Feel worse going from cpap to bipap

[mda74]

Has anyone had a bad experience going from cpap to bipap for OSA? My cpap was on a 14, but was taking my mask off all the time and my dr wanted me on a higher pressure so did another study and her thought was going to a bipap would allow her to get a higher pressure.

She went to 17/13 pressure. The first night i felt like I was hyperventilating with all of the air being forced in on the inhale. It just seemed very forced to me and I think it triggered some anxiety as well. She went down to 14, 15, 16 levels to try and work up but seems whenever I get above a 14 or 15 (inhale) I feel like crap the next day. My AHI on cpap (when I had my mask on) was almost always under 5.. many times 3-4. I'm now seeing my between 6 and 8 and on the bipap.

Just curious if it's worth it to stick with it, or just go back to cpap.

Thanks

[Miss Emerita]

Could you tell us a little more about the settings on the two machines? In particular, can you give us this information:

Airsense 10:

min =
max =
EPR =

VAuto:

min EPAP =
max IPAP =
PS =.

If you don't know what your settings are on the VAuto, here are the instructions for getting into the clinical menu, where you will see them:

https://www.apneaboard.com/resmed-airse ... setup-info

[mda74]

Airsense 11:

min = 14
max = 14
EPR = 3

VAuto 11:

Mode: S
EPAP = 13
IPAP = 16
PS = No PS Setting on "S" mode
Easy Breathe: ON

[vandownbytheriver]

Airsense 11:min = 14 max = 14 EPR = 3

VAuto 11: Mode: S EPAP = 13 IPAP = 16
PS = No PS Setting on "S" mode
Easy Breathe: ON

Easy Breathe is important... so glad that's turned on... with your old settings you were in effect 14/11, EPR 'ducks' the exhale instead of 'pushing' the inhale. You did not get a lab titration for bi-level? That's a shame... but it is expensive.

Try a night at 14/11cm S mode and see if it feels more familiar... Easy Breathe is better than EPR IMO. You can work the pressure up from there, maybe 16/13 is good but won't help if you can't stand it. Using SleepHQ, Oscar, or both will help you see what's going on with your pressures and therapy.... SHQ is best for sharing links here, I do both. Let us know how it goes.

[mda74]

Thanks. I did have a bipap study and the tech said he was comfortable with me around 14 or 15 IPAP. But the dr then ordered 17.

Either way.. I feel better on cpap I think. I even set the Bipap on Cpap mode last night at 14. I could still feel a difference in how the Bipap worked on cpap mode vs my cpap. I could hear a whirring in the motor and just felt it pushing more on the inhale, which I don't like and I think it messes with my head/body. So I then got up and switched to my cpap machine at 14 and I could tell a difference. I did also lower my epr to 2 on my cpap last night.

Also as a side note. In the last week since I got the bipap I have been having a bunch of heart palpitations during the day. I would have them occassionally before, but not every day. This is multiple times a day.

I use Sleephq. Here are links.

bipap 16/13 (felt like crap the next day)

https://sleephq.com/public/9af6ea54-cfc ... e420829921


cpap 14/ep2 2 (feel better today)

https://sleephq.com/public/99d42564-c19 ... a2d4885d2a

[mda74]

If you zoom in on breathing chart on each one, you can see that the inhale and exhale levels are much higher on the bipap. So it's like the bipap is forcing me to take bigger breaths or something. I don't think my body likes that and maybe that's why I have the hyperventilating feeling.

[vandownbytheriver]

Thanks. I did have a bipap study and the tech said he was comfortable with me around 14 or 15 IPAP. But the dr then ordered 17.

Thanks doc! Mine did the opposite, the tech said 21/17 was good, doc specified 21/17 PS 3, which I immediately changed to PS 4. I tend to go with the study's findings myself.

Either way.. I feel better on cpap I think. I even set the Bipap on Cpap mode last night at 14. I could still feel a difference in how the Bipap worked on cpap mode vs my cpap. I could hear a whirring in the motor and just felt it pushing more on the inhale, which I don't like and I think it messes with my head/body. So I then got up and switched to my cpap machine at 14 and I could tell a difference. I did also lower my epr to 2 on my cpap last night.

You're needing more support as shown by the big FL problems around 12:22 on CPAP. The report from your bi-level is all screwed up, the pressures don't match the settings... it may be that SleepHQ has a problem, the mode is UNKNOWN? Setting 20/10 PS 5, but your pressure shows to be 16/13? Perhaps you changed the mode and settings during the session?

If you zoom in on breathing chart on each one, you can see that the inhale and exhale levels are much higher on the bipap. So it's like the bipap is forcing me to take bigger breaths or something. I don't think my body likes that and maybe that's why I have the hyperventilating feeling.

Yes, that's shown by the Tidal Volume graphs, the bi-level is pushing you toward 500. Supposedly you've got vAuto on, so Easy Breathe should be on by default... hard to tell from the Unknown mode thing. If you're in S mode Easy Breathe is default OFF, this is not comfortable for me and sounds like what you're experiencing, big pushing on inhale. In addition you're on Nasal mask setting... this can be treated as a comfort setting, changing to Full-Face will soften the inhale push a little... if you want more, then Pillows will hit you hardest.

[mda74]

You're needing more support as shown by the big FL problems around 12:22 on CPAP. The report from your bi-level is all screwed up, the pressures don't match the settings... it may be that SleepHQ has a problem, the mode is UNKNOWN? Setting 20/10 PS 5, but your pressure shows to be 16/13? Perhaps you changed the mode and settings during the session?

Did not change any setting in the session. And after I got the machine I changed the mask type to Nasal because that's what I use. Not sure how much of a difference that would make, but could try it.

I had more pressure support with the Bipap (16 vs 14), but my AHI was worse. I just know that the pressure is a fine balance of comfort and therapy. I am known to tkae my mask off several times in the night so not sure I want to keep bumping pressure. Would consider my cpap night "bad"? The AHI was well under 5.

[Miss Emerita]

Did your doctor explain why she thought you should have a higher IPAP?

I'd suggest you put your VAuto in PAPVAuto mode and use settings that emulate your Airsense machine:

EPAP min = 12
IPAP max = 14
PS = 2.

For full emulation, turn off ramp and Easy Breathe. (One thing this change of mode should do is allow you to see flow limitation data.)

This is just to get you comfortable with the VAuto machine. Once you've used it a few days, it will be possible to try some modest changes, depending on what your charts show.

About that period of heavy snoring and flow limitation: did you roll onto your back, do you think?

I think many people on this forum regard a treated AHI of 2 as good and 1 as excellent. I'm guessing the UAs from your Airsense chart are OAs; that makes your OA index around 4, which is in need of improvement, I think. And OA + UA index on the Aircurve is around 7.5, which is definitely too high.

Your OAs (plus UAs) tend to be clustered. This suggests you may sometimes be tucking your chin down toward your chest, which can slightly narrow your airway, making it easier for OAs to happen. If you use several pillows, or a high pillow, try using one low, fairly firm pillow instead. Some people have excellent results from using a soft cervical collar.

[mda74]

Apprecate the feedback. Yes, I am most comfortable on my back. I try to sleep on my side, but I can only do it so long. In fact I can spend about an hour on my side and be unable to get to sleep and I have to finally go on my back to get to sleep.

I will look into my pillow.. it's a fairly substantial pillow, but it's the memory foam stuff. It's called the Coop pillow. I wil maybe experiment with another pillow.

As far as the Bipap I honestly felt so bad a few days trying to use it that I'm wondering if it's even worth it at this point. The main reason was for my Dr to try and get me to higher levels. But from what my body is telling me, it does not like the separate inhale/exhale pressure of a BIpap. Physically and psychologically it feels forced to me. Like the machine is telling me when/how to breathe. Everyone is different.. that's just my feeling so far.

[mda74]

Was watching this video posted by SleepHq guy on youtube. Really interesting stuff if anyone wants to check it out. The first 20 min or so.

The speaker talks about how raising pressure on IPAP isn't always a good thing. He cites studies showing Cpap, and more so BIpap can cause hyperventilation, as well as CAUSE central apneas.

https://www.youtube.com/watch?v=epXcTkchLXY&t=2380s

[robysue1]

Do you know the Trigger and Cycle settings on the VPAP?

They work with EasyBreathe to fine tune the way the bilevel machine transitions between IPAP and EPAP.

[Miss Emerita]

As far as the Bipap I honestly felt so bad a few days trying to use it that I'm wondering if it's even worth it at this point. The main reason was for my Dr to try and get me to higher levels. But from what my body is telling me, it does not like the separate inhale/exhale pressure of a BIpap. Physically and psychologically it feels forced to me. Like the machine is telling me when/how to breathe. Everyone is different.. that's just my feeling so far.

This is why I suggest emulating your Airsense settings on the Aircurve as a baseline for any further revisions to your settings. It will be just like what you have on the Airsense; then we can try to go from there in treating your OAs and flow limitations.

Also, robysue1 asks a great question about your Trigger and Cycle settings. Could you let us know?

A minority of people will see an uptick in central apnea (clear airway) events if they use EPR or PS. Often this will settle down with a bit of time. This is definitely not a reason for you to opt out trying the Aircurve VAuto at this point.

[vandownbytheriver]

I'd suggest you put your VAuto in PAPVAuto mode and use settings that emulate your Airsense machine:

EPAP min = 12
IPAP max = 14
PS = 2.

For full emulation, turn off ramp and Easy Breathe.

You can't turn off Easy Breathe in vAuto... it's part of the mode IIRC. Pretty sure they won't like it without EB.

https://www.respshop.com/manuals/37212_ ... n_menu.pdf

Page 13.

[Pugsy]

If it were me I would start with varying the "trigger" settings to see if one of the other choices matches my respiration better.
If no luck there then maybe look at Ti max,
I don't suggest that people go messing with Ti min though..