new biPAP auto SV user needs help

I can't sleep--it's after 5:00 am and I've been up for over an hour. And my sleep so far tonight has been intermittent at best. This is my first night on my new Respironics biPAP auto SV and it's not going well.

Before tonight, I had been using the Resmed Elite CPAP for about four months. My therapy with it was not successful because of centrals and untreated hypopneas and RERAs. (Increasing the pressure enough to eliminate the hypopneas and RERAs provoked centrals.) The centrals appeared on my original CPAP titration and my doctor noted in her report that I might need to switch to the ASV after a CPAP trial. She was right; I had an ASV titration a few weeks ago.

The problem tonight has been that the periodic bursts of pressure seem to wake me up more than I normally wake up. It seems once I get relaxed and am drifting off to sleep, along comes a burst, and I wake up again. Also, the bursts are also causing more leaks with what was a very successful mask (Resmed Mirage Quattro FFM) with my Resmed CPAP.

Will I just need more time to adjust, or is it possible my settings are wrong? My ASV titration went pretty well. Although I woke early during the titration, the tech said I slept enough for her to get what she needed. So I figured the prescribed numbers are probably accurate.

As a footnote, I started a very low dose of an SSRI several weeks ago, and I think it could be contributing to an already long-time problem with insomnia (in the form of early morning awakenings). Maybe I need to drop the SSRI . . . just don't know. I have seen some benefits from it and no negative side effects other than the increased insomnia.

Thoughts or ideas from ASV users or others?

wearysoul

Wearysoul, in reference to your post. I have been on cpap since 10/07, no positive out come. July 09 felt like I was going to die, no energy, could not sleep for about three days. Went to my doctor, long story short after titration got new bipap auto w/humidifier. Setting five exhale, inhale nine. Did not work just gave me more centrals, which by the way were noted on the titiration but were ignored. I was made aware of this from the RT on my most recent visit on 10/26/09, still waiting for the results from this one. I made some adjustment on my bipap auto last night, inhale 12, exhale 8.5. Was able to sleep, but had arousal about every two hours. Bottom line, if you don't have a good Dr. your treatment is going to be hit and miss or mostly misses like me. I've gotten positive advice from this forum. Just stick with your treatment and keep posting, there are many knowledgeble people on this site. My rating for this site is five stars.

I also use a biap auto sv. I found that for me, I needed to raise the head of my bed about 30 degrees. You can put a couple of old phone books under the legs of he bed at the headboard. I also found that there is an adjustment on my bipap that controls how fast it tries raise pressure that helps. My prescribed pressures are a little higher than yours (12 cm for me). It took me a couple of nights to adjust to the sv part, perhaps you are having a number of centrals too where the sv kicks in to help. I find that sometimes I don't synchronize with the machine and it wakes me up.

I think we all have times when it is hard to sleep for reasons other than the sleep apnea. I hope that things get better for you soon.

I am using exactly the same equipment as you; Bi-PAP AutoSV + Quattro. Your pressure range from EPAP-8 to IPAP-30 is pretty big. I would encourage you to talk with your doc about that. I don't know enough about pressures to venture an opinion beyond that. Maybe some of the pressure gurus here can chime in on that.

As for the "burst" waking you, I get that. I had/have that issue also. I think I've got some posts here with a similar question this past summer. Hang in there. You will adjust to that. It will take some time. Keep reminding yourself that you need this therapy to be healthy and that you will get used to it. I'm in month #5 and it's still not great for me, but it is much better for me than back in June.

Best wishes,
Tony

qjosea, After last night (and the last four months), I can appreciate your struggles. I wonder if your bipap auto is a bipap auto S/T? That was an option that was mentioned for me in my original CPAP titration. My DME later told me that it is a step down (that is, less sophisticated) from the auto SV. The doc decided I needed an auto SV. So I wonder if you may also need the more sophisticated auto SV.

DLDean, I tried raising the head of my bed when I was using a CPAP, but it didn't seem to help. I may try it again with my auto SV. Last night I discovered the "rise" feature you mentioned. Increasing the rise is supposed to increase comfort; I increased it from 2 to 4. Could not tell that it made much difference, though. I may now increase it to 6.

tonycog, Your question about the pressure range is a good one. I had wondered about that myself. I certainly hope I'm not having events that require a pressure of 30 for resolution. I will email my doc. I will read your thread from this summer. Have you had leak problems with your Quattro? I had been doing very well with mine (only had it a few weeks), but it became problematic last night with the auto SV. It squeals/leaks when I get a pressure burst. Maybe I just need to tighten the straps more. They already feel pretty tight.

Many thanks to you all for your replies. Any other ideas and thoughts from ASV users or others?

wearysoul

wearysoul wrote: I will read your thread from this summer. Have you had leak problems with your Quattro? I had been doing very well with mine (only had it a few weeks), but it became problematic last night with the auto SV. It squeals/leaks when I get a pressure burst. Maybe I just need to tighten the straps more. They already feel pretty tight.

For me, the Quattro has been the best for leaks. When lying on my side I get virtually none. Remember with your headgear that tighter is not always better.

As for my thread about the "bursts" of pressure, I think I wrote about being "startled awake". I don't remember any specific suggestions that helped with that, but I do recall encouragement to hang in there. But I have gotten used to the pressure increases to a great extent. It's still not ideal, but is still improving. For about 2 months, I resented bed time. I felt as though my 'fortress of solitude' - sleep - had been stolen from me. I would lie in bed for quite a long time, masked up and with the light on and just be angry that I had to wear a mask in order to sleep safely. That doesn't happen anymore (much). It's all part of a big adjustment that will happen. You will sleep well again and you will adjust to a mask.

Be sure to contact your doc about the pressures. Have him/her check your data also.

Best wishes,
Tony