[Treatment] SketchySleep - BiPAP Therapy Help

[SketchySleep]

Hi Apnea Board!

I was diagnosed about 9 months ago, with an AHI of 12 and RDI of 23. The doctors prescribed me an APAP machine that reduced my apnea and hypoapnea events, but not my RERAs, therefore my symptoms persisted. (pressures with the APAP were min 7, max 12, EPR of 3)


Recently I switched to a BiPAP hoping that my fatigue will improve by reducing the RERAs with a higher Pressure Support. (pressures are EPAP 10.5, IPAP 6.0, PS is 4.5)
In the Lab, my RDI reduced from 23 to about 18, so that is an improvement.

I only slept with the BiPAP for 2 days, but I generally feel better already. Although I am wondering if improvements can be made in my treatment.
If someone has the time to analyze my Oscar data I would be very thankful!

Have a good day!

   
   

[Deborah K.]

Your pressure settings are too low. You need to raise your EPAP to 10 and your IPAP to 15. Right now, you are at your highest setting all night. That's why you need to raise the settings.

You have a small amount of Positional Apnea. PA shows on your charts where Obstructives and/or Hypopneas are clustered together. A flatter pillow would probably be enough for you to solve this. PA is caused when your chin drops toward your chest, causing a restricted airway, much like a kinked hose causes restricted water.

Again, welcome, and best wishes for achieving great therapy and comfort!

[SketchySleep]

Thanks for the help!

I suspected the pressure settings were too low, but I didn't realize my chin could block my airway this much. Thank you for pointing that out.
I am definitely going to try a flatter pillow, great suggestion!

[Jay51]

Also, your back up rate is set to 20.  That may or may not be a little bit high.  

It is up to you if you want to keep it there.  If you want to experiment, lowering it to 15 and see if you like it better or not.  Your tidal volume is a bit lower since your breathing rate is at the high end of normal.  

I don't want to mess with your therapy if you like it like this; but just a suggestion if you want to try it and compare it to your settings now.

[SketchySleep]

The Lab Sleep Test showed that I had a BPM of about 21, so the doctors wanted to match that. I will probably end up reducing it by a bit and see if I feel any better. Thanks!

[Jay51]

Thank you for that information.  At least they had a legitimate reason for setting it at 20.  

Probably a better suggestion would be to lower it to 19 for a night and try that.  Then if you want, 18, etc. Stop and reverse any time you feel therapy getting worse. (And on the flip side, you could even go up to 21 just for the sake of experimentation).  I had to tweak ventilator settings many times in the past: so slower, smaller changes are easier to tolerate during experiments).

[SketchySleep]

That's what I am currently doing - 19 feels pretty good - and also with my pressures. I reached an EPAP of 7 and IPAP of 11.5, and already my AHI is about 0.5.
I feel much better compared to the last months with the APAP.
Thank you all for your help!

[Sleeprider]

Sketchysleep, You are using a Philips BiPAP ST which is not your best choice. If you find a Resmed Vauto, we can get you into a better place for comfort and efficacy. A couple areas in your setup are in serious error. You are using a Fixed breath rate of 20, and need to change that to Spontaneous. With a fixed breath rate the machine controls your respiratory pace and does not respond to your spontaneous trigger and cycle times. BAD! You are using a set rise time with a Ti of 1.2 seconds. Again, stop that and just use BiFlex at 2. My suggestions for your current device:
Mode: BiPAP S
EPAP 6.0
IPAP 10.5
Flex: BiFLEX Setting 2
Humidity: Manual Setting 4
Ramp: Off

If there are other settings available to you in BiPAP S mode that you have questions about, please feel free to ask. The Philips is discontinued in the U.S. and I'm getting a bit out of practice with it. As far as other comments in this thread, I was a bit confused by Deborah K's suggestion of much higher pressure. It looks like you could possibly use a higher pressure range, but with BiPAP S/ST, especially in Fixed mode, we are not getting a good look at your potential results. Once you return to spontaneous settings we can tell a lot more about pressure needs.

[SketchySleep]

Hi Apnea Board!

I switched from APAP to BiPAP about 2 months ago to help with RERAs, and while it is more efficient, I still struggle most night and I don't know why.
At the Sleep Lab my RDI was about 18 on the BiPAP, with IPAP 7.5 and EPAP 12.5. I also use a backup rate of 12 because of Treatment-Emergent Central Apnea.

Most nights I wake up at least once and after falling asleep again my sleep quality is substantially worse, so I end up sleeping very little and feeling tired during the day. 
OSCAR data shows clusters of Flow Limitations (UDFL, since Löwenstein doesn't have a dedicated Flow Limitations Graph); and I know these are somehow related to my sleep quality, because one night those clusters weren't present and I actually slept amazing.

I tried sleeping with a soft cervical collar on a firmer pillow, or elevating the head of the bed, but I could not recreate that night.
Any ideas as to what I might be experiencing, and is there something else I can do? I attached a close-up as well. 

Thank you

[Crimson Nape]

SketchySleep  -  Both of your threads were related to your therapy.  For this reason, I have merged them.  This provides the reader a history of your past settings and results.  Having the ability to see past attempts and their results will help to form better recommendations.  Additionally, it eliminates cross posting.  Please use this thread for all your therapy related posts. I have changed the thread title to, SketchySleep - BiPAP Therapy Help to be more inclusive.
- Red