BiPAP: Great Numbers, Super Dizzy

First, thank you guys! This forum is a gold mine. I'm learning a lot here. After reading many posts and making several adjustments, my therapy, at least in terms of the numbers, appears to be great.

But during the last two nights, when the great numbers finally appeared, I was extremely dizzy in the morning—about 7.5 on a 1-to-10 scale. On the other nights, I always felt like "I didn't sleep well," so I kept reading the forum and making adjustments. Now that I finally have great numbers, I feel so dizzy that I'm almost ready to quit PAP therapy.

Last two nights: (flow limitation does not show in OSCAR for Bipap S mode, but manualy zooming it's very low)





So, very low numbers.

For context:

In 2010, I did a sleep study when I was 23 years old:
- 0 AHI, RERA 10.8, and they had a different metric for "brief awakenings per hour": 33.4/h
- SpO2 min 97%, SpO2 max 98%, PML 13.5

No PAP therapy was given.
After 14 difficult years...

In 2024, I had another sleep study:
- 17.8 AHI, with 35.8 AHI during REM and 13 in non-REM
- SpO2 min 91%, SpO2 median 94%, PLMS 3.3, Bruxism 8.5/h (14.7/h in REM)

**Current Settings:**
- BiPAP-S mode
- EPAP: 3
- IPAP: 6.6
- PS: 3.6

I found that EPAP 3 just solves my apneas and hypopneas.
- With PS 4, I started having lots of Clear Airways events.
- With PS 3.6, using a medium trigger and cycle, I still had many clear airways.
- With PS 3.6, trigger set to "Very High" and cycle to "Medium," the clear airways seemed to be resolved.

I started with APAP and was experiencing lots of flow limitations. EPR 3 helped a lot, but didn't completely solve the problem, so I moved to BiPAP. PS levels of 2.2, 2.8, and 3 didn't resolve the flow limitations either.

I'm thinking I might be experiencing a mix of hyperventilation and hypoventilation at different times, and I'm unsure what else to do...

I'm posting a zoomed-in view of the last 30 minutes of my night:

10m zoom:


Wave format zoom in:


Does anyone have any suggestions? I'm really feeling hopeless about what to do next. I actually feel better without any PAP device than with it. I would be very grateful for any help—I'm almost giving up.

Welcome! While PAP therapy can occasionally affect the middle ear and causes dizziness, that side-effect shows up early and resolves on its own, or that's my understanding. So I suspect you're feeling dizzy for some other reason. How exactly do you feel? Light-headed? Disoriented? Unsteady on your feet? Spinning in space?

I think it'd be good if you (and we) could take a look at your FL graph. Change your mode to VPAPauto and use these settings:

min EPAP: 3
max IPAP: 6.6
PS: 3.6.

This will give you the same therapy you're getting in S mode. Don't change any of your other settings. Go ahead and do that and then post another chart, one that includes FLs.

For what it's worth, your respiration rate looks normal to me. It will vary throughout the night. (Mine usually goes up during REM sleep, for example, and it's often lower than the median when I'm awake and waiting to get back to sleep.)

churras wrote: ↑

Thu Nov 21, 2024 11:25 am

But during the last two nights, when the great numbers finally appeared, I was extremely dizzy in the morning—about 7.5 on a 1-to-10 scale. On the other nights, I always felt like "I didn't sleep well," so I kept reading the forum and making adjustments. Now that I finally have great numbers, I feel so dizzy that I'm almost ready to quit PAP therapy.

Not everything is about OSA and CPAP.

Dizziness and vertigo are not the same thing. And each of them are symptoms of a whole bunch of non-OSA/non-CPAP related issues, including upper respiratory infections like head colds, flu, and COVID.

Also: When you say "dizzy" do you mean light headed like you are going to faint? Or do you mean the sensation that the world is spinning around?

If I were you, I'd assume the dizziness might be caused by something other than CPAP/OSA and I'd be calling my primary care doctor's office to and see if they could get me in as an "urgent" or "sick" appointment in case the cause of the dizziness is viral. I'd also expect a referral to an ENT to rule out a whole bunch of non-viral, but common causes of both dizziness and vertigo.

In my case, I started to have severe vertigo spells the same fall I started CPAP. It turned out that my migraines had become chronic and were manifesting themselves through migrainous vertigo. Getting the vertigo under control required getting the migraines under control.

churras wrote: ↑

Thu Nov 21, 2024 11:25 am

But during the last two nights, when the great numbers finally appeared, I was extremely dizzy in the morning—about 7.5 on a 1-to-10 scale.

welcome to the zoo! i'm not an expert by any means, BUT! why not try the settings you used before the dizziness came and see if it disappears?

you say that brought on CA events. I dunno how badly those were nor how long you've been on therapy, but it happens when we start out. we get a boat load of centrals or clear airways that generally clear up over time.

in any event, good luck!

I got a heads-up from Pugsy, who notes that the lowest you can go in the mode I've suggested is 4. The option of 3 is available only in S mode. But I'd still recommend giving the new settings a try.

Eager to hear more about the nature of your "dizziness."