BiPap settings - double check and one question

First I should say, I found this quote from Pugsy while reading
“My number one goal has always been good sleep first...feel decent...and not a perfect AHI or beautiful report.”.
I like that focus.

I also want to mostly, with small exceptions, change one thing at a time so that I can see the effects (vs changing several and having no idea what caused the results – good or bad or mixed).

I am using a Bi-Pap. I have attached Oscar charts (just the respiration and pressure info).
I find the Bi-pap any my mask overall to be comfortable. I don't (have never) woken in a panic or gasping. However, I still don't get quite the same quality of sleep with the Bi-Pap as I do sleeping without it and my AHIs are still high most nights.

Today, I am doing my first real tweaks to the setup. I have only used it for 3 nights, so not a lot of data yet. I have been reading the forum for a couple of hours and my brain is starting to get bleary, so I am stopping to do this post (and book marked a couple bi-pap posts for later reading).

I have a question (next post). But if anyone has any feedback on settings, I am welcome to get this. I am just starting, so my first set of changes are listed below.

A big issue: My breathing seems to not be “textbook normal". While awake sitting up, I do significantly less than 16 breaths a minute, doing 2-3 seconds inhale, longer exhale, and a pause at the bottom of the exhale. I will often just stop breathing for short times while sitting (especially if talking or concentrating -e.g. thinking the words in my head while I type/read them – lol). I do that between breaths and sometimes in the middle of an in-breath. The chart for the first day (28th), the first half hour I was sitting up wide awake - getting use to the machine. Note there was CA and OAs recorded during this time – that seems to reflects my same pattern (no real OA or reason for a CA, I just was "distracted" and didn't breath/stopped breathing).

My settings and questions:

Mode & Pressure settings: - upping Max IPAP because I sit at the max 95% of the night.
Mode: VAuto
Max IPAP = 20 (Note: This came as 12, I kicked it up to 15 after first night because I sat at the top, I just kicked it up to 20 for tonight – I will see what my charts show from this).
Min Epap = 4 (came set this way)
PS = 4 (came set this way).

Respiration settings – This is the main place I want to start making changes, to match my breathing patterns.
Looking at the charts overall, it looks like I am taking more breaths than the typical 16 breaths a minute. However, when awake and sitting up I take significantly less than typical 16 a minute.
My TIMax (time for inspiration max) was set to 2 sec and I was hitting that limit a lot, so I suspect that is changing my normal breathing pattern. Awake I do about 2-3 seconds for an inbreath. So I increased that setting and I expect it to affect my respiration rate.
On the bipap laying down before falling asleep I would find myself yawning a lot (like 8-15 times). Real weird feeling to try and yawn with your xPap on – the yawn wouldn’t complete right so I would just yawn again and again. Again, maybe a sign I needed a longer inspiration timeframe (since my exhalation was long).

The charts show I do longer exhales. Using the manual, I set:
TiMax (time inhalation max)= 3 (Came set as 2).
TiMin = (time inhalation min) = .7 (this was .3 sec, I changed it to .7 just now just cause it seemed to match my charts better).
Trigger = Med (came that way and would be my first try anyway)
Cycle = Med (came that way and would be my first try anyway)

My question is on the next post (hit attachment limit).

My Question: The chart that shows TI Min & TI Max looks different than the description of the settings. The chart looks like TiMax is entire breath cycle, but description looks like only inbreath. Which is correct?

Norma45 wrote: ↑

Mon Jun 01, 2020 3:34 pm

My Question: The chart that shows TI Min & TI Max looks different than the description of the settings. The chart looks like TiMax is entire breath cycle, but description looks like only inbreath. Which is correct?
manual timax timin.pngManual page TiControl.png

The only affect Ti has is on... inspiratory flow. "Time Inspiratory" is what Ti stands for.

Norma, I have some information in response to your posts and a couple of thoughts and questions.

It is very common to breathe irregularly while we're awake. As you note, we commonly hold our breath when we are concentrating on something or exerting ourselves, for example. We also cough, clear our throats, talk, yawn, hiccup, all kinds of messy stuff. If your awake breathing pattern happens to match the algorithm the machine uses to flag events, it will flag events while you're wide awake. I don't think that's anything to worry about.

You will also see very irregular patterns for respiration, inhalation, and exhalation when you have a whole lot of events during your sleep. That reflects the stops and starts and gasps and so forth that characterize sleep apnea. So here, the number one job is to reduce events.

Our exhalations are normally longer than our inhalations; the I:E ratio for most people is around 1:2. Your charts show something between around that and around 1:3. Just to cover the bases: do you have asthma or some other condition affecting your respiration generally? If you have concerns about the length of your exhalations, you might bring that up with your doctor if you haven't already.

Could I ask whether you were given your (wonderful!) VAuto after a sleep study? If so, what did the study show about CAs, OAs, Hs, RERAs, or other kinds of disordered sleep? (If you have a copy of the study and want to redact and post it, that could be helpful.) Or are you self-treating?

I agree that it's good to make one change at a time. For that reason, I would recommend returning the respiration-rate settings to default and instead concentrating on reducing the number of obstructive events you are experiencing during sleep. And although you don't show your flow limitation graphs, the numbers look as though they might be fairly busy, which is something else it'd be nice to deal with.

You are on the right track: setting the maximum to 20 will allow your EPAP to go up to 16. I would recommend that in addition you raise your EPAP min as part of the same strategy. Do you think you'd have trouble raising it to 10?

Finally, your events exhibit clustering. That could be due to several factors: more events during REM sleep, more events if you've rolled onto your back, or more events if you're tucking your chin down toward your chest. Do you have a guess about which factor might be at work for you?

Miss Emerita,

I guess I should have said I am not concerned about my breathing patterns, but I want to give room for my natural breathing (e.g. not have the xPAP restrict me and force me into a pattern unnatural for me).

No asthma or breathing problems of any note.

I had a home sleep apnea study (apparently the Covid way). But I also have mixed feelings about sleep clinic studies since I would not sleep the same in a strange bed/room with tons of wires as I would sleep at home (and some are poor quality).

Home study was ResMed – it showed OAs (clustered), HAs (clustered, maybe 25% more than Oas), and some unclassified/mixed. CAs were there but rare (nor more than a handful all night). Diagnosed moderate OA, AHI 21.5 events/hr. Some O2 drops – “… Respiratory events clustered in a pattern consistent with REM dominate sleep disordered breathing with periods of OAs..” BUT I am not sure – they are less other nights even with AHI being high and one night I had only one that looked like a disconnect rather than a regular O2 drop.
I had a cpap for a very short time - epic fail, so I now have a bi-pap.

I do know so far that I do tons better on my side than my back (like many people I think). When awake and laying on my side for a while, then flipping onto my back I immediately feel the BiPap working very differently. It doesn’t seem to make any difference if my chin is tucked or not.
I am trying to learn to sleep only on my side (it was very uncomfortable the first time I tried but I think I am doing longer side sleeping time – up to a couple hours now).

Yes, I cluster like heck. And after a long cluster I can wake up and be unable to sleep for an hour or so (no bad dreams, no panic, heart rate not going nuts, just wide awake) – typically happens no more than once per night.

I am not sure about raising EPAP to 10, I would have to see if I can tolerate that ok while awake first.

Question:

So if I am hitting the upper limit both on TiMax (inspiration time) AND IPAP (max pressure on inbreath), my question is why change IPAP instead of TiMax? My inclination is to change TiMax first for 2 reasons:
I know I likely do a longer inbreath (based on what I see when awake). And I kicked IPAP up once already – it feels I am just following the upper setting (yeah a little early to know for sure, just a guess on my part) – which makes me suspicious something else is contributing to a high IPAP need. No hard-core info, just a suspicion. Yes, I was pushing it a little and wanting to change both, since I am seeing upper limit on both, to see where I would really fall without an upper limit restricting me.

palerider wrote: ↑

Mon Jun 01, 2020 4:09 pm

Norma45 wrote: ↑

Mon Jun 01, 2020 3:34 pm

My Question: The chart that shows TI Min & TI Max looks different than the description of the settings. The chart looks like TiMax is entire breath cycle, but description looks like only inbreath. Which is correct?
manual timax timin.pngManual page TiControl.png

The only affect Ti has is on... inspiratory flow. "Time Inspiratory" is what Ti stands for.

PaleRider- that what I thought. But then why does the TiControl - Inspiratory time control chart show TiMax as going across an inhale plus an exhale. Maybe a misprint.

Norma45 wrote: ↑

Mon Jun 01, 2020 7:44 pm

So if I am hitting the upper limit both on TiMax (inspiration time) AND IPAP (max pressure on inbreath), my question is why change IPAP instead of TiMax? My inclination is to change TiMax first for 2 reasons:

Because they're two different things.

Increase TiMax to 3 or 4, and ignore it.

set MaxIPAP to 25, and ignore it.

Norma45 wrote: ↑

Mon Jun 01, 2020 7:45 pm

palerider wrote: ↑

Mon Jun 01, 2020 4:09 pm

Norma45 wrote: ↑

Mon Jun 01, 2020 3:34 pm

My Question: The chart that shows TI Min & TI Max looks different than the description of the settings. The chart looks like TiMax is entire breath cycle, but description looks like only inbreath. Which is correct?
manual timax timin.pngManual page TiControl.png

The only affect Ti has is on... inspiratory flow. "Time Inspiratory" is what Ti stands for.

PaleRider- that what I thought. But then why does the TiControl - Inspiratory time control chart show TiMax as going across an inhale plus an exhale. Maybe a misprint.

Don't know, don't care, doesn't matter, it's the Maximum Time at Inspiratory Pressure.

Whoo Hoo. Last night is the first good quality sleep I have had on a machine. Yes, I have not had that many days on a machine but that is a big plus IMO.

Increasing the TiMin made a big difference that I could feel in the first moments.
Taking in a breath felt like a luxurious wonderful stretch.

I hung out close to but just under 3 for TiMin (which was set at 3). I think I will up that a little just to give some wiggle room.
My expiration time was closer to 3 while sleeping on my side (lots of ups and down and could go higher if sleeping on my back).
And my respiration rate was close to 12 on my side (again lots of ups and downs if on my back).
My highest AHI on the AHI chart was 31 instead of above 40.
Overall AHI dropped to 10.83, my lowest so far but... this is only one night and it varies, still a hopeful sign.

I lasted 3 hours on my right side - only 9 events during this time (I will take that! now just to get the entire night that low).

I tried sleeping on my left side - I felt like I was not getting enough O2. I played with things, trying to take deep breaths but couldn't find anything that felt comfortable. About 7 minutes in got a steady cluster of OAs that continued the remaining 10 minutes on that left side, another 15 minutes on my back, and another 10 minutes on my right side until they went away. Yes, I was awake the entire time trying to relax and breath effectively. Lasted another 1.5 hours on my right side with only 3 events.

I tried the trick someone did of taking their mask off to mark a spot on the charts - it didn't work well, I think I need to take it off and count to 10 or 30 (not just a couple of seconds). But many of the times I wanted to check out were related to changing position, so that was easy to see.

Overall things looked better but I still need to make some more adjustments.
Upper pressure needs to increase, again I sat just under the max 95% of the time.

First hour of sleeping on my back was lots of apneas (pretty clustered), but the last 1.5 hours were pretty good - almost as good as sleeping on my right side. I lost somnopose data from previous nights (and trying to import all charts gave an oscar error), but I don't remember having a stretch like that on my back that was good.

I am going to kick up the max pressure to 25, then get a couple of days of charts then I will post to see what to tweak next.

If you want to mark a spot and you are awake...just reach over and turn the machine off and then right back on again.
It will be much more easily seen than trying to look at what happens when you remove your mask.

A lot of people have trouble - with or without pap - sleeping on one side vs the other... nothing to do with apnea.

I'm so glad to hear you had a better night! And now I understand what you're trying to do with the adjustments concerning respiration, and you got good advice from palerider. Post another chart when you feel the time is right.

Some people sleep more comfortably on their sides with an extra pillow to hug and/or to prop their backs.

Thanks Pugsy, I will try the on/off machine trick.

Julie - that is what I thought (that I just didn't breath as easily on one side). But I took a nap without my bi-pap today and slept on my left side the whole hour and it worked great. I am just keeping the info that it felt harder to get in a full breath on my left side with the bi-pap in my back pocket to look at later one.

Miss Emerita - I have used a pillow between legs before (straps to one so it stays with you while you wiggle around. It is more pressure points at the same spots all night. If I can do a right to left back to right shift I think that would work. Time will tell.

Ok, tonight's test is raising the max pressure to 25.

For the next test... I am guessing it would be to increase my EPAP.
However...
Since my side sleeping pressure and my back sleeping pressure are so different,
should I :
Put my EPAP up to just below my lowest side sleeping IPAP
or
Put my EPAP up to just above my highest side sleeping IPAP (could this adversely affect side sleeping:)
or
we are just winging it, so don't try to figure out the "right answer", just try something, then try something else and figure out what seems to work best:D

I am posting this now (vs after few days) because I think it gave some valuable information.

So after great sleep 2 nights ago, last night was not so great.
As I expected, increasing my max pressure to 25 just meant I followed that up (e.g. the chart on the left shows I was at 24.58 for 95% of the time, but I really was there only about 1.5 hours). I am guessing this means something is going on that kicks this up high but the extra pressure is not solving the problem (something else needs to change). And the pressure made some horrendous noises that woke me up several times (mask vibrations that sounded like a junkyard parts band). So I am going to back down to 20 for now until more if figured out (I didn’t get that junkyard band song at 20).
I purposely did more sleeping on my back to test out the pressure changes.

I am breaking the night into 3 segments since they are very different.
1) slept on my side (start of the night). I am showing from when I put my book down to fall asleep (went to sleep quickly) until I woke and changed positions.
Max IPAP 25, Min EPAP =4, PS 4.
4 OAs and 1 HA in about 2 hrs 15 minutes. I definitely need to become a side only sleeper which means I need to figure out left side sleeping so I can change positions during the night. 2) I slept on my back,
Max pressure 25, EPAP min =4, PS 4. For comparison, here is a chart from the night before
Max pressure 20, EPAP min 4, PS 4 Next post shows back with Max pressure 25 and EPAP 10, PS 4

3) After waking for a while (not feeling rested at all but unable to sleep for a while), I changed the EPAP to 10 and slept on my back to test this. 10 is high on my side (got pressure leaks) but just at the edge of I could do it.
Max pressure 25, EPAP 10, PS 4
No Oximeter this sleep chunk - if I turn record off and then turn record on it erases the first recording (previous part of the night) and I didn't know how long I would be awake or if I would go back to sleep so I just turned off the oximeter. For now I will try Max pressure 20 (to avoid the discomfort at 25), and keep EPAP at 10, and keep PS at 4. Unless anyone has some brilliant ideas of what is going on
I am also going to try and do more side sleeping than back, and work on left side being more comfortable so I can sleep on that side with the bi-pap (it is comfortable with no machine and could be with just one incidence of left side with machine and one of left side without machine that my posture was a little different....).