Staying Asleep With BiPAP

[TwistRate]

Hi guys and gals! I've been sleeping with a BiPAP for about 40 nights now. Very happy with the results I'm already seeing. No longer waking up feeling like I wasn't breathing!

My AHI is quite low compared to other folks, but I'm still waking up a lot throughout the night, and I'm trying to put an end to that. I'm not sure if it's a therapy side effect (still adjusting to sleeping this way), hypopneas, or just poor sleeping habits. I can be in bed for 12 hours, and still feel groggy the next day due to waking up a lot. It's very rare I wake up feeling like I need air. I just...wake up.


I've been sleeping with a 4 EPAP min/25 IPAP max with 21 PS Max and the therapy is very comfortable, and I fall asleep easily. However, the first thing I noticed is that my machine was detecting some snoring, and a partially obstructed airway. My hypopneas are at 1.71. See below:




I thought raising my EPAP min could help with this. Maybe I'm snoring myself awake? I tried 6, with 19 PS Max. My hypopneas did lower to 1.04, but I ended up with an OA, and really no improvement in the amount of times I'm waking up:




Anything standing out that I could change right away? I'm thinking about raising my EPAP min again, but I hate to keep raising that since it does make things more uncomfortable and I swallow more air. Also not sure how to use this "flex" thing, and if it's helping me at all.

Open to advice!

[kteague]

I'll let those more informed about bilevel settings address your settings. Were you titrated with a bilevel to get your starting settings, and what factors are you basing your changes on? Just seems to me to be a wide spread in your numbers and that 21 PS Max gives me pause. I use a bilevel, but not an auto. Once your settings are dialed in, hopefully you'll start getting more consolidated sleep. If not, there are some routine things you can look at, like if you're on any meds that can cause sleep fragmentation, or if you have any issues with limb movements (jumpy legs). I'm interested in replies to your situation as I'm trying to better understand bilevel treatment. Good luck with things.

[Pugsy]

How did you come by getting this machine and what was your original diagnosis?
Did you have any sleep studies...at home...in a lab with a cpap machine or without?

[Pugsy]

Just seems to me to be a wide spread in your numbers and that 21 PS Max gives me pause.

There is an available wide spread but the machine isn't using it or actually varying anything including PS very much.
On the second report the max PS reached was 3.10 which isn't much at all.
With minimum PS of 0 the machine isn't even doing bilevel pressures. It's doing a lot of nothing more than fancy apap stuff.

[Pugsy]

Depending on what your answers are to the questions I posed above...from what I see on these reports the only thing I would change is minimum PS at this time. Maybe maximum PS later.
Change minimum PS from 0 to 2.
Don't change minimum epap from 6 right now. By adding in a little PS you are creating a little more inhale pressure (IPAP) and IPAP is what is generally used to deal with hyponeas when IPAP has some room to be increased.

[TwistRate]

How did you come by getting this machine and what was your original diagnosis?
Did you have any sleep studies...at home...in a lab with a cpap machine or without?

At home, with a CPAP. During NREM stages I suffer from witnessed apneas and little to no respiratory effort, frequent insomnia, and some mild snoring - idiopathic CSA. After being introduced to ASV my ability to fall asleep, and stay asleep improved significantly. Once I'm in deep sleep, I'm not really disturbed. However, usually what I experience, is a dream I'm having will come to an end, and I'll wake up naturally. I'm not gasping, feeling like I was choking, or feeling short of breath, I just wake up, and toss and turn for a bit, then go back to sleep. Rinse, and repeat every hour or so. Occasionally it'll lead to the dreaded insomnia again, especially in the morning hours after getting through 3/4 of the night.

Depending on what your answers are to the questions I posed above...from what I see on these reports the only thing I would change is minimum PS at this time. Maybe maximum PS later.
Change minimum PS from 0 to 2.
Don't change minimum epap from 6 right now. By adding in a little PS you are creating a little more inhale pressure (IPAP) and IPAP is what is generally used to deal with hyponeas when IPAP has some room to be increased.

I discovered that in order to raise my PS min, I'll need to lower my EPAP max. I've gone down to 23, and I'll raise ps min to 2.

[esel]

I am wandering why there is a regular increase in pressure and leak about every 10 minutes ?
Is this due to the type of machine ?

[Pugsy]

You don't need such a high EPAP max anyway. It's an extremely rare person who ever needs that much EPAP and you never went anywhere near it anyway.
Maximums of anything don't mean much if the machine doesn't go there and do it.

Let's see what happens with your reports and sleep quality with a small change like adding a little baseline PS so that IPAP goes up just a little and helps hold the airway open.
The way you had it set up initially it was functioning more like an apap with some big maximums that it never used or needed.
With ASV...just like with apaps...for obstructive stuff it is the minimum EPAP and by default minimum IPAP because of PS being added in that is the most critical settings. If we assume that the bulk of your OAs and hyponeas are probably obstructive in nature and not central...you just need a little more minimum EPAP and IPAP to clean up your reports a bit.

I am not sure but having max EPAP might be restricting PS....and if you do have centrals you want PS to range big.
I suggest lowering max EPAP to 12. I don't think you will ever need it anyway but if you do have real centrals you need more PS.
PS is what does the breathing for you if you have a central....PS for a central is a big burst of pressure that is quickly up and down.
Right not it's not happening when the most PS you have is 3.. If you really have a central a PS of 3 isn't enough...you need 10 to 15 for the machine to breathe for you.

[Pugsy]

I am wandering why there is a regular increase in pressure and leak about every 10 minutes ?
Is this due to the type of machine ?

With a Respironics machine (any Respironics machine) the increase in leak line is always going to happen with an increase in pressure when the machine is auto adjusting the pressures because Respironics machines report total leak which includes the vent rate plus any excess leak.
With more pressure the mask's expected vent rate increases...so if the pressure goes up the vent rate goes up and we would expect the leak line to go up.

[Pugsy]

The staying asleep thing....that may or may not be related to any apnea events you see on the report.
Since it is possible that apnea events are causing some wake ups or arousals then that's why we try to reduce them.
Now it is possible that they aren't the main cause of the arousals and cleaning up the reports may not help your sleep quality.
The cold hard fact of life is that there is a lot more to staying asleep than just problems with apneas.
Sleep onset insomnia or sleep maintenance insomnia...there is a long list of culprits that can cause either.

[TwistRate]

Just a short update: Friday and Saturday nights were very rough. I lied in bed for 14 total hours last night/this morning (went to bed at 11 PM last night, didn't finally roll out today until 1 PM). My Sleepy Head data isn't really worth analyzing, because I kept getting frustrated and messing with it throughout the night to try and find relief.

Pugsy, I think the increase in PS min will be helpful. I can't really induce snoring when I relax all of my muscles and I think that's a good sign.

My molars are very sore today. I sleep with night guards to help with jaw clenching, but on bad nights, they're sometimes not enough. I wish I knew what was causing this. The last two nights in a row have been dreamless, hypnic jerks, intermittent breathing, and frustration that leads to insomnia.