[Treatment] Switching to bilevel, self-titration - Xone therapy thread

[xone]

Hello,

I've been on PAP therapy for the last month, mostly on my own. With just APAP/CPAP at first and trying many different things between different pressure setting ranges, many different masks, etc. I was able to achieve low AHI machine numbers but was still not getting consistent satisfying and restful sleep. I was also wearing a pulseox and still often getting desaturations and pulse spikes despite low ahi numbers and waking up with headaches and fatigue. 

The last few days before this I was just trying straight CPAP and slowly raising pressures and was up to 14 CPAP. Events were down and pulseox data was looking better but had lots of leaks.

After consulting with CPAPfriend I was advised to try bilevel if I get the opportunity. Previous experience trying EPR at various settings were underwhelming, and I saw increases in CAs when using EPR even at 1 or 2 with little benefit to flow limits so wasn't sure how different bilevel would be. 

Yesterday I found an amazing deal on an unused aircurve 10 so I jumped on it. Was a bit lost where to start with titration and I have seen the resmed flowchart, but didn't want to start too high with EPAP based on my cpap pressures so did a night on vauto. From previous CPAP use it seemed OA events were resolved somewhere around 11-12.

For last night I tried vauto mode with EPAP in at 8 and PS of 3. I believe rest of settings were default. I first tried PS of 4 but I couldn't fall asleep with it, it felt very punchy inhaling and was hard to get used to. I eventually switched to PS of 3 to start. Feels very different from EPR and much faster which is interesting.

Attached is last nights OSCAR data, which went better than expected. I'm getting some CA events but thought it would be worse. My o2 data looks better than usual as well.  Not sure about my pulse rate.

I am using an n30i nasal mask with a cadera releaf collar, along with mouth tape. First time trying both at once and my leak data was great, though not a fan of the tape. 


   

   

   

For reference here is a sleep hq link for my entire last month on APAP (you can scroll through each day - would be impractical to share these as individual oscar screenshots, though I much prefer oscar): https://sleephq.com/public/teams/share_l..._id=jxGQGL

[xone]

   

Looking through the data to see why my pulse spiked there, that appears to be an obstructive apnea that the machine did not flag, correct? Glad to finally figured out to sync the wellue data. 

So then I'm thinking that means I need to raise my EPAP to 10 at least (it was 8 there).

[Jay51]

It seems like the flat line lasts about 8 or 9 seconds.   Very picky, I know, but that is most likely why it didn't register as an apnea.  An apnea has to be at least 10 consecutive seconds or more.

[Deborah K.]

Switching your Trigger to High or Very High will reduce your CAs.

You can lower your Flow Limits by increasing your PS to 4 or more.

[xone]

Thanks. Last night I raised min EPAP to 10, changed trigger to high, and PS to 4.

Getting CAs still but apneas and hypopneas seem completely controlled and flow limits better. I guess I can try very high trigger.

   

   

[xone]

Past few nights I've worked up to 12 EPAP 16 IPAP since it seems I need 12 EPAP to prevent all OAs. I hadn't worn the o2 monitor for a week or so since I feel it can sometimes throw me off. Wore it last night and I was surprised just how many desats it showed... 4.6 per hour at 3%. I know this thing is not the most accurate and underestimates o2 by several percent often but I feel like relative to itself it is ok usually.

I'm also trying to get an understanding of what is going on with this pattern I'm seeing. It looks like I'll be breathing normal, then take one single gasp, and then my breathing is diminished after. This is sometimes accompanied by a big 02 desat. What is this, and how do I prevent them? Is this a central hypopnea after an arousal? I have no idea.



















Ahi numbers look good as always but I'm wondering what all these desats are and why my pulse rate and tidal volume still looks spikey.

I'm still tired and low energy usually, but worse without the machine.

[xone]

Is 16/12 too low of a pressure for a PS of 4? Is it hurting respiratory drive and PS should be lower or pressure increased with that PS?

[Jay51]

Epap is increased until all OA's are under control (with positional apnea, though, the airway could possibly be completely blocked; and no amount of pressure would break through it. 

After epap is successfully titrated, then PS can be used to decrease hypopneas, flow limitations, etc.  

You can experiment a little higher than 12/16 and a little lower than that if you choose, to see how it affects you.  

In your earlier OSCAR charts, I cannot tell what caused your huge inhale and exhale kind of all of the sudden out of nowhere.