Do I need a BiPaP

[mike2020]

I have been using APAP (Resmed 10 Autoset) every night on a trial for about 2 months now. I have been checking OSCAR data every morning and found that it has been consistent that every 2 to 3 nights the pressure will max out to 20 for a period of time and I will have a higher AHI (still below 5) than normal. It looked from the graph that the machine is still trying to go higher after reaching a maximum of 20. Whereas other nights the pressure fluctuates between 16 (the minimum I set) to 20 and don't stay at 20 for any amount of time.

I've attached two screenshots, first one is when I think the machine is trying to go higher than 20, and the second is more like a typical night.

Will I benefit from changing to BiPAP which has a higher pressure up to 25? or CPAP is fine? I need to decide on the model to purchase my own machine pretty soon.
The BIPap model is almost double in price compared to the APAP.
Thanks for any help.

[Pugsy]

How much do you think sleeping position may have played a part in those higher pressure needs?
Any chance you were on your back when it was maxed out for a prolonged period of time in that first report?

[DreamDiver]

The beginnings of your nights seem more about flow limitation, but then they're tapering off and the rest of the both nights seem more peaceful, mostly free of flow limitation.

The filter on you machine may be screening something from the air that your body isn't happy about in your environment when you first mask up. As the night progresses, maybe the reduction in allergens getting to your lungs or nasal passages is allowing your body to normalize.

Is this possibly pollen-related, or something seasonal? Do you have furry pets that you might be allergic to? Dust mites? Other likely allergens?

[mike2020]

How much do you think sleeping position may have played a part in those higher pressure needs?
Any chance you were on your back when it was maxed out for a prolonged period of time in that first report?

I will be always (at least mostly) on my back I think, tried sleeping on the side but never work. Upper arm will get numb as well as shoulder and neck.
I don't think there is a possibility on the nights I had low AHI that I slept through the whole night on my side.

Is this possibly pollen-related, or something seasonal? Do you have furry pets that you might be allergic to? Dust mites? Other likely allergens?

Don't think so as well, I don't have any allergies and no pet and considered my environment pretty clean.

[Pugsy]

The other main culprit for increased pressure needs is REM stage sleep but normally REM doesn't happen so soon after sleep onset and it doesn't last that long either which is why I didn't mention it.

Third possibility might be chin tuck position for those parts of the night. We sometimes sleep with our head and neck in a manner that constricts the airway more. You might be doing this chin tuck thing and this is where some people find that using a cervical collar to keep the chin up and not tucked has helped reduce pressure needs. If you still have some time before you have to make a decision on which machine to get maybe try a soft cervical collar.

Ideally you would have a machine that can handle any position but since you are borderline with needing pressures over 20 cm for at least parts of the night....and that machine costs double for you and out of pocket...I don't blame you for wondering if you could get by with the apap machine.

How do you feel on those nights where your AHI is higher? How is your sleep quality? Any big difference in that regard?
You say most nights are like the lower AHI night....maybe it is an acceptable compromise to just have that slightly higher AHI just happen as long as you really can't tell any difference in how you feel or sleep. It's similar to the compromise I have made for my sometimes REM clusters happening. In REM my OSA is 5 times worse and I might need significantly higher pressures but it doesn't happen very often so I just let it slide since I really can't tell any difference in terms of sleep quality or how I feel during the day.

[DreamDiver]

Is this possibly pollen-related, or something seasonal? Do you have furry pets that you might be allergic to? Dust mites? Other likely allergens?

Don't think so as well, I don't have any allergies and no pet and considered my environment pretty clean.

Do you live where there is a lot of pollution, mold, or other things that could affect your flow limitation? Or work? Do you have any known chronic conditions that you know are causing flow limitation (stuffy nose, tight chest, etc.) during the day that could be alleviated with rest at night?

[mike2020]

The other main culprit for increased pressure needs is REM stage sleep but normally REM doesn't happen so soon after sleep onset and it doesn't last that long either which is why I didn't mention it.

Yes, the increased pressure needs always appeared not long after sleep.

deally you would have a machine that can handle any position but since you are borderline with needing pressures over 20 cm for at least parts of the night....and that machine costs double for you and out of pocket...I don't blame you for wondering if you could get by with the apap machine.

Can I assume the AirCurve 10 VAuto will handle any sleeping position? If so, I think the cost may be worth it to avoid the use of additional aids such as cervical collar. Wearing a cpap mask tightly fastened (due to my high pressure) is already quite uncomfortable and I can imagine adding a bulky collar to my neck. At first I wanted the AirCurve having read your posts on here about the more comfortable expiratory pressure but now I've gotten used to the high pressure and not really bothered by the pressure anymore. Your analysis of my situation (borderline need of pressure higher than 20 and cost) is spot on and is exactly what I have been trying to decide. If I haven't joined this forum then I would have not learned about BiPAP and would have bought the APap already.

How do you feel on those nights where your AHI is higher? How is your sleep quality? Any big difference in that regard?
You say most nights are like the lower AHI night....maybe it is an acceptable compromise to just have that slightly higher AHI just happen as long as you really can't tell any difference in how you feel or sleep.

I didn't feel any big difference for any night while on cpap really, but doesn't sleep apnea cause damage to the body regardless of feeling it or not? I am seriously thinking the same way as you about letting those nights slide but still can't convince myself yet. Buy an apap out of pocket and go through all this effort and discomfort using it for a potentially partly compromised outcome or spend double to get a BiPAP which may be overkill? If I can establish that I need the BiPAP then I think I would definitely get it.

for my sometimes REM clusters happening.

Just a side question, doesn't REM happen every night?

Do you live where there is a lot of pollution, mold, or other things that could affect your flow limitation? Or work? Do you have any known chronic conditions that you know are causing flow limitation (stuffy nose, tight chest, etc.) during the day that could be alleviated with rest at night?

Nope. If it were one of these reasons, I can't think of anything related to those nights where is AHI is higher.

[DreamDiver]

You may need a higher pressure than the Airsense 10 Autoset is capable of delivering. If you can afford it, why not give it a shot?

[Pugsy]

Just a side question, doesn't REM happen every night?

Yes REM happens every night and in most cases several times a night depending on how long we sleep and sleep quality in general.
You can google "sleep stages" and look at normal hypnograms to see the usual normal pattern to REM.
I almost always see an increase in pressure needs about 90 minutes into the night which is when first REM usually occurs. It's normally fairly short in terms of how long it lasts. As the night progresses REM comes on more frequently and each stage lasts a little longer than the previous REM stage with the greatest amount of REM happening in the wee hours of the morning. This is all assuming that we sleep rather "normal" so each stage can progress. When we have frequent awakenings it can mess with the normal progression of all sleep stages. Sometimes causes us to have to start all over and the end result is we don't get the needed amounts of deep sleep or REM stage sleep.

I don't know why I sometimes need a lot more pressure during the night on some nights and not much change at all on other nights.
I did a month long experiment where I built a wall so I could totally eliminate supine sleeping being a factor and stayed on my side for 30 nights. I still saw the same pattern for pressure increases even when on my side so I can only assume that supine sleeping isn't a factor or if it is ...sure isn't much of a factor. Now I don't sleep so great in those wee hours of the morning because of back pain issues and the pain meds start to wear off...so maybe some of the nights when I don't see much pressure change needs might be from simply not getting as much REM stage because of the frequent wake ups from pain. Some nights I sleep more soundly and will see more pressure variations so I guess it is possible that I just get more REM those nights. It's a pattern I have watched for over 10 years now.

In all honesty I don't worry about it overly much. It's very rare that I see clusters of OAs or hyponeas at any time and 99% of the time my settings work well for me. When I have a higher AHI and a bit of clustering I just let it slide. I could set my pressure minimums a bit higher but I have also done that experiment and even when I broke up the clusters I couldn't really tell it amounted to any difference in terms of sleep quality or how I felt during the day. Bear in mind when I talk about "clusters" it might mean 4 or 5 apnea events withing a 20 minute time frame. It's not like I am having large very dense clusters and they never last very long.

I just downloaded to the new OSCAR version a couple of nights ago. I don't download very often...maybe once every couple of weeks or even once a month at times. I was looking through the past couple of weeks and I saw an AHI of 9.4 I think it was. I thought whoa what's going on here but then I looked at it real closely and zoomed in on a bunch of those flagged events 90% of them were false positives. I must have had a really bad night in terms of sleep in general with a lot of arousals causing awake/arousal false positives.
I don't particularly remember it though and it was a couple of weeks ago when it happened. Not much I can do about it except shrug my shoulders and say "crap happens" and move on.

I don't blame you for not really getting excited about a cervical collar...I cringe at the thought of it for myself simply because I just hate having anything else attached to me. That's why I use the Bleep mask....I want as little as possible on my face, head or whatever.
Others aren't bothered by it but I know it would bug me.

Have you looked at secondwindcpap.com for a bilevel machine? How do those prices compare with what you found?

[mike2020]

Thanks for your replies.
Who knows sleep as a basic human need can be so complicated and comes with so many problems.

secondwindcpap is where I am comparing the prices from, Airsense 10 autoset is 429 and aircurve 10 Vauto is 799, both gently used. Converted the difference is around AUD600 which is quite significant for me.

[DreamDiver]

Thanks for your replies.
Who knows sleep as a basic human need can be so complicated and comes with so many problems.

secondwindcpap is where I am comparing the prices from, Airsense 10 autoset is 429 and aircurve 10 Vauto is 799, both gently used. Converted the difference is around AUD600 which is quite significant for me.

I thought Australia had universal health care or medicare for all. If your doctor changes your therapy and requires you to get a different machine, doesn't that mean you can get another machine? I mean, even a primary care physician in the US can order sleep machines/masks if a patient requests the prescription and the doctor knows the patient has credible evidence to support the need. Can you not document, go the the doc with the evidence and request a better prescription, thus a new machine? Or is the AUD600 your out-of-pocket or copay even with medicare? If there's a billing code you need to know for medicare/insurance purposes, there's likely someone on this forum know can tell you what to ask for off the cuff.

Surely there is some way the information you've uncovered here can help.