BiPAP, 10 days in

[SirNapsalot]

Hi all,

First of all, I appreciate this site and the regular helpers here. I've read quite a bit, but I must say I feel like I'm drinking from the proverbial firehose. At this point, I would say I'm struggling to understand my problems and how I should proceed. I'll try to be concise, but do my best to provide the info you need if you choose to offer advice.

Background:

I'm a 60 yr old male. I'm 6', 225, but I have a big frame so most people don't believe that when they see me.

I started having problems with near constant sleepiness about 8 years ago. At first it seemed to be seasonal, so I thought it was allergy related because the two seemed to be timed alike. Over the past year it has become a year round thing. So late last year, I gave in to my doctor's 3rd or 4th offer to do a sleep study (I am a very light sleeper... a cell phone 'ding' sound will wake me up, even with the volume relatively low, so I have always been skeptical that I would be able to sleep with a mask). Anyway, she referred me to a local sleep specialist who started me with an at-home study, and that resulted in an overnight titration study. Those results prompted her to prescribe BiPAP with backup and she referred me to a local med supply house that set me up with the equipment in my signature.

As far back as I remember, I have slept on one side or the other, and I switch sides through the night. I have never been able to sleep on my back but over the past several years, I stop breathing just before I dose off (hypopnea?). I never sense this on my side.

I take a fairly mild beta blocker for BP, a statin, a reflux med, and a low dose aspirin.

Current feelings:

I have intentionally struggled to avoid naps, so when I go to bed, I'm ready for bed! I still wake up frequently... roughly once/hr. I would say I don't feel any worse than before, but not any better either. My sense is I am getting better sleep, but I'm not seeing a big improvement due to the interruptions.

I have heard of dry mouth, but I've never contemplated what I am experiencing. Still, every time I wake up, I can take a small sip of water and go back to sleep. However, this is only true up to about 5-6 hours/night.

I want this to work, but I'm very discouraged. I would be willing to try other equipment, especially masks. However, this machine would have been pretty expensive without insurance and I don't think they will cover another one right now, so I would have to be pretty sure an alternative would make a substantial difference before going that far.

Thanks!

[Pugsy]

Where are you located?

[SirNapsalot]

Sorry, profile updated... near Huntsville, AL, US

[Pugsy]

When is your follow up visit scheduled with your sleep doctor?

Can you get your hands on the sleep study reports that you have had?

This isn't going to be easy....sounds like you had too many central apneas so that's how come you needed a machine with a back up rate but we don't know if you also had very many obstructive apneas or not or was your diagnosis just central sleep apnea.

The ST model machine...good for central apnea only but not so great for someone who has both central sleep apnea and obstructive sleep apnea.
Your AHI isn't horrible but there is definitely room for improvement and for sure enough apnea events still happening that could mean you aren't seeing a reduction in your unwanted symptoms.
Mainly hyponeas but the difference between hyponeas really isn't all that big of a difference....assuming the hyponeas are obstructive in nature and not central in nature.

All this should have been sorted out with the in lab titration sleep study but maybe there were factors involved where they couldn't get an optimal titration sleep study.

How are you sleeping? Soundly for the most part or a lot of wake ups????

[SirNapsalot]

Pugsy,

Thanks for your help. I believe the follow up is about 5 weeks away.

It's only been 10 days or so, but if I have a typical therapy night I would say I fall asleep quickly and wake up in 1-2 hours, and then every hour or so after. After 5-6 hours total, it is very hard for me to fall asleep again 'masked'. If I can't doze off in a half hour or so, I give up and take the mask off. I can generally take it off and fall asleep again and get another 1 or 2 hours. I would say my titration study was similar.

Before therapy I would wake up after about 4 hours or so, then go back to sleep for another 1.5 - 2 hours. If I don't have anywhere to go, I can probably repeat the last one again.

I very rarely have to go to the bathroom before morning.

I was unaware that I could ask for my study report, but at the time I thought I was OK to just follow instructions. That may still be the case, but I now sense that I should learn more so I at least know the questions to ask. So, I don't know my actual numbers, but I do know my AHI was 43 or 48. She said I had obstructive apneas, but also the centrals. I do not know the mix.

One more thing that some people think is strange, but not necessarily pertinent... I can set an afternoon nap timer on my phone for 5 minutes. I will fall asleep before it goes off, and I can do this repeatedly 5 or 6 times (and maybe more - never tried). This is regardless of how I 'feel' like I slept the night before. The only reason I ever thought to try this was after reading somewhere that falling asleep too quickly is one symptom of narcolepsy. To my knowledge, I don't have any other symptom.

[Pugsy]

When someone has both obstructive apneas and central apneas the diagnosis is complex sleep apnea.
The best machine in this situation would be the ASV machine (it will auto adjust for the obstructive stuff and it has a back up rate for the central stuff). This is my personal opinion and I am not alone with it.
The ST model machine is a fixed pressure machine...it can't auto adjust. It can be used to deal with obstructive stuff but you have to have a higher minimum EPAP usually and the pressure support is fixed as well and you get that PS with every breath.
It gets complicated but right now your pressure support is 6 cm and that's really borderline in dealing with central apneas. IMHO.
I had a sleep tech tell me that they felt 8 cm PS was the minimum they were okay with.
With ASV...the PS will also auto adjust. It will give a big burst of PS if a central happens but if none happen it just functions to deal with the obstructive stuff.

I hate ST machines....I see too many people coming here using them with much less than successful outcomes.

Do you have any history of congestive heart failure?

This would be the machine I would want to use if I had complex sleep apnea.
https://www.resmed.com/en-us/healthcare ... ve-10-asv/

[SirNapsalot]

Hi Pugsy,

No congestive heart failure, and I am going to request my results today.

Who determines which machine I am to use (the doctor or the medical supply I chose)?

Also, can't my machine settings be adjusted to the proper levels?

[Pugsy]

Your doctor always determines what type of machine the supplier can dispense...
now the supplier might determine brand but the kind of machine is always up to the doctor.

The ST bilevel....with some adjustment can sometimes deal with both obstructive apneas and the central apneas effectively.
But it's not ideal because it's a fixed pressure machine. Great if central apnea was the only diagnosis and you needed back up rate with every breath. It works essentially like a ventilator.
Not so great if you have both kinds of apneas and only need central apnea help every now and then.