Still struggling with bipap

Hi Pugsy and all. I’m getting worse. 2 nights ago I had an AHI if 8.6. 38 central. 20 some OA and 28 hypopnea. Last night was AHI of 13 but DreamMapper isn’t updating so I don’t have my specifics. My husband isn’t available to download data TIL tomorrow but I’m so discouraged. I did better on a steady pressure of 19 or so and am wondering if I should just go back to that. I was averaging 5-8 and one time even had a 1.6.

To add- I am still set at 19-25.

You keep reporting AHI but omit if you are sleeping well, crappy, fragmented, etc.

The AHI doesn't tell me squat when I know the person is often having insomnia issues.

Sorry. I felt I slept pretty well the last 2 nights. Today I feel awful- tired and headachy.

A little less than 50% of your AHI is central in nature....we can't do much about them anyway.

It makes no sense that you could have a night with AHI of 1 or 2 at 19...and then these nights with such high AHI.

Bilevel like you have is nothing more than apap with higher maximums that it can go to and of course the wider range in the PS..pressure support or difference between inhale and exhale.
I would have really liked to see that apap report where you just used 19 cm and got a nice low AHI.

Want to make the bilevel function like an apap??? We can do that....minimum 19...change PS to 0 minimum and 0 maximum...and let the max IPAP be 25...then it would function like an apap except it can go to 25 instead of 20.

I have been wondering just how much that PS might be a factor in your centrals anyway....I just didn't know if you could handle EPAP of 19 without some exhale relief.

Thanks Pugsy. I will try that tonight. I really have to wonder if my long-standing insomnia has been causing a lot of my variations. It’s been under control with meds for years but I think adding a mask has brought it back. Unfortunately the AHI of 1 was on my previous machine - the resmed Cpap so I can’t get the data.

Hi Pugsy,

Here are my last 3 nights. The first night I felt like I barely slept at all. The second night I felt that I slept ok but not great. Last night I slept well but woke up at 5:00 am and couldn't get back to sleep.

Refresh my memory please....have you ever had an in lab sleep study where there was a tech and you were using the mask and machine?

Try turning PS off...set the minimum to 0 and the maximum to 0.

No my test was without mask and I scored 67. Last night I did the PS O and O.

So you have never had an in lab sleep titration study where a tech figures out what your optimal pressures are???

You need to get with your sleep doctor...this obviously isn't working like it should.
You need an in lab sleep titration sleep study IMHO. This obviously isn't working like it should. It's not normally this difficult to get things dialed in.

No I’ve never had that. He just started me with APAP 5-15. When that was giving me AHIs of 4-7, he decided to try bipap andthats when everything started to go downhill. I see him May 16 and have to buy a machine at that point as I’ve been trialing since October.

You may need an ASV machine to beat the centrals.
I know I can't handle pressures over 18 and usually stay under 12.
My AHI has been bouncing around this year while I was getting used to my new machine and also had a respiratory infection. However I have had 2 zero AHI days as well as a couple over 10.

I agree with Pugsy, you probably need a good in lab titration study where they also consider ASV.

Needing 25/19 means that it is very obstructive. It may also be positional, like tucking your chin to chest. I would suggest a $10 foam cervical collar, to see if it help to diagnose what is happening. It will have an instant result if this is an issue. If you can then reduce the pressure, it may help the CA. I assume they weren't there in your sleep study and are new user pressure induced and may resolve over 12 weeks. Down the track your doctor may want to do a sleep study for a ASV machine if the CA don't resolve. The obstructive have to be fixed first, before an ASV is considered, either now or at the sleep study.