Most Unusual - Any suggestions please?

[sleepytexan]

Hi Everyone,

I've been on Auto BiPAP for a little over a week now. My sleeping has improved but there are still some patches of sleep where I go "apnea crazy" . They appear at random times of the night. Following are three examples of my data (#2 is actually my lowest AHI I have ever received. I'm so proud!) My average AHI hovers around 10 still but if I can take care of these patches, it would drop dramatically. Any suggestions?







Thanks in advance for any help!!

[Wulfman]

Maybe positional sleeping.....on your back?
Any history of GERD?

If none of those, maybe you need to move your minimum EPAP up a bit.

Den

[rested gal]

I'm no doctor but if that were my data and I saw that many Obstructive Apneas hitting, I'd raise the min EPAP by one or more full cm's. I'd leave the max IPAP at 20. I'd run the Max Press Sup (called "PS" on the older pre-M series bipap auto) up to as much as it would allow. How much that will "allow" depends on how much difference there is between the IPAP and EPAP pressure settings...but in no case will the Max Press Sup let itself be set for more than " 8 ".

If raising the min EPAP (more than once if needed) didn't make a significant dent in the AHI, I'd start thinking seriously about GERD possibly interfering with good "cpap" treatment. By that I mean...if the esophagus and vocal cords are getting nightly acid baths, that might cause irritated inflamed tissue. Inflamation or swelling could cause the tissue to be harder or the vocal cords to spasm. CPAP is designed to push aside soft tissue. Can't do its job very well if blowing against a brick wall.

[sleepytexan]

I do sleep on my back 98% of the time but no history of GERD. I will try raising my EPAP tonight and see if that does not help. Is it unusual for the apneas to be clumped together like that?

[Wulfman]

I do sleep on my back 98% of the time but no history of GERD. I will try raising my EPAP tonight and see if that does not help. Is it unusual for the apneas to be clumped together like that?

Yes......it's not a good thing and indicative of some of the things that were mentioned. Sleeping on one's back is generally the worst position for Obstructive Apneas (and snoring) because the tongue can fall backwards and close off your airway.
If you could learn to sleep on your sides it may significantly reduce the apneas. If you use a large or multiple pillows that raise your head, that's another problem. Special pillows have been designed for CPAP users. There was/is an old "remedy" for the snoring......doctors would recommend sewing tennis balls in the back of a T-shirt and wear that at night. Other ways are to use a pillow behind one's back (they make "wedge" pillows for this) and wearing backpacks. I believe there are some forum members who have done some of these things.

Den

[sleepytexan]

Sleeping on one's back is generally the worst position for Obstructive Apneas (and snoring) because the tongue can fall backwards and close off your airway.

This is very ironic as I had to "train" myself to sleep on my back about 10 years ago because of back problems

[Wulfman]

How's the back these days?

If it's any consolation, I can relate to the "back problems"......but I can't sleep on my back in bed.

Den

[rested gal]

I do sleep on my back 98% of the time but no history of GERD. I will try raising my EPAP tonight and see if that does not help. Is it unusual for the apneas to be clumped together like that?

Clumped apneas wouldn't be unusual at all if most of your obstructed breathing happens (as is the case for most people) in REM (Rapid Eye Movement) sleep. We usually cycle into REM (when most dreams occur, even if you don't remember having dreamed) several times during the night. Each REM period is usually longer than the preceding one. The first REM normally happens about 90 minutes after falling asleep, and the longest REM normally happens near morning.

Being on one's back AND in REM is usually the worse case scenario for apneas. More apneas are likely to happen for most people in either of those situations. So, the two together... wham!

[Goofproof]

If my mask leak rate was as high as yours, I might as well put my XPAP in the closet, a leak rate of over 38 LPM kills my treatment, 35 LPM is more friendly in my case. Jim

[Snoredog]

For your pressure, your leak seen is pretty good, you are only averaging 51L/m for 18 cm pressure so that is pretty good.

What is your PS setting set to? From your report, it looks like you are using the default as pressure support never exceeds the machine minimum of 2 cm's. The may be from the primary phenotype seen is obstructive apnea. It would take a Hypopnea to demonstrate Pressure Support is being addressed by IPAP. From the reports, the OA events are what causing pressure to move up, since they are OA's it is pushing IPAP up as needed.

EPAP Min=14.0 cm
IPAP Max=25 cm
PS=3 (3 to 8 is the range).

The events driving up your pressure is mainly Obstructive Apnea (OA),

I would try:

Mode=BFlex Auto
EPAP Min=16.0 cm
IPAP Max=25 cm
Max PS=4 (I would try 4 to 6, range is 3 to

You have cut-off the legend data at the bottom of your daily reports, use that data as your guide to see which pressure
eliminates each type of event seen.

If your AHI doesn't drop soon, you might want to try switching to Bi-level mode and go with fixed pressure settings for EPAP and IPAP. Then you could establish fixed pressure support (fixed range between EPAP and IPAP) which may reduce the frequency of OA's seen.

Do you have any chronic nasal congestion?

[sleepytexan]

How's the back these days?

Actually, I was hoping that this sleep therapy might help with the pain as I was reading that sleep apnea and fibromyalgia have been linked but that is way off topic

Clumped apneas wouldn't be unusual at all if most of your obstructed breathing happens (as is the case for most people) in REM (Rapid Eye Movement) sleep. We usually cycle into REM (when most dreams occur, even if you don't remember having dreamed) several times during the night. Each REM period is usually longer than the preceding one. The first REM normally happens about 90 minutes after falling asleep, and the longest REM normally happens near morning.

I mentioned at the beginning of the post that the apnea clumps show up at random times of the night but I would say 90% of the time it is right after I go to sleep at night or after falling back asleep from getting up during the night.

For your pressure, your leak seen is pretty good, you are only averaging 51L/m for 18 cm pressure so that is pretty good.

Yes, that was one of the first things I looked up was my acceptable leak rate.

What is your PS setting set to?

I took rested gal's advice and set it up to the max at 8. viewtopic/t36632/viewtopic.php?f=1&t=36 ... 30#p312559

Do you have any chronic nasal congestion?

I've never been diagnosed with such but I believe I have a deviated septum which makes any small amount of congestion that much worse. One of the reasons I use a FF mask.

I REALLY appreciate everyone's feedback. From a distance, it's funny to see how eager I have become to go to bed with a new setting/mask/fix. Also, it seems lately that the first thing I do after I wake up and take off my mask is grab my card, some coffee, and head to the computer

[nightjar]

I REALLY appreciate everyone's feedback. From a distance, it's funny to see how eager I have become to go to bed with a new setting/mask/fix. Also, it seems lately that the first thing I do after I wake up and take off my mask is grab my card, some coffee, and head to the computer

Hard to believe, but I wait to make coffee until after I've started up the designated Encore machine.

But I, too, tend to have clusters of apneas, and I'm hoping that some of the advice here will work for me, too. I wasn't able to see your charts for some reason, so I can't really compare.

Anyway, I don't have any suggestions since I'm new to BiPAP, but it sure looks as if you've got some good suggestions from folks who know what they're talking about.

Good luck!

nath