Switched from CPAP to BiLevel but feeling worse

[vHungry]

Hello everyone,

After being on CPAP for about 2-3 years, I have paid out of pocket for my own BiLevel (RedMed AirCurve 11) to attempt to treat my flow-limited breaths. I suspected I have UARS.

It has been about a month since I got my BiLevel, but honestly, my sleep has felt terrible.

I notice I tend to wake up after about 5-6 hours.

I tried having my PS 4+, but I didn't really notice any big difference in my FL numbers, so I decreased it back down to around 3, and I notice that my AHI with PS 4+ is 1-2, while my AHI ~3 is <1.

I know my numbers aren't alarming, but I wish they were so I could have a definite reason as to why I have been feeling so poorly. 

I have read on Reddit that people with UARS should keep their TiMax at 4s (to not restrict any long breaths) and TiMin at 0.3. Is 

I also read that a Trigger of Very High is good for people with UARS to decrease the effort it takes to breathe.

Are those settings good options for people with UARS?

I tend to suffer from aerophagia and am cautious with increasing my EPAP/IPAP very much.

Does anyone have any idea what I can do to improve my settings?

Below is my SleepHQ chart for last night of sleep:
https://sleephq.com/public/dda2f258-fdf1...6179946838

[jdougc]

Both of your leak rate and your flow limitations are too high.
Consider going back to PS of at least 4 and a lower EPAP of 7 or 8 cm to help you with your leaks.
How did you get the EPAP settings?

Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea
https://pubmed.ncbi.nlm.nih.gov/38530665/

Consider using the p30i mask and use lanolin to protect your nostrils.

[vHungry]

I thought my flow limit 95% being under 0.05 is considered excellent as per https://www.apneaboard.com/wiki/index.ph...rpretation

I honestly did not get my EPAP settings through any meaningful method.

Just curious, how would those settings help with my leaks?

Thank you!

[jdougc]

 flow limit 95% being under 0.02 is considered excellent.

https://www.apneaboard.com/forums/Thread-Understanding-OSCAR-statistics

The lower EPAP might be more comfortable and lower pressure might cause less leaks, as a test.

The ResMed N30i although very comfortable, can leak if you're a side or stomach sleeper.

[vHungry]

Here is last night's sleep: https://sleephq.com/public/93c06018-de54...8a40686675

I created a very narrow range (EPAP: 9, IPAP: 12) with and PS of 3 because I heard that having an auto-adjusting machine can affect sleep negatively, as changing pressure all night can be bothersome.

My Flow limits ended up being very similar but my AHI even lower (which is good). My leak about the same despite me mouth taping last night. 

I still noticed myself waking lightly a few times last night. 

I know you suggested lowering my EPAP and increasing PS haha. Is PS or EPAP what I should focus on adjusting?

Much thanks

[jdougc]

You've got breaths with flatten tops that aren't scored. 
PS is what deals with flow limitations. 
Try 4 for a few nights.

Why is your epap so high? That can also help you deal with flow limitations. So if you're comfortable with that, good.

[vHungry]

Thanks for getting back to me

What are the disadvantages of having a higher EPAP? From what I understand, EPAP treats OAs, but too high of an EPAP causes Aerophagia and general difficulty exhaling.

You're suggesting I lower my EPAP a bit (until I start noticing more OAs) and bump up my PS towards 4 (being mindful of CAs)?

I am just afraid of OAs haha that's why I have my EPAP so high but I think I can bring it down closer to 8.

I think I am enjoying having 2 fixed pressures/ a very tight pressure range for less fluctuation at night.

[jdougc]

If you are not having Aerophagia and general difficulty exhaling, then leave epap as it is, it helps with Flow limitations also. 
But raise PS to 4.

[SarcasticDave94]

We might be able to help more with the actual OSCAR charts.

[vHungry]

Here are two nights, I can provide more.

Does OSCAR provide some data that SleepHQ doesn't?