Aircurve 10 VAuto BIPAP Data Interpretation

Hello all,

I'm in the process of trying to tweak my settings after switching from the Dreamstation Auto BIPAP to an AirCurve 10 VAuto. I have been using the BIPAP consistently, every night, for a year now. While I feel better than I did before using it, I still have residual daytime sleepiness. I never feel fully "rested" in the morning and despite consistently getting 8-10 hours of sleep, I am usually fighting feelings of brain fog/sleepiness most of the day (albeit, less than I did before treatment). Usually, I will only wake up one or two times to use the restroom. Recently, I have had an issue with nasal leaking (especially last night). I'm going to experiment with loosening the straps on my headgear and *not* using Lanolin, because it seems like that may be causing the seal to break.

Right now, my settings are EPAP 12 with an IPAP 17. Last night I tried increasing the EPAP to 13. It seems like my flow rate looks more "normal" after switching from the Dreamstation AutoBIPAP to S mode on the VAuto. But, I have noticed periods of sleep where my flow rate looks highly irregular and I'm wondering what kind of events I'm having.

Some more information: I am 24 F, I don't take any sleeping medications, I use a sinus rinse + flonase before bed for allergies, no significant physical/mental health issues other than anxiety.

I am attaching a screenshot from the last two nights with a zoomed in portion of last night where my flow rate looked particularly irregular. My questions are: What is happening during this period of time? Is it possible that the brief nasal leaking is disrupting my sleep enough to cause fatigue, even though it's not waking me up?

Full graphs: https://imgur.com/a/0qeFdCt

Zoomed in screenshot of portion of last night: https://imgur.com/a/2TFUVcR

Thank you!

Using the S mode, you don't get data for flow limitations, which might be useful. So try using VPAPAuto instead. Set your minimum EPAP to 12, your maximum IPAP to 17, and your PS to 5. You'll get the same pressures as you do with your current settings in S mode.

We'd need to see a closer zoom -- maybe 2 minutes -- to see what's going on during that choppy stretch. Could you pick a couple of spots and zoom in more closely?

Miss Emerita wrote: ↑

Sun Feb 18, 2024 4:56 pm

Using the S mode, you don't get data for flow limitations, which might be useful. So try using VPAPAuto instead. Set your minimum EPAP to 12, your maximum IPAP to 17, and your PS to 5. You'll get the same pressures as you do with your current settings in S mode.

We'd need to see a closer zoom -- maybe 2 minutes -- to see what's going on during that choppy stretch. Could you pick a couple of spots and zoom in more closely?

Thank you for your response Miss Emerita! Here are some zoomed-in screenshots of the wonky spots from that night: https://imgur.com/a/cd3GuAD

I did what you suggested and changed my settings to V Auto mode. Here is the graph from the night before last with flow limitation data: https://imgur.com/a/aR13MSv

Are the flow limitations on this night significant? I didn't feel rested at all during the day. Although I've solved one issue that I've had (mouth leaks), I'm wondering if perhaps my new settings are causing clear airway apneas that the machine isn't picking up on, or if the spikey-looking leaks are positional leaks that are disrupting my sleep.

Your FL graph looks great, so no problems there. As leaks go, yours are not at all bad, but even small leaks can disrupt sleep for some people. Do you think yours are from your mouth or from your mask?

What strikes me now is that you go to bed late, at quite different times on different nights, and tend to be in bed for less than 7 hours. It'd be well worth trying to change these patterns. What is most important is to go to bed and get up and close to the same time every day, and to leave enough time to get at least 7 hours of sleep. This means being in bed for more than 7 hours.

While you're at it, you might review these guidelines for better sleep. I thought they were too vanilla to give me any real help, but I was wrong!

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

Miss Emerita wrote: ↑

Wed Feb 21, 2024 12:52 pm

Your FL graph looks great, so no problems there. As leaks go, yours are not at all bad, but even small leaks can disrupt sleep for some people. Do you think yours are from your mouth or from your mask?

What strikes me now is that you go to bed late, at quite different times on different nights, and tend to be in bed for less than 7 hours. It'd be well worth trying to change these patterns. What is most important is to go to bed and get up and close to the same time every day, and to leave enough time to get at least 7 hours of sleep. This means being in bed for more than 7 hours.

While you're at it, you might review these guidelines for better sleep. I thought they were too vanilla to give me any real help, but I was wrong!

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

Thank you for looking at my data! I think the leaks I've been dealing with recently have been from my mask. However, last night I tried tightening the headgear on my P30i mask and it seemed to significantly reduce how many times I was waking up due to apparent leaking. I had read that one should be careful of not over-tightening the mask, but I think I was overcompensating by making the headgear too loose to maintain a proper seal throughout the night.

I agree with you that I need to work on my sleep hygiene. It's been really hard to wake myself up at the same time every day, because I will let myself sleep in due to being sleepy. But, it has become a vicious cycle of sleeping in some days, staying up late, then waking up early the next day and being exhausted. It sucks to be in my 20s and have to be so stringent about my sleep schedule, but you're right that I will be better for it in the long run and I can't afford to have such an inconsistent sleep schedule, lol.

I decided to increase my IPAP to 18 (with a PS of 6) last night to see if it would help with what I suspect is RERAs that I'm still having. I'm feeling a bit better today, with noticeably less brain fog this morning even though I am still a little sleepy (probably because my circadian rhythm is still off and I didn't sleep quite enough).

I've read that TESCA is one issue to look out for when increasing PS, especially beyond 5. Would TESCA be obvious through the machine flagging central apneas? In other words, do I need to worry about increasing my PS too much if I'm not having lots of obvious centrals that are being flagged by the machine?

Here is my graph from last night, for reference: https://imgur.com/a/jopkSnp

Good job on the leaks!

Treatment-emergent CAs would be flagged just like any other CA, so if you're not seeing CA flags, you're not having them. I'm delighted to hear you feel you're doing better with greater PS.

Keep your current settings for at least a week to see how they do over time; sleep can be quite variable from one night to another. (I'm notice you're having PS of 6 when you've set 5; I suspect the explanation is that in S mode the IPAP and EPAP settings override whatever the PS setting may be.)

And if you can also do more to keep a regular schedule and sleep more, all the better. I agree it sucks to be young and have to be strict with yourself, but that sure beats living like a zombie!