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[Pressure] Switched to Bi-Level - A lot of clear airway events
#1
Gross 
Switched to Bi-Level - A lot of clear airway events
Hello All,

This is my first post so please forgive me if I'm missing basic data or info. I started CPAP therapy for OSA in February. I had got my AHI down to an average of 2.83

I noticed most of my events have been clear airway since the beginning. If I had 1 OSA, I probably had 10 CSA. 7 OSA, 20 CSA... Can anyone see what I'm doing wrong with the settings on the bipap? I tried the settings the doctor prescribed, which ended up giving me an AHI over 45. Life was miserable all night and the morning. It pumped me full of air so I was burping all night and gas later in the night and early morning... I like the feel of the bipap, it's easy to breathe against. I just can't deal with this high ahi... Any help would be greatly appreciated.


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#2
RE: Switched to Bi-Level - A lot of clear airway events
Welcome to the forum.
Why is your PS set to 8? What do you have going on that would cause your doctor to suggest that?

On your AutoSet all you should need is to set your min pressure to 7 to allow room for the EPR to work.

With a PS of 8 I suspect your doctor is trying to force all of your breaths. Barring some legit medical reasons for those settings, the doctor saying I said so isn't good enough, try the following.

These settings are intended to provide nearly the same therapy as your AutoSet

Mode: VAuto
Min EPAP= 4
Max IPAP = 15, only because I don't want you to freak out if I say 25. The intention being to prevent significant pressure increases, and thus your aerophagia, by preventing events via proper settings.
PS=3, this is the big change you are currently using 8. The titration protocol is to start with 4.

Increasing the PS, the difference in pressure between inhale and exhale, increases the amount of waste products you remove from your system, specifically CO2 and it's byproducts. Our primary trigger to breathe, simply put, is the need to eliminate CO2, not to intake O2. When your CO2 levels fall below your apneic threshold a Central Apnea is triggered. This is what is happening to you without question.

Try the settings I suggested, they will feel much better, post your results and then we can help you fine tune it.
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#3
RE: Switched to Bi-Level - A lot of clear airway events
Hi IhateCentralApnea!  -  Welcome

You are seriously over pressured.  Your PS would be better at 3.  Min EPAP set to 4 and the Maximum set to 9.  Since you now are on a VAuto, set the Trigger to High.  Take these settings for a sleep session and report back.

Also, please follow the following steps to organize your charts and taking a screenshot while in OSCAR.
  1. Make sure that your display is set to the Standard view.  (View > Reset Graphs > Standard)
  2. To take a screenshot of your Daily screen, select one of the following:
    • For Windows or Linux: Use the F12 key
    • For a Mac: Use the Fn+F12  key combination.
- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
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#4
RE: Switched to Bi-Level - A lot of clear airway events
Thanks Red! I've updated my settings. I'll hopefully get a minute to post the results tomorrow.

-Ken
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#5
RE: Switched to Bi-Level - A lot of clear airway events
(05-20-2023, 02:36 PM)Gideon Wrote: Welcome to the forum.
Why is your PS set to 8?   What do you have going on that would cause your doctor to suggest that?  

On your AutoSet all you should need is to set your min pressure to 7 to allow room for the EPR to work.

With a PS of 8 I suspect your doctor is trying to force all of your breaths. Barring some legit medical reasons for those settings, the doctor saying I said so isn't good enough, try the following.

These settings are intended to provide nearly the same therapy as your AutoSet

Mode: VAuto
Min EPAP= 4
Max IPAP = 15, only because I don't want you to freak out if I say 25.  The intention being to prevent significant pressure increases, and thus your aerophagia, by preventing events via proper settings.
PS=3, this is the big change you are currently using 8. The titration protocol is to start with 4.

Increasing the PS, the difference in pressure between inhale and exhale, increases the amount of waste products you remove from your system, specifically CO2 and it's byproducts.  Our primary trigger to breathe, simply put, is the need to eliminate CO2, not to intake O2.  When your CO2 levels fall below your apneic threshold a Central Apnea is triggered.  This is what is happening to you without question.  

Try the settings I suggested, they will feel much better, post your results and then we can help you fine tune it.

Hello Gideon, thanks for the reply. I didn't see your post until just after I seen Red's recommendation and make the changes on my air curve. I'll give those a shot tonight and tomorrow night give yours a try. I don't think my doctor has a clue. He looks at that one magic number and that's it. I was talking to him about  some of the data seen in OSCAR and he was like a deer in the headlights... I took a sleep test because my cardiologist (my 2nd cardiologist, the first let me suffer 2 years with sleep apnea and aFib) said I was too young to have Atrial Fibrillation. I think during the at home study I had about 11 OSA or hypopnea's per hour. After getting the cpap and using it for a while I started to open my mouth a couple times a night and realized I never knew what a real dry mouth is. When you can barely open your mouth because of the friction between your cheeks and gums.. Lol. I felt like a mummy. I asked my doc about a bi-pap and he said he doesn't think it will help because he thinks I'm a mouth breather... If I were a mouth breather I'd probably have been having the same issue earlier. I think I was subconsciously fighting exhaling against pressure. The bipap has felt better and I haven't been dozing off to find myself whistling. Thanks for the info!
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#6
RE: Switched to Bi-Level - A lot of clear airway events
I changed to your recommended settings and had a much better sleep! Thanks!!! AHI of 3.13.


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#7
RE: Switched to Bi-Level - A lot of clear airway events
Basically, all your events are at the low end of being an event. That is good. Did you set the Trigger to High? If so, set it to Very High. We will revisit this after the new setting.

How do you feel?

- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
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#8
RE: Switched to Bi-Level - A lot of clear airway events
(05-21-2023, 05:28 PM)Crimson Nape Wrote: Basically, all your events are at the low end of being an event.  That is good.  Did you set the Trigger to High?  If so, set it to Very High.  We will revisit this after the new setting.

How do you feel?

- Red

It was set to high. I set to very high last night. I feel a lot better than I have since I got the bi-pap. Thanks! I've uploaded my SP02 data from my viatom ring on this one. My 02 went down to 76% just around 00:04. By the way, considering I'm seeing more clear airway events every night since February, do you think I should move to an ASV? My insurance is good so I don't think there'll be any out of pocket cost or deductible as I've reached it for the year. I think the doctor will support whatever I tell him.


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#9
RE: Switched to Bi-Level - A lot of clear airway events
It looks like your witching hour was midnight.  Everything before midnight seems a little hectic, like you never went to sleep.  After midnight, your data smooths out.   For fun and giggles, try dropping your PS to 2 and let's see if the CAs reduce.   The OAs look positional. - Work on that and the leaks!  Smile

- Red
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
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#10
RE: Switched to Bi-Level - A lot of clear airway events
Put your Trigger setting in your profile, it is important.
See what I meant by the max IPAP, the high not mattering because when well treated it matters little. You set it to 9, which is a very low setting, and never touched it
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