BIPAP Recent PS increase leading to higher AHI numbers

[timeforagorism]

Hey All,

I recently had a really bad night where I had way too many OAs. I had 50 in the period of 1.5 hours. I actually went to the ER as I had a really bad lump in the throat feeling, this is why I only had 1.5 hours of sleep that night. My numbers had been okay up until then, but now I want to look at tweaking my settings a bit.

After this night in the ER I took my machine to the supply house to get it tested. I told them the EPAP didn't seem to be working, they said my BIPAP was acting more like a CPAP and my numbers looked fine except for that one night. I see they did make a change to the PS setting they raised it from 0 - 8, to 2-8. This pressure change has seemed to give me more CAs. I wonder if it is that whole blowing off the CO2 idea.

Attached is a good night before the pressure change:

Good night before PS change

Good night september.png (123.01 KiB) Viewed 13253 times

A recent night after the pressure change:

After the PS change

Regular night October.png (117.82 KiB) Viewed 13253 times

I have been reading up on the forums and I will try to do more research. Any advice is greatly appreciated.

Thanks

[Pugsy]

Welcome to the forum.

Before the change in PS the max PS was a lot lower than it is now with the new PS minimum.
For some people more PS does cause the blowing off of too much carbon dioxide so the levels don't get high enough for the brain to send the signal to breathe.

The change in minimum PS from 0 to 2 is minimal but sometimes there is a fine line between what PS causes too much carbon dioxide wash out and what doesn't.

My suggestion would be to go back to the old settings. They worked well apparently except for maybe one night. I never suggest changing something based on a one off weird night.
And yes...when PS minimum is 0 the machine will function more like cpap/apap with a single pressure instead of 2 distinct pressures but that's not necessarily a bad thing.
If you want to keep the bilevel distinct pressure thing...limit the max PS to 4 and see if the centrals reduce.

[timeforagorism]

I will try setting my pressures back. I called the DME therapist yesterday and they said my report is fine. They must not even look at the real data because I have never had flow rate waves like this, and all these CAs. AHI was good this morning, "technically treated", but I felt worse.

I am having these really wide flow waves:

Wide waves 10.9.18.png (26.87 KiB) Viewed 13220 times

Then these really long CAs:

CA 10.9.18.png (26.05 KiB) Viewed 13220 times

The Night overall:

10.9.18 Centrals.png (117.56 KiB) Viewed 13220 times

This is kind of frustrating to feel worse and see the data all jacked up, and they keep saying you are doing fine, don't change anything.