Extremely rapid breathing on bi-level (28 resp. rate)

[Too Sleepy]

Hi,

I posted here before about how APAP did not relieve my symptoms of tiredness, it also did not relieve my extremely long and vivid dreams; to me that was a sign of arousals occuring during REM. For reference, my sleep study picked up an AHI of 50 during REM. In short, I am now using a bi-level in an attempt to resolve the significant flow limitations/RERAs that I was experiencing on CPAP. However, I now have ran into the problem of having periods of extremely rapid breathing with no expiatory pause. These periods seem to always end in arousal. I have traded RERAs with what now seems to be hyperventilation ending in arousals.

Any ideas on what's causing these and what I can do? My trigger is usually set on very high, and cycle is on medium. Right now I'm using VAuto with a minimum of 6 EPAP and a PS of 4, effectively 10/6.

What I've tried so far:

• Lowered Trigger from very high to high, which causes a massive amount of central apneas.

• Lowered Trigger from very high to medium, which causes an even more massive amount of central apneas (9.6 AHI over 7.5 hours)

• Raised Cycle from medium to high, Trigger remained at very high.

• Raised Pressure Support to 5.

• Raised Pressure Support to 6.

• Tried a variety of higher pressures; 11/6, 11/7, 12/8, 13/8, 13/9, 14/10. The rapid breathing does not cease no matter how high the pressure is.

Pictured below is the high respiratory rate ending in arousal. Trigger: very high, Cycle: high.




Here is an example of when both Trigger and Cycle were on medium. This is on a pressure of 13/9.




And finally, this is an example of the flow limitations/RERAs that I experienced on APAP with a pressure of 10/7.




So I cannot go back to using an EPR/PS of 3 because then I'll experience RERAs/flow limitations. What can I do?

[Too Sleepy]

Forgot to mention that I'm using a Resmed Aircurve 10 VAuto. Ti Min and Ti Max are at default.

[Rubicon]

What can I do?

First of all, don't be saying

an even more massive amount of central apneas (9.6 AHI over 7.5 hours)

when technically that's a "mild" amount.

Secondly, those snippets provide insufficient data to determine anything. Load up the SleepHQ file.

[Too Sleepy]

How is a 9+ AHI of CA okay?

Also, what's the point in responding to my post when you're just going to have a rude tone? Don't need your help then, thanks.

[ozij]

You were told a CA index of 9.6 is technically defined as mild, and not as "massive".

You were also told to upload you data to SleepHQ because "those snippets provide insufficient data to determine anything."

Both statements of fact.

You were not told "How is a 9+ AHI of CA okay". Had it been considered OK, nobody would have wanted see you data on SleepHQ.

Facts are needed in order for you to be helped. I suggest you focus on the facts and provide the data in the form that helpers ask for.

Focusing on people's tone and style - which may at times even be misunderstood - will not get you help you need with your therapy.

[Rubicon]

Don't need your help then, thanks.

Yeah, you're right. Looks like you're getting everything you need on TOF.

[Rubicon]

Focusing on people's tone and style - which may at times even be misunderstood - will not get you help you need with your therapy.

Hey o.! Always good to hear from you! So how's your summer going?

Y'know, I keep forgetting what people expect:

Expert advice.
Immediate response.
Free, of course.
Presented gift-wrapped covered with hearts, rainbows and flower stickers.

[ozij]

Hey o.! Always good to hear from you! So how's your summer going?

Y'know, I keep forgetting what people expect:

Expert advice.
Immediate response.
Free, of course.
Presented gift-wrapped covered with hearts, rainbows and flower stickers.

My summer's good, all in all. HOT -- but reasonable.