First Night on BiPAP Pro - Thoughts?

[Gator5000e]

Last night was my first night on the Dreamstation BiPAP Pro machine. It is a fixed machine, not auto. My AHI was still 3.95 on the first night and I don't feel noticeably better even though I managed about 7 hours sleep. I posted the charts for my last night on the Auto-CPAP and the first night on the BiPAP. Any thoughts on these results would be appreciated as well as any thoughts on adjusting the machine for better results. Thanks in advance.

7-17-18.JPG

[Gator5000e]

No takers here? Or do I just need more data?

[Pugsy]

I was wondering why the change from the Auto cpap to the Pro BiPap?

There is slight improvement in AHI but not enough to get all excited about and I don't know what your problem is.

You were given a PS of 6...that's a little higher than I normally see unless there is a special reason.

So I guess...why the change in machines???

The first cluster of events at the beginning of the night...I am betting you were still awake. So I think that likely the real asleep AHI is probably lower.

I need more information to be able to offer much. More history.... Is there another thread somewhere that I missed that documents the history. I was gone from the forum on vacation and I haven't read all the threads that were posted while I was on vacation. I might have missed it.

[Gator5000e]

Thanks, Pugsy. Hope the vacation was great. Short summary. I was placed on the BiPAP because my PA was not happy with the centrals she said I continued to have. When I first started the Apnea stuff I was only approved for the first sleep study by my insurance company Florida Blue (fka BCBS). They did not approve the second night (titration) and approved an Auto CPAP machine in lieu of the second part of the study. That happened in November 2017. Recently, the PA, tired (no pun intended) of the centrals, ordered the titration study and the results of the study (shown in the thread below) showed that I had a good 3 hours w/o centrals with Bi-Level pressure. So based on the results of the second test, a Bi-PAP was ordered. They gave me the Dreamstation Bi_PAP Pro. The SH pic I posted in this thread was the first night. For whatever reason, I couldn't pull the results from last night. I was having issues with the DreamMapper app and I don't know if that did something to the SD card data. So that is where I am.

Sorry for the long thread. I did recall after hunting for these older threads that you had advised to keep all my stuff in one thread for ease of review. I apologize for not doing that. I will try to do that in the future. HEre are the links to the two prior threads:

Thread about the Titration Study with a copy of the report - viewtopic/t172108/Had-Titration-Study-- ... I-get.html

Thread with some prior SH results on the APAP machine - viewtopic/t171881/Adjusted-Machine-per- ... ughts.html

Thanks for your help.

[Pugsy]

Short on time at the moment but I will go read those other threads later when I have more time.

I think you need a crash course in evaluating flow rate to determine sleep status to help you figure out if those events you see flagged are real or not.
http://freecpapadvice.com/sleepyhead-free-software

Even without the detailed graphs you should have an AHI and event category breakdown show up on SH for last night.
Can you tell me what it is?

How is your overall sleep quality? Wake often? Spend much time awake with mask on?

I know from personal experience with the Respironics BiPap Pro that it does take a bit of time for the body to get adjusted to the new way of doing things so I wouldn't be in a rush to go changing things unless there is an urgent need to change something and to be honest I don't see it here especially since we don't know for sure if all those flagged events are real or not.

A few centrals here and there...not usually a problem and could just be a normal sleep onset or sleep stage transition central happening and if you have some wake ups going on during the night there is an increased chance of more sleep onset centrals when you go back to sleep.
Also it's possible that some of the flagged events are awake events being flagged mistake. We call them SWJ Sleep/Wake/Junk and they get flagged because our awake/semi awake breathing is more irregular than our asleep breathing and the machine can only measure air flow...it doesn't have a clue if you are asleep or not.

So my main questions now...figure out how much of those events are real or awake...and ask about sleep quality in general.
If you had many wake ups...I wouldn't expect you to feel any better. Sleep quality is just as important (if not more so) than the AHI and what we see on these reports.

[D.H.]

Supposedly and AHI of less than five is considered "acceptable." This is quite arbitrary. Your AHI of approximately 4 means you're having an episode on the average of once every fifteen minutes. This can't be good.

However, if it's considerably lower than your baseline, it is an improvement. Medicine has a very hard time of measuring the "severity" of this (or any other) disease. It's reasonable to assume that more events are worse than few events, longer events are worse than shorter events, and that the lower your blood oxygen goes, the worse it is. Just how much (or little) is how bad; that's very hard to measure!

[Gator5000e]

Thanks for the reply. Here is last night's graph. I am hoping it is an anomaly but it doesn't look good.

Also, I cant find the Flow graph that was in my last report. Not sure how to get it back.

I will review the page you linked to below. Thank you.

[Pugsy]

Was the SD card in the machine or the computer last night?

How much time might have been spent with mask and machine on?
Especially at the beginning and ending of the night where you see the clusters of CAs/centrals?

[Gator5000e]

I had accidentally used the wrong SD card so that is likely why the chart wasn't correct.

I usually don't put the mack on until I am ready to go to sleep. I usually don't take it off until I have to get out of bed, to either use the rest room or to get up in the morning. That night I didn't feel like I could fall asleep until about 2AM and fell asleep around that time and woke up around 7AM or so.

I have been having a lot of congestion in my sinus and upper chest and am constantly trying to clear my chest as well as try to clear my sinuses by inhaling hard and then swallowing. Maybe that is affecting me more earlier in the night as I fall asleep with the mask on and closer to the morning. But I have no idea.

I didn't bring the SD card with me this morning but the DreamMapper app says that last night I had 5:31 hours of usage, an AHI of 9.5 with 17 Total clear Airway Apneas, 33 Total obstructive Apneas and 2 Total Hypopneas.

So far, it seems as if I am regressing and getting worse with the BiPAP Pro machine. I think I will try to increase the max inhale pressure to the same level it was at with the A-CPAP machine. I have no idea if that will help, but I need to try something. I will try to grab my SD card at lunch and upload the new image to this thread.

[Gator5000e]

Was able to get last night's graph. When I expand the Flow Rate graph to look at the OAs and CAs they appear (to me) to be real pursuant to the video Pugsy linked to above. Usually my OAs and CAs have falt lines before and after them and if I understand the video, that's an indication that they are real events. I attached the basic graph as well as a graph with the Flow Rate expanded to show 2 of the events.

Any thoughts are appreciated. Thanks to all.

[Gator5000e]

And if anyone is interested, the Events summary.

[Pugsy]

My suggestion...try EPAP 6 instead of 5...don't change anything else.
Let's see if reducing the obstructive stuff helps anywhere else.

[palerider]

Usually my OAs and CAs have falt lines before and after them and if I understand the video, that's an indication that they are real events.

Well, no. The flat lines *are* the apneas, thats where you're not breathing... the vertical lines are just where the machine says "ok, fine, you're having an apnea somewhere around in this area. (usually around 10 seconds after the flatline part starts.

Whether a CA is 'real' or not is something you get an idea of by looking at the breathing *before* the flatline part. If it's regular, smooth breathing and then a flatline with a CA, then it's thought to probably be real If however, you've got regular breathing, then some big breaths, THEN the flatline, the impression is that something else woke you up, and you just held your breath while you turned over and got comfortable... so that's not a 'real' CA, it's just breath holding while moving around, (for instance).

All of the events you showed are too zoomed in to see what was going on before the event itself.

[Gator5000e]

Thanks, Pugsy and PR. I appreciate the advice and education. I will change the EPAP to 6 to see what happens. I did move the IPAP to 12 to see if that would help. And here is the graph from last night. I didn't blow it up at all. BTW, the big gap around 3:10AM was because of a phone call I got.

[Gator5000e]

I am beginning to become concerned that I should have been given an Auto Bi-PAP machine instead of the non auto machine. Here are the last 3 nights SH graphs. I started on the Bi-PAP machine on July 17th and as of today, I don't feel any better. I did raise the EPAP to 6 as Pugsy suggested. I don't think that really helped. I was given the non-Auto machine based on the sleep study that said I was good for 3 hours at 6/11. I guess they felt I had found the correct settings. But as I said, I don't feel any better and as of this time I was getting similar results on my APAP machine. I am very curious as to what the experts here think. I don't think I have any option to return the machine to the local supplier at this time.

Thanks for any thoughts.