Please help

[Coloradokid]

Please help me.

I'm a 29 yr old male. Physically active, in good physical condition. I was diagnosed with sleep apnea about 5 years ago. I've been using a CPAP since then. I had the UPPP surgery at Stanford about a year and half ago. I know that it helped a little because I don't need near as much pressure as I used to. The problem is that I'm still exhausted. I still wake up 10 to 15 times a night (that I remember), and I have problems concentrating and thinking clearly after bad nights. Some nights it's just a constant nodding off and waking right back up, for hours until sunrise. The strange thing is that every couple of weeks I'll have a really good night's sleep and I'll feel amazing the next day. But I can never seem to replicate it. I've tried cutting out caffeine, not eating 3 or 4 hours before bed, and sleeping in an elevated position. I exercise (almost) daily. Nothing helps. The fatigue and brain fog have been ruining my life for the past 5 years and even after surgery I only feel marginally better. I have another appointment with the sleep clinic at the end of November. I guess I'm just posting in the hopes that something in the data jumps out at someone who knows more about this stuff than I do. Do I have CSA? Do I need a new machine? Does it look like I'm sleeping fine and maybe I have another medical issue that causes me to wake up repeatedly throughout the night? Also, does the machine record every arousal? Because I feel like I've counted more times than the data shows for most nights. I'm miserable. Please help.

(Thanks in advance for any advice)

My machine:



Data:

[Pugsy]

Who/how were these settings came up with?
You are using a bipap but it's little hands are tied so it is working like an apap and your minimum pressure is only 4.
Your obstructives apnea events are clustered and too high. I don't know why the clustering but that's usually related to pressure needs during REM stage sleep or sleeping on your back or maybe both.
I don't know that all your symptoms are related to what we see here but your therapy isn't anywhere near optimal and there are better ways to use the bipap to make it more effective.
How come you were given BiPap only to have its little hands tied?

[Wulfman...]

Looks like a train wreck to me.
Have you tried straight BiPAP settings......like a fixed IPAP and EPAP?
It appears you have some very wide-open settings and they're chasing lots of events instead of having the settings to where it would prevent many of the events from occurring. It seems to me that a higher EPAP and lower IPAP might be a place to start.
It appears to me that all those pressure changes during the night could be pretty disrupting to one's sleep.


Den

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[Bill44133]

You don't need a new machine. In fact you have a very good machine. It also happens to be the same machine that I use.

Your problem is your therapy sucks! You need to get it optimized. Your AHI is supposed to be under 5.

You have the software now and let the people here guide you to where you therapy should be at.


I wish you well...

[Coloradokid]

Your problem is your therapy sucks! You need to get it optimized. Your AHI is supposed to be under 5.

You have the software now and let the people here guide you to where you therapy should be at.

I wish you well...

Thank you for the response. I really appreciate it. How does the data from the past few nights look?

Who/how were these settings came up with?

Hi. Thank you so much for responding. The machine was given to me (and programmed) by the VA Healthcare system.

It appears you have some very wide-open settings and they're chasing lots of events instead of having the settings to where it would prevent many of the events from occurring. It seems to me that a higher EPAP and lower IPAP might be a place to start.
It appears to me that all those pressure changes during the night could be pretty disrupting to one's sleep.

Thank you for the response. I tried to adjust the setting over the past two nights. How does last night's data look? I felt like I slept better (woke up less), but it came with some crazy aerophagia--I was in pain for a few hours this morning. Do the numbers look good right now? Or do I need to tweak them some more?


Data from the night before last:



Data from last night:








Thanks.

[Pugsy]

It's no wonder you got the bad aerophagia with the jumps in pressure you made and you still are using it like apap.
Let's make use of the bilevel pressures to help with the aerophagia and still get the apnea better treated.

How about trying these settings?
EPAP minimum....8
PS ...min 3 max 4 (right now it is at 0 which means no difference between inhale and exhale which essentially means a single pressure being used and bilevel (2 pressures) will help a lot with the aerophagia)
IPAP...P max 13
If using BiFlex...whichever is comfortable but the setting of 2 is nice middle of the road.

Then see what happens with these settings.
EPAP is exhale pressure
IPAP is inhale pressure
PS Pressure support is just the difference between EPAP and IPAP

I own this machine...I think this will be a lot more comfortable for you and still do a better job for you.
Might still need a little tweaking but this should get you real close to optimal.

[Wulfman...]

Definitely looking better. Heading in the right direction.


Den

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[chunkyfrog]

Welcome to the forum, CK; and thank you for your service!

[Coloradokid]

Thank you everyone for the welcome, kind words, and advice. And thank you Pugsy for the detailed instructions. How do the past few nights look? I noticed that there are a lot of CA events, but I read on another thread that those are normal during the period when you're transitioning into sleep? -thanks

[Pugsy]

Those CAs/Centrals that you see clustered so densely right after you start the machine are most likely awake/semi awake breathing irregularities getting flagged by mistake.
Sleep onset centrals are what happens when we transition from awake to asleep and they don't normally cluster so densely.
My bet would be that when you see those dense CA clusters is that you are still awake and when that happens we have to mentally remove those events from our evaluation of things.

If we remove those clusters...your reports look great and I see no need to change anything in terms of the settings if you are sleeping decently and feeling decently.
The sawtooth spikes you see are what we call test pressure probes...the machine does it on its own just to sort of test things out a little bit. It is not responding to anything in particular when you see those spikes that are so prominent and always look the same.

So....how is the general sleep quality and how are you feeling?
Are you waking often and if so for how long?

How come such short hours of sleep? Do you do the short hours often or was this a rare thing?

[Wulfman...]

Those CAs/Centrals that you see clustered so densely right after you start the machine are most likely awake/semi awake breathing irregularities getting flagged by mistake.
Sleep onset centrals are what happens when we transition from awake to asleep and they don't normally cluster so densely.
My bet would be that when you see those dense CA clusters is that you are still awake and when that happens we have to mentally remove those events from our evaluation of things.

If we remove those clusters...your reports look great and I see no need to change anything in terms of the settings if you are sleeping decently and feeling decently.
The sawtooth spikes you see are what we call test pressure probes...the machine does it on its own just to sort of test things out a little bit. It is not responding to anything in particular when you see those spikes that are so prominent and always look the same.

So....how is the general sleep quality and how are you feeling?
Are you waking often and if so for how long?

How come such short hours of sleep? Do you do the short hours often or was this a rare thing?

These were the questions in my mind, too.

Except for those "clusters" at the beginnings, you're having few events.


Den

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[Coloradokid]

Hi. Sorry for the late response. I was trying to see how these settings worked over a longer period of time. Last week I felt a lot better. Felt rested. Here's last week:






I didn't change any settings, or anything in my routine. But this is this past week's data:







I'm not feeling very rested. I feel tired/groggy most of the day. I feel like I've been waking up a lot, and a few times I've had to remove the machine altogether during the night due to pain from aerophagia. Is there anything else I can do at this point? Any further adjustments? Thanks in advance for any advice.

[MaskingtheNightAway]

Have you tried adjusting your pressure range higher?

Your MIN of 4.00 might be too low. Get the MIN closer to the pressure you need. Allow the MAX some room to go higher, in case the machine decides you need the extra pressure at times. Then, look at the readings in your software and see what your averages are. I try to keep my 95% pressure in the lower 25% of my MIN/MAX pressure range.

My range is set 14.0 to 20.00. My 95% comes out around 15.5. I have the same equipment setup you are using now. (machine and mask).

I felt my therapy was not a good as it could be several years ago and slowly tweaked my pressure on a single pressure machine (Resmed S7) from 10.5 to 14.0 and noticed an improvement. Now with the System ONE APAP, the range setting of 14.0 to 20 gets me started out close to the 95% rate of 15.5. My AHI is < 1.0 for the last year at these setting.

I'm not a doctor, but just can offer advice on what has helped me.

The Auto CPAP should find your best setting, but starting out too low could be letting it HUNT for the pressure need too long before you are at the right spot.

Glad to see you have a full face mask and you are getting the full benefit of the therapy. Since you are used to CPAP, I also would advise against ramp, just put it on, turn it on, and get the right therapy from the very beginning.

You can do this! Many of your recent posts show AHI below 5.0. Keep up the good effort.

[Pugsy]

Have you changed your primary sleeping position for some reason?
Odd that you had some really good reports and some not so good reports without changing anything.

Has the aerophagia always been there or just recent?
The usual recommendation for bad aerophagia is a bilevel machine which you are already using.

[Pugsy]

Your MIN of 4.00 might be too low.

That 4 cm EPAP is just the ramp. It's only for a short period of time and hurts nothing to start there.

The Auto CPAP should find your best setting, but starting out too low could be letting it HUNT for the pressure need too long before you are at the right spot.

OP isn't using an APAP machine...he's got a BIPAP machine and he's had some good results with current settings and some not so good results
BUT he is now complaining of major aerophagia issues so increasing the pressure or letting the machine do it may not be the best thing to do until.

More pressure is going to make the aerophagia worse.

The Auto CPAP should find your best setting, but starting out too low could be letting it HUNT for the pressure need too long before you are at the right spot.

His starting pressure isn't 4 cm.. It's 8 cm exhale and inhale is 3 to 4 cm higher.
On Oct 27 the results were great and were great until Nov 3...then the AHI increased but it was mainly CA/Central and more pressure won't fix centrals and in some situations can make it worse...so increasing the pressure may not be the best advice in this situation.
Be careful when suggesting more pressure when the primary event category is central in nature. It could potentially make things worse for someone.