UARS - BIPAP Pressure too low?

[laberbacke]

(Translated from German to English with Google Translate)


Hello,

I've been diagnosed with obstructive sleep apnea, but I suspect it's UARS. In 2017, my pressure requirement was 14 mbar (supine). My weight was 85 kg at the time.
I currently weigh 97 kg, and I feel like even 17/12 mbar BIPAP isn't enough.
I suspect it's in the supine position with simultaneous REM sleep.

Please take a look at the screenshots... could these be RERAs or airflow limitations?

           

I'm still constantly tired with 17/12 mbar and have trouble sleeping through the night. I also often can't get a full night's sleep.

I sometimes have a headache in the morning.

I'm having to help myself at the moment; the sleep lab doesn't know much about UARS. And it always takes months to schedule an appointment.

Thank you for your advice!!!

[laberbacke]

My Ahi is always very low, with 14 mbar, for example, it rises to about 2/h (all hypopneas)

[Sleeprider]

The indicators of UARS are flow limitation, often with a relatively high inspiration time. With PS 5 (pressures 17/12), I don't see any indications of flow limitation and inspiration time is less than one-second...very short. Tidal volume at 560 and respiration rate at 15.8 breaths per minute result in a very high minute vent. I don't see anything here that is a problem, and you may actually be over-ventilated. I want to confirm you have EasyBreathe™ on. That should make this therapy much more comfortable. I am seeing a 300 ms inspiration time and that usually means the Easybreathe is off and you have a manually set rise-time. That is why your inspiration time is actually too short and you get the pauses at the end of expiration.

[laberbacke]

Hello @Sleeprider, and thank you for your answer and advice.

I currently have a BIPAP device (Resmed Aircurve 10 in S mode).
I can't find an Easybreathe option.

Can you please tell me how to proceed, what should I change?
Also, should I reduce the pressure slightly?

My Other Settings are: Ti Max = 2.0s , Ti Min = 0.5s, Time 300 ms, Backup Frequency 10

I also have mild untreated RLS, I don't know if that plays a role.


Thanks!

[laberbacke]

The doctor in the sleep lab told me at the time that the gap between my IPAP and EPAP couldn't be too wide, otherwise my airways would collapse when I was lying on my back. (I was set to 14 mbar CPAP EPR 2 at the time.)...
Could it be that the IPAP-EPAP gap is currently too large? And that's why I'm having these pauses after the expiration?

Thank you so much for your advice, really!

[Sleeprider]

Is there a trigger sensitivity setting? If so, set it to High.
Is EasyBreathe™ available on your machine (this may be an option under aufstieg aktivieren.
Your device appears to be an ST (spontaneous/timed) because it has a backup rate of 10 breaths per minute. What therapy modes are available on this device?
There is no problem with the time between breaths. Your respiration rate appears to be about 12 bpm which is normal. Change rise-time aufstieg aktivieren to 500 so your inspiration time is longer. This will sustain rise time through the set Ti Min of 0.5 seconds.

It will be helpful to use the Mask Pressure chart when you provide closeups of the flow rate. This lets us see how the machine is timing your breaths.

[laberbacke]

Set both triggers to high? TGL trigger and TGE trigger?

No, unfortunately, easy breathe isn't available.

My device has S mode and CPAP mode.

Could it be that my sleep has been so poor lately because my inspiratory time has been too short? because of the pauses after exhalation? (due to the 300 ms rise time)
Thank you very much!

[Sleeprider]

I don't recommend high cycle trigger.

[sonetti]

It seems like you're also having some leaks? Not sure if these are triggering arousals. I have UARS and I find leaks typically make me feel worse as I'm more sensitive to any abrupt changes in airflow?