new bipap auto machine

So I've been trying an oral appliance for about nine months. I've gotten to the point where I feel good but not good enough. I had a sleep study done with it in and it brought my ahi to a 9.8 from 44 without. I went to my sleep doctor and he suggested we go to a bipap machine. So far it has been a week I'm averaging a little over six hours a night but my ahi is at 14.6. I have a follow up with my doc and the dme in 3 weeks should I try to get in sooner or keep at it? I am more tired than I was with the oral appliance and it is very frustrating like I am going backwards but I was extended as far as I could with the oa.

Any suggestions?

Dolpp wrote:So I've been trying an oral appliance for about nine months. I've gotten to the point where I feel good but not good enough. I had a sleep study done with it in and it brought my ahi to a 9.8 from 44 without. I went to my sleep doctor and he suggested we go to a bipap machine. So far it has been a week I'm averaging a little over six hours a night but my ahi is at 14.6. I have a follow up with my doc and the dme in 3 weeks should I try to get in sooner or keep at it? I am more tired than I was with the oral appliance and it is very frustrating like I am going backwards but I was extended as far as I could with the oa.

More information would be helpful if you want answers.

Could you please define what you mean by "oral appliance"? Was that in conjunction with or in lieu of a CPAP-type machine?

What Bi-PAP machine are you using?
What are your pressure settings?
Do you have the software to monitor your therapy?

Please fill out your equipment profile.


Den

Medical History (Hx) is key to trying for figure how to proceed. That is all too often left out of forums but something the docs rely on.

So the question should include all medical Hx to guide the respondents.

Ok, I started with CPAP about 2 years ago. After a sleep study that I had an RDI of 27. I was put on a pressure of 10. I spent the first year with a not very knowledgeable DME. I would unknowingly take my mask off every night. Every once in a while i would wake up with it off and put it right back on but it got to the point where I would put it on before i fell asleep and i would wake up with it off and the machine actually turned off and i would have absolutely no recollection of doing it. Every time I asked my DME what to do he would just tell me it is an "adjustment period". After a year i decided this isn't going to work. I was feeling no better. So I hooked up with a dentist who specializes in oral appliances. He fitted me with an oral appliance "Herbst Telescopic Appliance". He was very knowledgeable and really felt I had a good shot at feeling better with the oral appliance because I am 5'8" 160 lbs. and a neck size of 15 1/2". After about 4-5 adjustments I was actually feeling better but not 100%, but we were advanced as far as we could go. We did another sleep study and my RDI was 9.8 with only the oral appliance. I never used the oral appliance in conjunction with the CPAP. So discussing with my sleep doctor he suggested we go to a bipap machine. No reason to wear the oral appliance and a PAP if we can fix it with just the PAP. So I had to have 2 sleep studies done (for insurance reasons)one without the CPAP to confirm sleep apnea and one with the BIPAP. The first one I did half the night without the CPAP but since my RDI was 44 the technician put the CPAP on me for the second half. They gave me a pressure setting of 8 it only dropped my RDI down to 12 at a pressure of 8 but 6 and 10 were way worse. Then i had the bipap study done for the whole night. My RDI was 9.0 at 12/8. 8.4 @ 14/8 7.4 @ 16/10. He put me on 12/8 which didnt really make sense to me but I didnt question him. The part makes me nervous is that this study was the first of my 4 total that had any central apneas. They started at a pressure of 12/8. The sleep doctor assured me that they would go away when i got used to the bipap.
I dont have any software im just using what the machine tells me and after about ten days I am averaging a little over 6 hours a night but my AHI is averaging 14.9. Do I just stay the course or try to get in for an "adjustment" of some sort.? I am keeping the mask on all night, but am really tired.

Did you get a copy of your sleep study? If you had Centrals, you need to know where they were showing up....(at which pressures).

You'll also need this:

https://www.cpap.com/productpage/respir ... eader.html

(Be sure to check the computer system requirements so you'll know it's compatible with what you have)


Den

Sounds like you need more pressure. Don't wait. They usually would use the lowest RDI to choose your pressure. I would ask why they chose the lower pressure. There might be a reason. Also sometimes when they try to "split" you they can run out of time. It sounds like they might have stopped short. Did they know your RDI was 10 with the oral device? My goal would have been to beat that RDI with the BiPAP by at least half (<5 being the standard goal).
Do you have an auto or single pressure BiPAP?

Wulfman,
I did get a copy of my sleep study. The centrals started at a pressure of 12/8 which is the pressure he put me at. It was 3.2/hr at 12/8. Then 1/hr at 14/8. Then 1.6/hr. at 16/10. Nothing before that or on any of the other studies i've had. I asked him why he chose that setting and he said that he felt that the centrals were occurring because I wasn't used to the bipap yet and that they would go away and when they did and I would be right in where I should be.

Big Daddy,
I do think that they ran out of time. I was at 1 pressure for only 30 minutes. I did let them know that I was at a RDI of 9.8 with the oral appliance and we need to do better and he assured me that those centrals would go away when I got used to the bipap and we would be under 5.
I have an auto bipap but i'm not currently using it on auto, it is at a setting of 12/8.

Even those number look better as you go up. 16/10 being the best from the info you have provided. Do you have heart or lung disease? Were oxygen desats a problem? You might try getting the software to download your data from your BiPAP. Then try to titrate yourself. This is something people in the forum do often. It would be against most doctors recommendations.

Are you willing to take responsibility for your own titration?

You will need to get the software to be able to see if you cause central apneas by increasing your pressure. This seem to have been the concern.
I would do some reading before I tried but certainly it has been done before with success.

Going by what you are saying, it doesn't sound like the doc was all that worried about those few pressure-induced centrals, so I see no reason you should be. Find the pressure that gets you feeling better but with the lowest number of "apneas" and "hypopneas" on your machine, I say. Tweak a bit. Dial it in. Then let it ride. Breathe and sleep.

A few other things you can do . . .

According to your sleep study, were most apneas on your back? If so, rig something up to stay off your back. (A kid's bicycle helmet with a belt through it, up against the shoulder blades with the belt up under your arms, for example.) Train yourself to stay off your back then you won't have to wear it but once in a while.

If you need to, just get the pressure where you are most comfortable with it so you can get in the habit of wearing it all night, then dial in the right pressure if you need to take it slow.

Take it easy if you need to, but take it. It ain't worth playin' around with your life.

You are in the right place. Don't get sick of us. We will continue to throw ideas at you until you tell us to stop.

jeff

I am willing to start titrating myself. I think I have to take more control in my therapy. That is why I tried to get what i thought was the most sophisticated machine I could. I ordered the software last night. How do I get started? I am a type-A personality and will research the hell out of this. I did ask the doctor his opinion on software and he brought up a good point he said, when we have a sleep study done we are hooked up to 30 plus wires and constant supervision and we have trouble what is an apnea and what is not. How can this machine through 1 hose get any kind of reliable information? What do you guys think about that?

All of the apneas were on my back because that is how I laid during the sleep study because it was impossible to lay on my side or stomach with all those wires and the mask on my face. Normally I am a stomach sleeper but i have trouble exhaling with the BiPAP when I am on my side or stomach and when I lay on my side or stomach the next morning I have a stomach full of air that is very painful until the afternoon. I'd rather sleep on my stomach. But don't want to deal with that. Any suggestions?

I also have waken up a few times throughout the night with an extremely dry mouth. Is that indicative of opening my mouth during the night? My nose isn't stuffed up or anything. Any suggestions. I don't know that I can bring myself to tape my mouth shut.

I got eight hours of sleep with the mask on last night and I am exhausted today. My AHI (on the readout of my machine) is up to an 16.4 average. My original diagnosis was 27. I might as well just not wear the CPAP. Any suggestions?
I also woke up with a dry mouth in the middle of the night.

A dry mouth IS, as you say, an indication you are opening your mouth and losing the therapy that way. Taping is an option. A few have success with a chin strap. But many mouth-breathers end up with using a full-face mask. Have you tried that?

Find some joy in the fact that you used it eight hours. Training your brain that way is part of the battle. Things will not fall fully into place until you have the right mask, low leak, and the right pressure all night, however.

It is true that a home machine may count some events as hypopneas that would get ignored in a sleep study. Home machines don't so much miss apneas and hypopneas (unless there is large leak), they just sometimes count changes in breathing as hypopneas that might not meat the definition used in a sleep lab. That's OK. The information from home machines is meant to be used as TRENDING information to see if a change helps or hurts over time. You get the best numbers you can and then judge by how you feel.

Please don't get discouraged. Start the process of solving problems one at a time. Priority one is stopping mouth leak, so ignore AHI and focus in on the leak. Getting leak down may mean tape, strap, or full-face. You can always rig up a home-made chin strap to try that first. If that doesn't do it, full-face may be the way to go. If you can't find one of those that does it for you (and mask comfort is a very individual thing), a nasal interface with mouth-taping my be something to try.

Sleeping prone may be possible using what many here call the "Falcon" position, if you want to search that here.

Hang in there. You can make this work. You are already making progress. Keep at it.

jeff

I got the software and installed it today. I downloaded my information from my card and the only information that comes up is how many hours i used it each night and my pressure each night. I couldn't find anywhere else to get anymore information than that. Please tell me I didn't spend $140 to get less information than my machine already tells me......

Nevermind, I found it all. I was trying to scroll down and didn't realize you had to go page by page. So, pretty much all of my apneas were centrals. In the two weeks i've been using this I am at an AHI average of 15.0/hr. 1.4/hr obstructive and 13.6/hr CA. Recommendations? I am on straight BiPap. 12/8.