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I've posted on here a few times, and I'm back once again to try and get to the bottom of my issues. I recently had surgery to fix a deviated septum, and decided to try using a BiLevel machine, which I am trying to correctly titrate.
I'm noticing quite a bit of "arousal" breaths and a pretty inconsistent respiration rate. Any help would be greatly appreciated. Thanks!
Change to Vauto mode so we can see the flow limitation stats accurately. Even if you want fixed pressure EPAP min 6.0, Max pressure 0 and PS 4.0 in Vauto mode will get us more information. Is there a reason you are used fixed pressure VPAP-S mode? It looks like you might benefit from a bit of range, like EPAP min 6.0, Max pressure 14.0, PS 4.0 to see where things work out.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
06-24-2025, 06:41 PM (This post was last modified: 06-24-2025, 07:13 PM by SleepyBoi97. Edited 1 time in total.)
RE: Improving BiLevel Therapy
In short - no. There’s not a particular reason I have it set to “S.”
I started with fixed EPAP because I’ve struggled with aerophagia/sensitivity to rapid pressure swings. I can switch it to Vauto and allow it to titrate up though to see how it goes.
Do you see any initial reason to change either the EPAP min or the PS, or should I stick with EPAP: 6.0 and PS: 4.0 with a higher EPAP max? I'm considering lowering the pressure support to see if that helps with those large swings in respiration rate.
You have only 4 OA events, so it's okay to start lower, but mostly, I want to get a better idea of what is really going on in terms of flow limitation. That would require either switching to Vauto mode or some closeups of the flow rate charts to see why respiratory flow seems so variable. The zoomed flow rate at 01:20 shows some irregularity, but nothing I can really define as an issue. I'm basically looking to just change the mode, and don't want to trigger pressure that will cause you to have aerophagia.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I understand. I've attached a few close-up screenshots, but will switch to VAuto to make sure the flow limitations show up.
My main issue, as has always been the issue, is a large number of unflagged arousal events and uneven flow throughout the night. I'm not sure if it's UARS, or PLMD, or loop-gain issues or what.
From the close-ups, your events mostly arise out of arousal, rather than by a clear respiratory cause. Lots of breath-holds and cardio-ballistic artifacts in expiration. I don't know what kind of setting changes might offset the irregular breathing, but we can experiment with trigger sensitivity on high to see if helps by lowering the flow threshold to trigger IPAP.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
06-25-2025, 11:04 AM (This post was last modified: 06-25-2025, 11:23 AM by gohoos1998. Edited 2 times in total.)
RE: Improving BiLevel Therapy
Very very similar charts to you although my spikes are a bit higher. Also have a deviated septum/nasal valve collapse (both not operated on though).
Also similarly, I have those "W" shapes during expiration...not sure if those are expiratory flow limits?
Were you born in 1997 (username)? Are you skinny/in decent shape?
Also, @SleepRider - how do you know the below this? - "From the close-ups, your events mostly arise out of arousal" rather than by a clear respiratory cause.
And what do these look like?- "Lots of breath-holds and cardio-ballistic artifacts in expiration.
Following up with results from last night. Unfortunately, I only managed to get through 3 or so hours prior to waking up with some severe aerophagia.
However, I think I managed to get some useful data, which I've included here. A few things I notice that I'd like some thoughts on:
- The most "stable" of portion of my breathing actually occurs during my large mask leak, which I suspect is a jaw drop due to the slow increase in leak followed by the abrupt stoppage in leak. As soon as the leak resolves, my flowrate begins to become erratic again until I eventually give up on my PAP for the night. (See screenshot of flow during and after leak).
Is it possible that I'm having nasal-breathing-related RERAS that resolve once my jaw drops and I am able to supplement my airflow via mouth breathing, or does that not make much sense?
- There is a clear waxing and waning pattern in the first portion of the night (See attached screenshot).
