an AHI of 20-40 for the first 30–60 minutes. If I get past that, my AHI usually falls to around 5-7 for the next four hours. I feel my mind starting to drift, then there’s a CA/H that maximizes the pressure on my Aircurve, and I wake right up, over and over again. If there’s a way to fix this, it would greatly improve my PAP therapy.

[Dogberry35]

Interesting. Try one more night but change trigger sensitivity to very-high.

I lowered the pressure to 8-4 and set the trigger to very-high and that worked a treat, thank you!

Night 2 was much better - I was able to sleep with the machine for the entirety of the night. Does anything pop out to you based on the screenshots?

I need to mouth tape it seems. I'm not quite certain how to titrate but my understanding is that since the 95 percentile is 7.92 it may be worth increasing the IPAP max to 9 and see how that goes?

[Sleeprider]

Hey! what a great change for the better. Who would have guessed such a simple change could do that? Me thinks not your doctor.

[Dogberry35]

Can anyone advise on titrating bi-level for UARS?

I'm trying to do this gradually as large changes seem to disturb my sleep, but I'm unsure whether I should also increase ePAP and PS. My OA events are <1, so my understanding was that I don't need to raise ePAP.

So far, the increase in iPAP seem to reduce flow limitations as demonstrated in the SS below

Resmed Aircurve 11 Vauto
iPAP: increased to 8.6 from 8.
ePAP: 4
PS: 3
Trigger: Very high

Thanks in advance

[SarcasticDave94]

You'll want to post the OSCAR charts like you did before.

The way things are with your sensitivity to changing settings, you'll want to limit it to only one thing changed at a time.

[Dogberry35]

You'll want to post the OSCAR charts like you did before.

The way things are with your sensitivity to changing settings, you'll want to limit it to only one thing changed at a time.

Thanks for your reply. Here are the equivalent Oscar charts for those nights

[Sleeprider]

The 95% flow limits are still 0.00 and AHI is very acceptable. Most events were during periods shown as "awake" on the first chart. If you want to try fixed pressure, just change EPAP min to 5.0 and keep max pressure at 8.0 and PS 3.0. Keep the Vauto mode so we get good stats on flow limitation.