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[Health] New BIPAP user, odd symptoms
New BIPAP user, odd symptoms
Hi all,

I am a new BIPAP user after having to give up my MAD that stopped addressing the sleep apnea after 5 years of use. I have been on my machine for almost 2 months and feel so much better except for the following issues:

-Ankle/leg edema midday (I work from home and sit a lot)

-minor sinus swelling (you can see swelling on either side of my nose first thing in the morning)

I sleep between 9 and 11 hours a night, so I guess I am making up for years of sleep deprivation. My last sleep study with Lofta showed that I had 120 AHI and O2 as low as 55%. Now my events are less than 3 each night and I don't take off my mask until the morning although the pressure does get uncomfortable enough to wake me up. (I haven't downloaded OSCAR yet because I only have a work laptop and can't download software to it.)

Is my experience normal for someone newly adjusting to BIPAP? My sleep study required my machine to be Auto-BIPAP set 25/6 PS 4 cm H2O.
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RE: New BIPAP user, odd symptoms
Crimson Nape
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RE: New BIPAP user, odd symptoms
Welcome to ApneaBoard, MsNewToThis.  I will take a shot at this (but anyone who sees anything else, please feel free to post).  

First of all, going from 120 AHI to 3 is massive progress IMO.  Even though you mention 2 possibly related side effects, it seems the positives already outweigh any negatives.  

I read a thread in the past here that said when the member turned down his pressure, he noticed a decrease in swelling in his body.  I am hesitant to recommend this to you since your therapy is so much better now; and you sit a lot during the day, etc.  And that may be the reason for your leg swelling.  Have you seen a Dr. about this?  

2ndly, the nose issue could possibly be coming from your nasal mask.  What kind of nasal mask do you have?  Brand name and type?  It may be unrelated also (could be severe allergies, an anatomical anomaly, etc.).  Have you seen a Dr. about this?  

If you are eventually able to download OSCAR and upload some charts in the future, that might help also.
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RE: New BIPAP user, odd symptoms
Please post some OSCAR charts for review in the event something shows up there. The link in my signature “Formatting OSCAR charts” explains what we like to see.

Regarding the nasal issues, to what do you have your temperature and humidity set? Given your low O2 during the sleep study, are you on O2?

With the edema, any heart issues or medications of which we need to be aware? I have read about some who get upper body edema, but not lower body unless there are heart issues involved.
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RE: New BIPAP user, odd symptoms
Excellent observation and question.

If you are up for some reading and controversy, see the attached links below.

I can't give you a definitive yes or no, because this is a complex situation depending on your own anatomy and physiology, the results of your sleep study: this is something you need to chat to your medical team about.

Although this is not a common issue discussed in regards to PAP treatment, my own experience is identical to yours.

No issue with leg swelling prior to CPAP/APAP and then BIPAP. After that: marked leg swelling, sore leg veins, limiting daily activities, whereas  immediately prior to PEER therapy I was able to walk all day every day, we walked Italy flat in 2019!

All bloods normal. Full cardiac workup all normal, both as an outpatient and inpatient. No DVT, no venous incompentence, both tested for twice.

Cardiologists and Resp physicians have no answers. Blank looks. No answers. No clue, not disparaging them, this is a complex issue.

I know for a fact this happened only after I started xPAP therapy.

For me the benefit of the Vauto is the ability to set this on S-mode and reduce my EPAP to below 4, stick with fixed pressures currently 3.6 - 6.4 but I do need to use a soft cervical collar. In other words my goal is maintain the lowest pressures and PS as possible, accepting an AHI of < 3 with some short OSA events. I regard this as normal for me, with no effect on my pO2 levels as shown by Nonin / Resmed pulse oximeter readings. And my mouth and mask leaks are now very much improved as an additional benefit.

My leg swelling is less, the veins no longer are as distended but more importantly they are less painful, and no longer limit my activities.
First holiday in Five Years last month in June. Yay!

In addition to this my headaches have reduced, which lends credence to the theory that sustained PEEP induces raised intra-cranial pressure in one of the links.

Certainly sitting all day is a no-no for many reasons, not just leg swelling.

I always ask myself the question if reducing AHI too much too fast is necessarily a good thing.
Try the same thing with very high BP or blood sugars for example, and see where that gets you.
If I were to start my xPAP journey again, I would go slowly slowly.

Enjoy the reading. Complex. Read between the lines. 

Above all raise the issue with your own doctors, they may have some new insights.

This is not a cookie-cutter one size fits all situation.

This links provide food for thought and discussion.

link 1

link 2

link 3

link 4

link 5
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