Rough First Night On Bi-level

[slowmo2000]

Hi all,

About 5 months into CPAP journey and have made a lot of progress. Have been using Airsense 11 with pressure at 11 and EPR at 3, which has been yielding pretty great results (AHI ~1) but have been dealing with two issues: 1) Breath shape on Oscar was somewhat flat/choppy and needed to be more consistently rounded 2) As I increased pressure (beyond 12) I get aerophagia and CAs.

Given this, I decided to try Bi-level. I looked at my Oscar history and saw that at about a pressure level of 7 cmH20 my obstructive apneas disappeared but when this pressure level would get to 9/10 on exhalation I would start to get CAs. So I set the Bi-level to 12 inspiration and 7 on exhalation (recall that I was essentially on 11/8 previously).

It took me a few minutes to get used to the sudden increase and drops in pressure with Bilevel but fell asleep pretty quickly. I slept okay but got about an hour earlier than normal, but looking at Oscar it wasn't even close to a good night.

Any thoughts on how to improve this?

https://imgur.com/a/g3C8GoL

[Pugsy]

So how did you come to be trying the ST model and in S mode? Do you have your doctor involved or are you doing all this one your own?

Are you aware that machine doesn't distinguish between central and obstructive apneas? That's how come you have a truckload of UAs flagged....it dumps all central apneas and obstructive apneas into the Unclassified Apnea basket

Given the PS setting of 5 that you are using.....I wouldn't be surprised if the bulk of that UA weren't plain old centrals popping up.

[slowmo2000]

Thanks for the speedy reply, Pugsy.

Purchased the ST device second hand and did research on how to go about a multi-night titration. I am working with a doctor but my bi-level sleep study is scheduled months out and was hoping to improve my sleep quality between now and then

From your questions, I'm inferring that I'm in way over my head Unless there are some very obvious setting changes I can make, I'll likely just go back to my previous therapy and wait for my study

[Pugsy]

I would be over my head with the ST machine. It wasn't your best choice of models for sure.
It was designed to work better for people with some very specific respiratory issues because it works more like a ventilator forcing a person to breathe when they don't/can't breathe on their own.

I don't know that those UAs for sure are central but it would be my first suspect.
Cut your PS down to 2...and leave the EPAP at 7 (that would make IPAP 9) and stay in S mode and see what happens.
Some people find that very much PS actually triggers centrals and 5 PS could sure do it.

You would have probably done better with your bilevel experiment if you had got a machine like I use.
I don't know that it would have helped you with your flow rate breath rounding thing but it would at least tell you if you were having central vs obstructive apneas. The ST machine simply won't/can't tell the difference.