Help Please with Aircurve VAuto BiPap Settings/Night Pain

Hi - I have posted before about Humidity and Anxiety Problems. The Humidity Problem is definitely a mask-related problem. No issues unless I try to use any F&P mask, which sadly are my favorite - too much rainout/flooding, and no amount of anything fixes it. So just using/trying mostly ResMed and mostly Nasal Masks. Even with a humidifier, I also still have to wake up between about 3:30-5 to change out water bins because the first one is completely empty - never been able to solve that issue and it does bother me to wake up breathing overheated plastic.

Anxiety/multiple awakenings and panic attacks have been solved by switching from Pristiq to Cymbalta. I have to take the Cymbalta at night as it makes me too drowsy, but now instead of having infrequent CA events, I have many more - not horrible, but definitely causes more CAs. But I have to stay on Cymbalta - no more constant panic and trips to the ER.

So - that leaves me with the issue of Settings on the BiPap. When I ask the sleep doctors about the "other" settings like Trigger, etc., they almost cross their eyes and look at me like I'm speaking an alien language - then they say "what other settings besides IPAP/EPAP/PS"....nice. I still wonder about these settings and what, if any, effect they have on my sleep.

My AHIs right now average in the high 3's, and my sleep is more consistent without multiple awakenings in a panic attack, but there is something going on that is strange. I have really awful pain at night that gets worse as the night goes on and goes down dramatically about 10 minutes after I wake up. I have filmed myself for a few nights, and I don't see any mouth breathing at all, so I don't think strong mouth breathing is causing the muscle pain - it's all over body pain like every muscle has been tensed up all night - even a low grade headache all night.

I have tried adjusting the upper and lower pressures and the pressure support, and the current settings seem to be the best right now, but maybe more adjustments are needed on those. If I go above PS of 2, my AHIs increase to 8 and above. The machine's other settings are on factory settings right now. I looked at the 30 day results and they are as follows:

Pressure: 14.9
Exp. Pressure: 12.8
Leak: 8L/min
Vt: 580 ml
RR: 11
MV: 6.4 L/min
TI: 1.5s
I:E: 1:2.6
Cycle: 960
AHI: 3.4

Posted below are 3 nights using a ResMed Nasal Mask. Just wondering if there are any obvious things that I need to change, and if there are any suggestions as to what might be causing the very bad muscle pain at night. At bedtime, I'm at my usual Level 3 in pain, and during the night and upon awakening, I feel like it's about a 7 - everything hurts like I've been in battle at night and I can barely get out of bed because of the pain. But looking at the recording, there is no evidence that I am doing anything more than turning over from time to time.




Thanks for any suggesting/input!

Dallaslady51 wrote: ↑

Sat Mar 10, 2018 12:45 pm

Hi - I have posted before about Humidity and Anxiety Problems. The Humidity Problem is definitely a mask-related problem. No issues unless I try to use any F&P mask, which sadly are my favorite - too much rainout/flooding, and no amount of anything fixes it. So just using/trying mostly ResMed and mostly Nasal Masks. Even with a humidifier, I also still have to wake up between about 3:30-5 to change out water bins because the first one is completely empty - never been able to solve that issue and it does bother me to wake up breathing overheated plastic.

Thanks for any suggesting/input!

You say you have "flooding" and "rainout" and your water tank is running dry during the night........Your humidifier is set too high. Reduce the humidity
The problem with the humidity is not mask related.

The flooding with F&P occurs with Manual of 1 and Auto with Climate Control Hose and with a Room Humidifier, etc. I have tried everything - has occurred with 2 of the Aircurve VAutos and 3 of the Airsense 10 Autos - it is an issue with the humidifier functions of those machines with those particular masks (full face/nasal/pillows) and seems to occur with me and only a few other users that have mentioned it. Just is what it is. Even tried with humidifier Off and just the condensation in the mask resulted in spraying water in my face within about 2 hours.

I currently have it set to Auto with Climate Hose and works ok with all masks except F&P - but has the issue of running out of water on all settings in the middle of the night - others have this problem also and suggested I keep an extra filled bin and just switch them out, rather than refilling the tank. Annoying but I don't get fully awake and can switch it out fast and get back to sleep. Had the DME replace the machine - same result.

Dallaslady51 wrote: ↑

Sat Mar 10, 2018 12:45 pm

So - that leaves me with the issue of Settings on the BiPap. When I ask the sleep doctors about the "other" settings like Trigger, etc., they almost cross their eyes and look at me like I'm speaking an alien language - then they say "what other settings besides IPAP/EPAP/PS"....nice. I still wonder about these settings and what, if any, effect they have on my sleep.

Your charts would be more useful without the bottom four and a half graphs showing.

trigger,cycle, TiMin, TiMax are all explained in the manual.

For what it's worth, you don't have a 'bipap', since those are made by respirioncs, and they don't have any of the settings you're questioning.

Trigger is how sensitive the machine is to switching to ipap, cycle is how sensitive it is to switching back to epap.

TiMin is the minimum amount of time it stays at ipap. TiMax is the max time it stays there.

I increased my TiMax because I noticed that my Inspiration time chart was clipped at the default setting, indicating that I often wanted to inhale for longer than that default setting... so I increased the setting.

I also raised my trigger setting because I'd seen a number of apneas that were preceded by what looked like attempts to take a breath, but the machine wasn't responding to it, so I made the trigger setting higher, so the machine could help me take those breaths.

Ok, sorry - the ResMed machines say Bilevel. But I don't understand when you say they don't have the settings of Trigger, Cycle, TI Min and Max - The ResMed Aircurve has these settings and mine were left at the factory settings. But I am able to change them if needed in the Clinical Settings area. I guess, based on your comment, that my TiMax is ok since it is set at 2.0 and my 30 day average is 1.5, so it is not trying to go past the upper setting.

I will delete the extra 5 graphs in the future - I just thought the more information, the better. Thanks.

Dallaslady51 wrote: ↑

Sat Mar 10, 2018 8:54 pm

Ok, sorry - the ResMed machines say Bilevel. But I don't understand when you say they don't have the settings of Trigger, Cycle, TI Min and Max - The ResMed Aircurve has these settings and mine were left at the factory settings. But I am able to change them if needed in the Clinical Settings area. I guess, based on your comment, that my TiMax is ok since it is set at 2.0 and my 30 day average is 1.5, so it is not trying to go past the upper setting.

I will delete the extra 5 graphs in the future - I just thought the more information, the better. Thanks.

I said:

palerider wrote: ↑

Sat Mar 10, 2018 4:09 pm

For what it's worth, you don't have a 'bipap', since those are made by respirioncs, and they don't have any of the settings you're questioning.

the settings you're questioning are exclusive to some Resmed bilevel machines.

When people include all those extra graphs they have to make all the graphs so tiny that they are worthless for evaluation purposes.
That's why we ask for only the basic graphs so that they can be of a size that is useful.
If we want or need more than the basic graphs then we ask for those other graphs specifically if needed. Most of the time they are not needed.

It is possible that you are hyperventilating in your sleep? I wouldn't say so, since your respiratory rate is very stable throughout the night. But, a median tidal volume of 580ml + (looking at your charts) is pretty (very) high for a woman unless you're in the WNBA. How tall are you?

What is your "rise time" setting set to? If it's the default setting, I believe that is 150ms - which is rather fast. Try setting "rise time" to 3 and see if that helps.

My other suggestion would be to lower your "cycle sensitivity" by one notch, to spend slightly longer in the "inhalation" phase of the breath. Some of your median I:E ratios seem to indicate you're spending a lot more time exhaling than inhaling. AFAIK a "normal" I:E ratio in "healthy" individuals is 1:2.

I am 5'8" but I do weigh twice what I should for my height (been on steroids for autoimmune illnesses for over 6 years). I don't know how to tell if I am hyperventilating. I don't think my Aircurve VAuto has a "Rise Time" setting unless it is called something else - on the VAuto setting I don't see anything set to 150ms? There's a PS that is set to 2, Trigger of Medium, Ti Max at 2.0 and Ti Min at 0.3. I can change the cycle which is set to medium to a lower setting.

I have noticed that my nose closes up on the side I am sleeping and sometimes wakes me up - not getting enough air. I have tried several different full face masks and my numbers are usually a mess and leaks everywhere and can't get much sleep. I almost always breathe through my nose, but it does feel like an effort despite nose strips, steroid spray, etc. That may be where all the pain is coming from - struggling all night to breathe through my nose, but not really getting the air that I need. Over 11 years on CPAP, I guess I've trained myself to breathe through my nose even if it is not working very well for me. I sure can't stand the full face masks and hope I don't have to switch...

Since having to take the Cymbalta at night, my numbers are increasing and the percentage of CAs is increasing a lot - from infrequent to over 50% of the total AHI. I guess it messes up my breathing at night quite a bit, but it makes me so sleepy, I can't manage it during the day. I'm going to try taking it about 6 at night instead of 9-10 and see if that helps any. Usually I could just try a different med, but since this one has eliminated the 24-hour panic attacks, awful anxiety, and ER visits, I have to figure out a way to deal with the sleep side effects.

Please let me know if the "Rise Time" you mentioned is either the Trigger, or Ti Max or Min, and I will try changing those as well.

Thanks for your help.

Matt00926 wrote: ↑

Sun Mar 11, 2018 8:08 am

What is your "rise time" setting set to? If it's the default setting, I believe that is 150ms - which is rather fast. Try setting "rise time" to 3 and see if that helps.

There's no "rise time" setting when in vauto mode.

palerider wrote: ↑

Sun Mar 11, 2018 12:41 pm

Matt00926 wrote: ↑

Sun Mar 11, 2018 8:08 am

What is your "rise time" setting set to? If it's the default setting, I believe that is 150ms - which is rather fast. Try setting "rise time" to 3 and see if that helps.

There's no "rise time" setting when in vauto mode.

Doh, I forgot that. It's been a while since I've used the vauto mode.

Dallaslady51 wrote: ↑

Sun Mar 11, 2018 12:11 pm

I am 5'8" but I do weigh twice what I should for my height (been on steroids for autoimmune illnesses for over 6 years). I don't know how to tell if I am hyperventilating. I don't think my Aircurve VAuto has a "Rise Time" setting unless it is called something else - on the VAuto setting I don't see anything set to 150ms? There's a PS that is set to 2, Trigger of Medium, Ti Max at 2.0 and Ti Min at 0.3. I can change the cycle which is set to medium to a lower setting.

I have noticed that my nose closes up on the side I am sleeping and sometimes wakes me up - not getting enough air. I have tried several different full face masks and my numbers are usually a mess and leaks everywhere and can't get much sleep. I almost always breathe through my nose, but it does feel like an effort despite nose strips, steroid spray, etc. That may be where all the pain is coming from - struggling all night to breathe through my nose, but not really getting the air that I need. Over 11 years on CPAP, I guess I've trained myself to breathe through my nose even if it is not working very well for me. I sure can't stand the full face masks and hope I don't have to switch...

Since having to take the Cymbalta at night, my numbers are increasing and the percentage of CAs is increasing a lot - from infrequent to over 50% of the total AHI. I guess it messes up my breathing at night quite a bit, but it makes me so sleepy, I can't manage it during the day. I'm going to try taking it about 6 at night instead of 9-10 and see if that helps any. Usually I could just try a different med, but since this one has eliminated the 24-hour panic attacks, awful anxiety, and ER visits, I have to figure out a way to deal with the sleep side effects.

Please let me know if the "Rise Time" you mentioned is either the Trigger, or Ti Max or Min, and I will try changing those as well.

Thanks for your help.

I was mistaken about the rise time - not an option when you're using vauto mode. Only thing I can think of is maybe checking the lcd screen while you're awake to see what your spontaneous Ti is, and then setting the Ti min .1 or .2 below that value, to make sure you're not breathing more shallow while sleeping. I really doubt it's the culprit, but I guess worth a shot.

Could this possibly be a side effect of your medication?

Starting and having to take Cymbalta at night is definitely part of the problem - just trying to work with it as best as I can since it has eliminated my uncontrolled anxiety...always a down side to everything...