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UARS BiPAP Titration help
#1
UARS BiPAP Titration help
Hi everyone ill just start with a little background on me. Been sufferring with mild sleep apnea (AHI 6) and UARS (RDI 27) for about 3 years now, only diagnised early part of last year through watchpat and then confirmed by PSG but have been severly suffering for the whole 3 years.

I tried Resmed ASV back in January 2024, this was a massive failiure. The algorithm for this machine is just insane and i dont know how anyone can sleep with it was pumping me with so much air and just wildly swinging. After 2 weeks i couldnt take it anymore as it made me feel so much worse so i gave up and went back to my ENT.

Had surgery at the beginning of April this year for swollen turbinates, so I had a RFA reduction. A month later im not any better but i thought i'd give Bipap a go as i kniow nasal resitance can be a big issue with cpap tolerance. The reason I thought an RFA turbinate reduction would help me alot is because is some how when my turbinates completly open up i have a near 100% resolution of symptoms, im talking going from sleeping 10+ hours most days and feeling like ive been hit by a train everyday and needing mutiple naps just to survive to sleeping 8 hours and not needing a single nap and feeling completely sharp and on point. The only times my nose has ever opened up like this was when i fist sarted using Flonase, this lasted a month or so and then i was back to how id felt before and my turbinates were swollen again. Oxymetazoline (sudafed) spray will always give me perfect sleep and open my nose right up, but can only use for a few days once a month as this has serious drawbacks if abused. I also completely randomly had a whole week back in march where my nose opened up (I wasnt using any medication at all!) and i had perfect sleep all week then randomly closed up again and i was back to sleeping awful. You can probably see how frustrating this all is for me as a cure is seemingly danged in front of my face like a carrot on a stick, i get a few nibbles here and there and then its pulled further away again for no apparent reason. Ive tried making miticulous journals to note all of my diet, enviromental factors to see what the hell is causing my nose to be so fucked up but there is no correlation with anything, allergy tests come back with nothing, im just completly lost...


Anywayyyyy onto me starting with Bipap this past week, over on the UARS subreddits it seems to be the consensus is that you should use the VAuto mode only and defeat the auto-ranging ability of the machine with the formula maxIPAP=minEPAP+PS. So that is what I have been doing, Ill show  below three screenmshots of the past three nights and I changed the settings very slightly on each night.


After night 1 my sleep was very unrefreshing, now i always wake up alot in the early hpours of the morning, this being when im supposed to be in REM sleep, this was exarcerbatted with this Bipap machine. However the whole night leading upto that i felt like i was in a very deep sleep it is only in the early hours of thr morning say the last 2 - 3 hours that i get these seemingly rapid awakenings.


Now night 2, i noticed some centrals from night 1 and from what I had gathered it is the pressure support causing this so i bumped it down by 0.2 to a PS of 1.8. This however ended with me having even more centrals and i really felt this in the morning as i was going in and out of REM rapidly. Luckily i noticed this which is usually extremly hard for me to do as i am in a weird catatonic state normally when this is happening so i decided to get the mask off me and sleep without, this was roughly 7 hours into treatment with the machine, the next 2 hours i slept okay and only remember waking once so for a total of 9 hours, and i felt alright throughout the day and didnt need to nap which is a big win for me. Also to note i did increase the minEPAP and maxIPAP by o.2 as there was some obstructive events on night 1.


Night 3, due to all of the centrals i noticed from night 2 i done some further research and some suggest that i bring the trigger time up to high to help so i did just that. This seemed to bring my CA events all the way down to 12 which i thought was a big improvement however my sleep was still unfreshing, not as bad as night 1 but still alot more unrefreshing that night 2, i needed a nap today to get through. The reason my sleep was so unrefreshing today in my opinion was that i woke up roughly 2-3 hours before i was supposed to and was just in a very light sleep  for the remainder of the night, never really being able to get back into REM.






So where do i go from here? I seem to be having deep sleep through most of the night its the early morning where my sleep seems very disturbed, this is how its been for the past 3 years. Do i just continue with the pressure im at and hope the centrals go away or is there any other tweaking i can do? 


Im sorry if this seems like a rambling mess, Im really trying my best but the sleep deprivation over these past few years has really turned my brain to mush i can barely function most days, even a simple post like this is very difficult for me. Thank you all in advance for reading this post...if you got this far lol


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#2
RE: UARS BiPAP Titration help
I disagree you should be defeating Vauto mode. Embrace it in a narrow range and it can help avoid the OA events. Lots of issues with your setup that basically defeat all the benefits of bilevel, but this is my recommendation:
Mode Vauto
EPAP min: 5.4
IPAP max: 10.0
PS: 3.0
Trigger: Very high

This will result in a range of 8.4/5.4 to 10.0/7.0.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#3
RE: UARS BiPAP Titration help
Thanks for the advice sleeprider, I really appreciate it.

Last night I put the exact settings you suggested into my machine and it seems to have completely rid me of CA events, I did have one registered within the first 10 mins but I definitely wasn't asleep at that point and was tossing and turning about getting comfortable in bed still so we can safely discount that.

Still had a few hypopnea's but only 6 throughout the night so I still really don't understand why my sleep quality was still so poor again. I still had the same issue with waking up a lot in the early hours of the morning, again up until that point sleep felt deep and I had no perceived awakenings except to urinate once which I do every night. 

Where do I go from here? should I wait it out a bit and keep increasing pressure support by 0.2 each week to stop flow limitations as I assume this is what is really causing my sleep issues at this point.


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#4
RE: UARS BiPAP Titration help
This change has reduced your flow limitations to a 95% level of 0.02. I can help you to fully eliminate them by changing PS to 4.0 and minimum pressure 5.6, maximum pressure needs to go up by 1-cm to 13.0. Need your input on comfort. I can see the numbers are better.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#5
RE: UARS BiPAP Titration help
I had to give cpap a break as i just couldnt fall asleep with it and had alot going on in my life at the time. 

The past week I changed some settings to allow for more comfort, so i now have a 45 min ramp up time and put the Timax to 3.5 as it feels more natural to my breathing pattern. Have been using cpap again the past week and had very good results, i feel alot more rested now, still not 100% but atleast 80%.

Ive attatchted the last two days of data, where else do you think i can do to make improvements? do i just keep bumping up IPAP and PS each week or only one?


Cheers


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