How Long To Feel Better When Starting CPAP Therapy

[chuck29]

Hello All,

I'm a BiPAP user of many years. Pressure is 18/10. My machine was going bad (it was very old) so my AHI was 60 for several months, I later found out. Needless to say, I have been exhausted. I have new BiPAP that I started using last week. AHI is around 7 or 8. I feel worse than I did on old machine getting 60 AHI. I just found out from prescriber today that I was not supposed to be using VAuto mode, so today they changed it to Spontaneous. We'll see how things go starting tonight. I have used VAuto years back and it was ok.

I am HOPING that the reason for feeling so awful is 1) catching up on sleep debt, now that I have a functioning machine, 2) sleep cycle realignment, or maybe 3) VAuto was not sufficient.

I am curious to hear ANY thoughts/inputs anyone has regarding this. Does VAuto not do a sufficient job in providing the correct pressure? Does it simply take a while for body to adjust after having such awful sleep for so long?

Thank you!!

[Pugsy]

Does VAuto not do a sufficient job in providing the correct pressure?

No that's not the case. Auto mode works quite well when properly configured. Totally sucks when not configured optimally. I use the VAuto mode myself and my AHI this morning was 0.5.

Spontaneous mode is nothing more than fixed bilevel pressure settings. It doesn't work so great either unless it is also optimally configured with its settings. IMHO your machine is NOT configured optimally or you wouldn't still have a high AHI.

Fixed bilevel at 10 exhale and 18 inhale.....that's 8 PS and pretty much going to trigger a boatload of centrals at that setting. Unless of course you have some sort of respiratory or lung disease issue going on besides the sleep apnea.

What is your AHI composed of in terms of event category breakdown?

It would be helpful to be able to see the detailed OSCAR or SleepHQ reports because how you deal with an event optimally is going to depend on what kind of event is being flagged.

[chuck29]

Thanks, that is good to know about VAuto, I suspected as much. I am curious what my numbers will be after using S mode night and what my AHI will be.

Interesting note on my PS being 8. I'll keep that in mind about triggering central apnea.

Here are my AHI numbers for one night:

AHI 10.32
Clear Airway 5.71
Obstructive 4.25
Unclassified 0
Hypopnea .36

I can post OSCAR after tonight's sleep. I assume people look at screenshot of daily output?

I also would like to note that the other time I felt like this was when I 1st tried nasal pillows one time. My mouth was open all night and I felt like a truck hit me. I could barely move, talk, or think that next day. So wondering if there is a oxygen level issue??

Thanks much!!

[Pugsy]

If you have a VAuto detailed report available can you also include a typical report in auto mode along with the report using S mode when you post tomorrow?

[robysue1]

Hello All,

I'm a BiPAP user of many years. Pressure is 18/10. 

Is this the setting in Spontaneous mode? Or was your VAuto in Auto mode with Min EPAP = 10, Max IPAP = 18? And if so, what was the PS set to?

I agree with Pugsy: If your machine is set in Spontaneous mode with IPAP = 18 and EPAP = 10, that PS = 8 is really unusual and is quite capable of triggering a boatload of centrals.

If I were you, I'd be checking the actual settings on the machine before turning it on. I think I would also ask the doctor's office for a written copy of the script for the machine that was sent to the DME that set you up with the machine.

 I have used VAuto years back and it was ok.

Do you remember the settings on your old machine? If the doc has issued a new pressure settings script, it is worth asking how the new pressure settings were determined.

[/quote]My machine was going bad (it was very old) so my AHI was 60 for several months, I later found out.[/quote] How did you find out later that your AHI was averaging around 60 for several months? Did you not ever look at the data?

Here are my AHI numbers for one night:

AHI 10.32
Clear Airway 5.71
Obstructive 4.25
Unclassified 0
Hypopnea .36

These numbers are not where they should be. But with the CA making up over 50% of the total AHI, it does raise the question that Pugsy already asked: How well did you think you slept on this night? Were you tossing and turning and fighting for sleep with a lot of wake mixed with dozing during the night? If so, those CAs may be nothing but sleep-wake-junk breathing and your feeling bad could be ascribed to the fact that you just didn't get much sleep in the first place.

Does it simply take a while for body to adjust after having such awful sleep for so long?

It can take a while to start feeling better after having really atrocious sleep for months on end. But it could also be that your treated AHI and/or your general (non-apnea related) sleep quality just need to be improved. It all depends on whether these numbers are the result of a night where you slept soundly (in the sense of getting to sleep and not remembering any long wakes during the night) or not.

[chuck29]

If you have a VAuto detailed report available can you also include a typical report in auto mode along with the report using S mode when you post tomorrow?

I will certainly make sure to do!

[chuck29]

Thank you robysue1, I will reply to your questions for me.

[chuck29]

If you have a VAuto detailed report available can you also include a typical report in auto mode along with the report using S mode when you post tomorrow?

I will certainly make sure to do!

Attached is last night's OSCAR data 7/9. Currently, I can barely focus, think or keep my eyes open. When I walk, I feel like I'm drunk. Hopefully a big part of this is just my body adjusting to getting decent AHI numbers after having months of 60 AHI.

OSCAR 7-9.png (372.85 KiB) Viewed 10193 times

[chuck29]

I have an additional question. One of the metrics on my sleep report on machine itself is I:E, which I assume to be IPAP to EPAP ratio. My number was 50. Is this good?

[robysue1]

I have an additional question. One of the metrics on my sleep report on machine itself is I:E, which I assume to be IPAP to EPAP ratio. My number was 50. Is this good?

The I:E ratio is the ratio between your average inhalation length to your average exhalation length. As far as I know there is no obvious clinical significance to this number. But it is typically going to be a number that is less than 3 or 4 (at the highest). If I recall correctly the I:E ratio may be of some use in setting the Ti Min, Ti Max, and Trigger settings if the patient reports that the Resmed EasyBreath algorithm does not feel fully in sync with their breathing pattern.

Are you sure the machine said the I:E ratio was 50? Or did you miss a decimal point? Or both?

[ozij]

OSCAR says it's an AirCurve 11

Now, it could be saying "PAP Mode: Unknown" because you changed in the middle of its tracking period. But we"ll have to pay attention to this issue - maybe it has trouble interpreting other things as well.

This image is clearly in Auto mode, you can see the pressure going up and down. Too far down because every time it goes, you get obstructive events.

Your machine has a minimum inhale pressure of 14, and a pressure support - the difference between inhale and exhale - of 4.
What that means is that:

• Your machine can go down below your recommended
• pressure of 18
• the difference between your inhale pressure and exhale pressure is a constant 4

Not what you need. You are never at inhale 18 exhale 10. Never.

[chuck29]

I have an additional question. One of the metrics on my sleep report on machine itself is I:E, which I assume to be IPAP to EPAP ratio. My number was 50. Is this good?

The I:E ratio is the ratio between your average inhalation length to your average exhalation length. As far as I know there is no obvious clinical significance to this number. But it is typically going to be a number that is less than 3 or 4 (at the highest). If I recall correctly the I:E ratio may be of some use in setting the Ti Min, Ti Max, and Trigger settings if the patient reports that the Resmed EasyBreath algorithm does not feel fully in sync with their breathing pattern.

Are you sure the machine said the I:E ratio was 50? Or did you miss a decimal point? Or both?

I looked again, and looked very closely. Today it said 58. I did not see a decimal point. What you explained makes sense, which is what I stumbled across before, which is why I had concern about this number. Hopefully there should be a decimal and it's just missing

[chuck29]

This image is clearly in Auto mode, you can see the pressure going up and down. Too far down because every time it goes, you get obstructive events.

Your machine has a minimum inhale pressure of 14, and a pressure support - the difference between inhale and exhale - of 4.
What that means is that:

• Your machine can go down below your recommended
• pressure of 18
• the difference between your inhale pressure and exhale pressure is a constant 4

Not what you need. You are never at inhale 18 exhale 10. Never.

I appreciate this input! How can you tell that when the pressure goes down, I get OSA?

You mentioned minimum pressure of 14. Since my settings are 18/10, isn't the minimum 10 then?

I shouldn't have difference between exhale and inhale of 4. That is the pressure support setting of 4, correct? What is a recommended setting?

If I am not to have inhale 18 and exhale 10, what is recommended please?

I truly appreciate the input and feedback!

[robysue1]

I appreciate this input! How can you tell that when the pressure goes down, I get OSA?

By looking carefully at when the tick marks for the OAs occur and comparing them to the pressure curve. Here's a marked up version of your data:



Note that in each of the red boxes a cluster of obstructive events occurs before the pressure increase. In other words, the pressure has dropped low enough for the obstructive events to start. Once they start, the machine raises the pressure and the events stop.

That's why ozij is suggesting that you need to raise your min EPAP setting.

You mentioned minimum pressure of 14. Since my settings are 18/10, isn't the minimum 10 then?

Ozij is talking about your minimum IPAP pressure.

Yes, the settings on your machine are:
Max IPAP = 18
Min EPAP = 10
PS = 4

That means that on very breath you take the EPAP is at least as great as 10 cm, the IPAP is no more than 18 cm, and the PS = IPAP - EPAP is always equal to 4.

At the start of the night, your pressures start out at EPAP = 10 and IPAP = 10 + 4 = 14. So the minimum IPAP pressure for the whole course of the night is 14 cm.

During the night, your IPAP and EPAP pressures go up and down together in response to what the machine is detecting; the critical idea is that IPAP is always EPAP + 4 because PS = 4.. But the highest your pressures ever reach are IPAP = 18 and the corresponding EPAP = 18-4 = 14.

I shouldn't have difference between exhale and inhale of 4. That is the pressure support setting of 4, correct? What is a recommended setting?

A PS = 4 is a pretty common setting for AirCurves. That's a bit bigger than the max EPR = 3 on the AirSense AutoSets, but not so great as to cause potential problems with centrals in most people. Without knowing why you were put on an AirCurve (instead of an AirSense), there's no way for people on this forum to give you a meaningful recommendation of how to set your PS.

If I am not to have inhale 18 and exhale 10, what is recommended please?

Do you have the actual script written by the doc that was used to authorize the purchase of the machine? The script is your recommended starting point, and it would specify a Max IPAP, Min EPAP, and PS setting.

The only way to have inhalations (always) at 18 and exhalations (always) at 10 in Auto mode would be to set Max IPAP = 18, Min EPAP = 10, and PS = 8. But quite frankly, as Pugsy said upstream, that would be a crazy setting that would not normally be used for run of the mill OSA and such a setting would run a (very high) risk of inducing lots and lots of centrals due to too much CO2 being blown off during the exhalations because of the huge drop in pressure. Given that your CAI=3.45 on this night, I'd be reluctant to increase the PS past 4 if I were you.

I think what Ozij is suggesting, and what I would concur with, is that a modest increase in your Min EPAP from 10 up to 11 or 12 might get rid of obstructive events while not aggravating the number of CAs being scored.

[robysue1]

I have an additional question. One of the metrics on my sleep report on machine itself is I:E, which I assume to be IPAP to EPAP ratio. My number was 50. Is this good?

The I:E ratio is the ratio between your average inhalation length to your average exhalation length. As far as I know there is no obvious clinical significance to this number. But it is typically going to be a number that is less than 3 or 4 (at the highest). If I recall correctly the I:E ratio may be of some use in setting the Ti Min, Ti Max, and Trigger settings if the patient reports that the Resmed EasyBreath algorithm does not feel fully in sync with their breathing pattern.

Are you sure the machine said the I:E ratio was 50? Or did you miss a decimal point? Or both?

I looked again, and looked very closely. Today it said 58. I did not see a decimal point. What you explained makes sense, which is what I stumbled across before, which is why I had concern about this number. Hopefully there should be a decimal and it's just missing

I know it's a big ask, but I'll ask it anyway: Can you take a picture of your AirCurve's screen with this number and then upload the image to imgur and post the link over here so I can see exactly what you are seeing?