My Experiment: From AutoBPAP to CPAP & Not Sleeping on Back

I began PAP therapy a little over a year ago. My RDI (AHI) was 114.7 during the diagnostic, and I was titrated bilevel 16/14, which got me through supine REM with few events. The doc changed that to 16/12 for my prescription. For the last month, I had been running my autobilevel at maximum IPAP 18 and minimum EPAP 10, with a constant pressure support of 4. My software shows that my machine was staying at 14/10 much of the night, but occasionally it would go up a little above15/11, never quite hitting 16/12.

My energy levels have improved over the year to the point where I can eat much better and be much more active. So I have lost about 30 pounds. I decided yesterday to celebrate by rereading my sleep studies from a year ago and trying to figure out what the next step might be. I noticed in rereading that I stayed on my back all night during the titration. I also noticed that my numbers didn't look all that bad at around 11 cm CPAP during the titration. So I decided to experiment last night. I switched my machine from VAuto mode to CPAP mode, 11 cm straight, and I ran a belt through two sandals and used that rig as a way to keep me off my back all night. I then slept comfortably more than 8 hours that way.

This morning my numbers looked pretty amazing for me, considering it is a ResMed. My AHI was 4.6 including my AI of 0.2. I felt rested and got more than 8 hours sleep. That was just one night, mind you; I still have to see how the week goes. But I wanted to see how I would do on straight CPAP to make sure I could sleep OK that way, in case I can get my PCP to write me an Rx for CPAP (instead of bilevel) so I can start looking at inexpensive travel machines with battery backups and the like.

I was surprised I didn't miss the feel of bilevel. And I was surprised that leak seemed lower and easier to manage.

Just wanted to share my experience in case anyone has any observations, ideas, or thoughts. How odd is my approach to all this stuff? Am I missing anything that I should be thinking about, or should have thought about a long time ago?

All posts welcome!

JNK

Your comments hit on an interesting theme & that is that after successfully going on therapy your 'feeling good' has allowed you to lose weight & that in turn is altering your circumstances in that you can handle more variations of the therapy.

I have been wondering for a long while now if it takes a couple of years of consistently successful therapy to get our 'attitude' (mind) into a good frame which in turn boosts our ability to better manage our eating & exercise.

Having done similar I am finding everything changing in ways I wasn't expecting. My GERD problem seems to have gone away - had an endoscopy last week after visiting specialist to discuss possibility of GERD operation. His comment to me after the endoscopy is you are fine & everything looks pretty good & I don't need any op & may not even need the GERD medication any more ! (haven't had a Pariet tablet for 3 days now).

It will be interesting to hear from you in time as you progress with your success. I am thinking you will be telling a story of greatly reduced symptoms & greatly improved health & wellbeing.

DSM

Thanks for your comments, DSM.

I feel a bit bold deciding to come off bilevel and onto straight CPAP, all on my own, and I feel a little embarrassed about not noticing just how positional my apneas were before. But I figure I ain't learnin' nuthin' if I ain't experimentin'. I guess I'm more of a dial-winger than I thought I was.

Reading all the comments here about people eventually moving away from APAP, and many even moving away from using exhalation-relief comfort adjustments like flex and EPR, emboldened me to see how I would do with a straight pressure. Maybe tonight will go lousy and I'll end up going back, but I was just amazed how easy it was, now that I'm used to breathing against pressure.

And I've told enough people over the last year about rigging something up to keep them off their back that you would think I would have tried it myself before now!

I expect you will continue to see good numbers by not sleeping on your back and from using a straight CPAP pressure. I had very poor numbers sleeping on my back, and have very good numbers sleeping on my sides. Additionally, I did an Auto pressure range for my first month before switching to straight CPAP. With the Auto, my nightly numbers were all over the board and I could not figure out if what I was doing lowered or raised my numbers (AHI and time-in-apnea). Once I switched to straight CPAP, I finally started to see some cause and effect relationships and could confidently make changes that resulted in my numbers going lower and lower and my feeling more rested in the morning.

I suspect that many forum members are interested in your experiment so please let us know how things are progressing.

Glad to hear that, Jeff.

Den

cinco777 wrote:I expect you will continue to see good numbers by not sleeping on your back and from using a straight CPAP pressure. I had very poor numbers sleeping on my back, and have very good numbers sleeping on my sides. Additionally, I did an Auto pressure range for my first month before switching to straight CPAP. With the Auto, my nightly numbers were all over the board and I could not figure out if what I was doing lowered or raised my numbers (AHI and time-in-apnea). Once I switched to straight CPAP, I finally started to see some cause and effect relationships and could confidently make changes that resulted in my numbers going lower and lower and my feeling more rested in the morning.

I suspect that many forum members are interested in your experiment so please let us know how things are progressing.

Glad to hear of your success, too.
Now you know why I keep TRYING to get (mostly "new") Auto users to switch to CPAP mode to see what happens.


Den

OK, Den, I finally get your message.

And Happy Forum Anniversary to you, too.

jnk wrote:...I stayed on my back all night during the titration...

In my split study, they made me start sleeping (or as close as I got) on my back (favorite position) then switch to side. After identifying I really had events, mask-up and sleep on my back...can't remember if they then switched me to side, I'm thinking not as all my events were when I was sleeping on my back. Guess not all of us get tested the same way; I'd have thought given that apnea is positional for many of us that all sleep studies would check that. I was tested Aug '07, maybe you were tested earlier.

Wulfman wrote:Glad to hear that, Jeff.

Den

Thanks for being patient with us, Den. We eventually come around!

Second night of my experiment week went well. AHI 5.9 and AI of 0.4. My breathing is different on CPAP compared to BPAP--higher respiration rate, lower minute volume and tidal volume, but still within normal limits, I think. Maybe all that will even out after a few weeks.

jnk wrote:I ran a belt through two sandals and used that rig as a way to keep me off my back all night. .

Just wanted to share my experience in case anyone has any observations, ideas, or thoughts. How odd is my approach to all this stuff? Am I missing anything that I should be thinking about, or should have thought about a long time ago?

All posts welcome!

JNK, you sick, twisted, guitar play'n, sleep study read'n, celebrat'n freak.

This cpap world is an odd place.
We wait for cpap equipment to be delivered like it was Christmas.
We tape, glue, wear panty hose on your head, slice and dice innocent pillows,
invent ingenious contraptions to house machines, hang hoses and prevent
one from sleeping on their back.

....so, I guess reading a sleep study to celerate isn't the least bit odd.

What would we do if we didn't have this cpap family to share all this with.
In my world, non-'papers, don't have a clue what I'm talking about.
When I do try to share some of my experiences, they kind of slowly move away.

Here is my contribution to your celebration.....

http://pajamapillowshirt.com/

You just keep thinking about it, no matter how odd....and whatever
you miss....well, someone else will catch it and let us all know.

Congrats! on all your accomplishments this past year.

Muse-Inc wrote:

jnk wrote:...I stayed on my back all night during the titration...

In my split study, they made me start sleeping (or as close as I got) on my back (favorite position) then switch to side. After identifying I really had events, mask-up and sleep on my back...can't remember if they then switched me to side, I'm thinking not as all my events were when I was sleeping on my back. Guess not all of us get tested the same way; I'd have thought given that apnea is positional for many of us that all sleep studies would check that. I was tested Aug '07, maybe you were tested earlier.

I was only tested last year. I had events on my side during my night of diagnosis testing, but I couldn't find a way to sleep on my side with the mask at my titration, so I stayed on my back.

Wulfman wrote:
Glad to hear of your success, too.
Now you know why I keep TRYING to get (mostly "new") Auto users to switch to CPAP mode to see what happens.


Den

I tried going to CPAP mode with mine. My AHI stayed exactly the same and it was harder to sleep with the higher pressure. Experiment over...

carbonman wrote: ....so, I guess reading a sleep study to celerate isn't the least bit odd. . . .

You mean I might be normal? I hadn't considered that option!

carbonman wrote: . . . When I do try to share some of my experiences, they kind of slowly move away. . . .

I've got some non-forum friends who are pappers, so I occasionally get to jaw about it. Others may ask me how my PAP therapy is going, but if I give any answer other than fine, their eyes tend to glaze over right away.

carbonman wrote: . . . Here is my contribution to your celebration.....

http://pajamapillowshirt.com/ . . .

But if I gave up my belt-through-sandals method, what would my wife have to laugh at every night?

carbonman wrote: . . . You just keep thinking about it, no matter how odd....and whatever
you miss....well, someone else will catch it and let us all know. . . .

I hope so. Seems to me if I can get decent therapy on straight CPAP, that would make the most sense, if I can handle it. CPAP may not exactly be natural, but it has to be more natural that BPAP, and if my only real problem is OSA, then CPAP seems the way to go. What I can't figure out is why so many of my events were called "mixed" in my diagnostic study. I guess it doesn't matter if the diagnosis was OSA.

carbonman wrote: . . . Congrats! on all your accomplishments this past year. . . .

I appreciate it, man. And back at ya. Let's make it another year, shall we?!

BeanMeScot wrote:

Wulfman wrote:
Glad to hear of your success, too.
Now you know why I keep TRYING to get (mostly "new") Auto users to switch to CPAP mode to see what happens.


Den

I tried going to CPAP mode with mine. My AHI stayed exactly the same and it was harder to sleep with the higher pressure. Experiment over...

I admit that I am using the ramp at 8 for 20 minutes.

jnk wrote: My breathing is different on CPAP compared to BPAP--higher respiration rate, lower minute volume and tidal volume, but still within normal limits, I think. Maybe all that will even out after a few weeks.

Minute volumes especially might be worth comparing.

Our bodies tend to regulate minute volumes toward adequate gas exchange for any given cellular mass or "biological load". CPAP essentially stents with static pressure. However, BiLevel tends to more efficiently ventilate each breath. That is as long as BiLevel does not happen to induce central dysregulation. Anyway, when BiLevel increases inspiratory volumes more efficiently than CPAP, lower respiration rate can maintain similar minute volumes because of those more efficient inspiratory volumes that are slightly larger.

CPAP does not help ventilate inspiratory volumes as well as BiLevel does. Rather CPAP is employed primarily to help stent upper airway obstructions. But your body still tries to maintain a similar rate of oxygenation or blood-gas exchange over time (minute volumes). So if CPAP relinquishes ventilatory efficiency formerly provided by BiLevel, then each inspiratory volume may be comparatively smaller. The body, in turn, tries to compensate for those smaller volumes by increasing respiratory rate. Thus more of those smaller volumes per time can still manage to adequately oxygenate that same body mass via similar minute volumes.

Your minute volumes thus should be more or less similar using those two xPAP modalities. They don't have to be identical for both xPAP modalities to work well. However, if there is a significant difference between CPAP minute volumes and BiLevel minute volumes, then closer scrutiny is probably warranted.

jnk wrote:What I can't figure out is why so many of my events were called "mixed" in my diagnostic study.

For some of us, supposedly, untreated obstruction can induce slight central dysregulation.

Enjoyed reading about your experimentation, Jeff. Kudos to you!