Frequent Awakenings

[Wulfman...]

And, after looking at your APAP settings and your comments, I'm thinking it's the pressure changes that are messing up your sleep. Along with the possibility that your breathing events.......FLs and Snores.......are the main problem in that they keep driving up your pressures till the mask leaks wake you up.


Den

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[OkyDoky]

Sorry, I had to leave last night and go to bed. I'm with Den, I think those wide settings may be waking you up. Maybe others will contribute today. I use straight bipap and have very little experience with auto bipap so I'll let others give you setting suggestions.

[Sleeprider]

Your machine is setup with an incredible pressure support of 15 cm in fixed bilevel mode. The IPAP pressure is off the chart at 25, and EPAP is fixed at 10. No wonder you're getting aroused and wakened. That 15 cm pressure differential between inhale and exhale is very disruptive...at least to me.

I would think Auto BIPAP mode would be more comfortable, with EPAP at 10 and IPAP PS min at 5 and PSmax at 10. I just think you're way over ventilated. When I use the BiPAP, I find any pressure support greater than 5 is a lot for me. If you used CPAP or APAP previously, I would suggest setting EPAP at the equivalent to your CPAP pressures, and add some pressure support for comfort. Fixed PS of 15 suggests you have a major ventilation issue.

[OkyDoky]

Sleeprider, she previously reported her APAP settings were 4-20, also not optimized. She has plenty of room for improvement.

[Sleeprider]

Sleeprider, she previously reported her APAP settings were 4-20, also not optimized. She has plenty of room for improvement.

A fixed PS of 15 is just harsh! Can you imagine? It would be like being inflated by a hose. I spent 1/2 night on fixed BiPAP with a minimum pressure of 10.5 and fixed PS of 5 and felt completely beat. Some people need pressure support in order to adequately ventilate, especially with obstructive disease, but 15 fixed pressure support is a LOT unless there is a prescribed reason for it.

It's hard to know where to start with this one. I think Auto bilevel mode would be better. She seems to do okay with 10 cm EPAP. I might just go as low as 2.0 min PS and allow PS max to be 15. That way we're allowing the IPAP pressure to find a theraputic level. However, after being on a 15 PS for so long, she is likely to feel she is not getting enough air. If that happens, she need to increase PS min to comfortable levels.

[OkyDoky]

Java, Did you have a sleep study and do you have a copy of the report? What were the results? Did they titrate you with pressure settings? Do you have lung or cardiac problems? Why did you switch to bipap?

[OkyDoky]

I have a question when I look at her settings and statistics. If she is on mode: bilevel, why does it not stay fixed Epap 10 Ipap 25 with PS 15? My statistics are what it is set for and do not change. Hers vary and the 95% is 17.00 both E and I with PS of 2.30
That is why I thought she was on auto initially. Not that I am suggesting that it should be greater. Just thinking something doesn't seem right.

[Wulfman...]

Sleeprider, she previously reported her APAP settings were 4-20, also not optimized. She has plenty of room for improvement.

A fixed PS of 15 is just harsh! Can you imagine? It would be like being inflated by a hose. I spent 1/2 night on fixed BiPAP with a minimum pressure of 10.5 and fixed PS of 5 and felt completely beat. Some people need pressure support in order to adequately ventilate, especially with obstructive disease, but 15 fixed pressure support is a LOT unless there is a prescribed reason for it.

It's hard to know where to start with this one. I think Auto bilevel mode would be better. She seems to do okay with 10 cm EPAP. I might just go as low as 2.0 min PS and allow PS max to be 15. That way we're allowing the IPAP pressure to find a theraputic level. However, after being on a 15 PS for so long, she is likely to feel she is not getting enough air. If that happens, she need to increase PS min to comfortable levels.

I seriously question that.
I'm curious as to why she's on Bi-Level to begin with.........because they set her up for "failure" with APAP?
All she needs is a little more minimum pressure to help knock down the snores (and maybe some nasal cleansing). The Flow Limitations aren't all that "bad" in that report. I just don't believe there's any valid reason for that machine to be pursuing "junk" that doesn't lead to apneas and is extremely destructive to sleep architecture.


Den

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[Java]

Java, Did you have a sleep study and do you have a copy of the report? What were the results? Did they titrate you with pressure settings? Do you have lung or cardiac problems? Why did you switch to bipap?

I did not have a sleep study. Well, I had an at home sleep study/titration where I just took home their machine for a weekend. but that was back in 2012 when I was given the APAP. I was switched to BiPAP because I have COPD (mild) but I kept waking up every 1-2 hours so she thought BiPAP would help me.

[Java]

I appreciate everyone's help so much! Honestly all these numbers are so confusing to me. I thought EPAP meant Exhale pressure and IPAP meant Inhale pressure! I am clueless. As to my machine being in fixed mode???? I thought it was on Auto! I am so lost and confused. I have horrible doctors who just look at AHI and say, "Yep you're good." I don't even know what the 15 PS means. I still have my APAP machine, maybe I should go back to that. Maybe I should just put this in CPAP mode. I won't give up, because even with these horrible arousals at least I don't wake up with my heart pounding and my head throbbing in a state of panic (Like when my AHI was 30+ and my oxygen desaturation was 53%) I guess we've established my numbers are off. I just don't know where to start to fix them. And FYI: Some nights I wake up with my mask literally hovering over my face because the pressure is so high.

[Wulfman...]

I appreciate everyone's help so much! Honestly all these numbers are so confusing to me. I thought EPAP meant Exhale pressure and IPAP meant Inhale pressure! I am clueless. As to my machine being in fixed mode???? I thought it was on Auto! I am so lost and confused. I have horrible doctors who just look at AHI and say, "Yep you're good." I don't even know what the 15 PS means. I still have my APAP machine, maybe I should go back to that. Maybe I should just put this in CPAP mode. I won't give up, because even with these horrible arousals at least I don't wake up with my heart pounding and my head throbbing in a state of panic (Like when my AHI was 30+ and my oxygen desaturation was 53%) I guess we've established my numbers are off. I just don't know where to start to fix them. And FYI: Some nights I wake up with my mask literally hovering over my face because the pressure is so high.

We appreciate the extra information you've provided.

Yes, EPAP is exhale and IPAP is inhale. But, there are some issues with the way yours is set up and with your breathing events causing the machine to keep increasing pressure, it's wrecking your sleep........and THAT is what they're NOT supposed to do. They're supposed to make sleep more comfortable and give you restorative benefits.

I think it would be interesting if you would put the APAP in either CPAP mode or leave it in APAP mode but set the minimum and maximum pressures to the same setting. From my observations of that report you posted, I'd suggest about 12 cm. as the pressure setting (to start with). No "guarantees", but I can't see how it could be any worse than what you've been trying to deal with so far.


Den

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[Wulfman...]

Additional info:
By leaving your APAP in APAP mode and setting the minimum and maximum pressure to the same setting, it will allow you (us) to see the other events like Flow Limitations that are not shown in CPAP mode.


Den

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[Java]

Additional info:
By leaving your APAP in APAP mode and setting the minimum and maximum pressure to the same setting, it will allow you (us) to see the other events like Flow Limitations that are not shown in CPAP mode.


Den

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Okay so I am clear, I should try my APAP machine with settings of max 12 and min 12? I hope I don't die. I thought I needed the high pressures like 17 and 18 to stop my apnea.

[Wulfman...]

Additional info:
By leaving your APAP in APAP mode and setting the minimum and maximum pressure to the same setting, it will allow you (us) to see the other events like Flow Limitations that are not shown in CPAP mode.


Den

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Okay so I am clear, I should try my APAP machine with settings of max 12 and min 12? I hope I don't die. I thought I needed the high pressures like 17 and 18 to stop my apnea.

Yes, that's what I would suggest trying.
There were hardly any apneas on that report you posted and most of the "things" that the machine was chasing was snores and a few flow limitations.
Most machines will NOT try to stop an apnea once it's in progress (and it takes at least 10 seconds for the machine to define "lack of breath" as an apnea, anyway).

I didn't see anything in that report that appeared to be "life threatening". And, 12 cm. would be just a couple of centimeters more than your minimum EPAP.........which hasn't been enough to eliminate the snores.


Den

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[Wulfman...]

I couldn't see in that report whether your Bi-PAP was set to use BiFlex or what setting. If you don't "need" a Flex setting with the APAP, so much the better. Otherwise, either an A-Flex or C-Flex setting of "1" or "2" would probably be OK.


Den

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