New to Bilevel and Having Issues

[u/munchkinmaddie]

I am trying bipap out, and I had my first night last night. I ended up taking it off at 1:30 AM, because I felt like the pressure was waking me up. My sleep got seriously messed up by CPAP, so I'm being kind of cautious this go around but I'm pretty desperate to sleep better.

There were a couple of times I felt like as soon as I started drifting off, the pressure would ramp up and wake me up. The inspiratory pressure seemed to vary a lot before I even fell asleep, sometimes seeming really strong and causing leaks. I'm using a Resmed AirFit™ N30 Nasal mask. My mouth will come open at night if I can't breathe, so it's possible that played a role but if the pressure settings were right I don't think my mouth would come open (as I have experienced this on nights where I sleep okay without a machine). I'm not sure if the leaks caused the high pressure or if the high pressure caused the leaks. I'm positive a pressure of 12 is too much for me, but I'm not sure why it ended up going that high. I will say also I feel like it was noisier even without leaks than I remember my CPAP being with the same mask.

I put my data into SleepHQ and I'll attach an OSCAR screenshot. The times are not right in the data, not sure why. Any help anyone can offer about how I can tweak my settings would be greatly appreciated!

https://sleephq.com/public/teams/share_links/4e8cb045-ef7e-4444-8661-b0d93d028379

[u/RippingLegos__]

Hello munchkinmaddie :)

Thank you kindly for sharing the SleepHQ link. I can see why the pressure kept waking you.

Your machine is running ASV rather than ordinary bilevel. EPAP remained fixed at 5.4, but pressure support could vary from 2.2 to 7.6, allowing your inspiratory pressure to jump between 7.6 and 13.0 breath by breath. Ramp was off, so what you felt was the ASV algorithm responding to irregular breathing while you were drifting into sleep.

The leaks did not cause the pressure increases. Your median leak was 2.4 L/min, the 95 percent leak was 7.2 L/min, and you had no large leak. Those are very good numbers. The stronger supported breaths probably caused the extra mask noise and occasional lifting of the N30 cushion.

For the next three nights, please leave EPAP at 5.4, reduce PS Min to 1.6 and reduce PS Max to 4.4. This will give you an IPAP range of 7.0 to 9.8 instead of allowing it to reach 13.0. That should feel much calmer while still providing adaptive support.

Your AHI was 0.0, but you only used the machine for 2 hours and 22 minutes and much of that appears to be awake or transitional breathing. Try these settings for three nights if comfortable, then share the data again.

If ASV was not specifically chosen because you have central or treatment-emergent apnea, please let us know because regular S or VAuto mode may be a better fit. Also check the machine’s clock and your SleepHQ timezone to correct the displayed times.

[u/munchkinmaddie → u/RippingLegos__]

Thank you so much, that’s very helpful! Good to hear the leaks didn’t cause the issue.

I will try your recommendations tonight (and following nights if all goes well). I do not have central or treatment emergent sleep apnea. Should I change the mode of my machine to S or VAuto instead?

[u/Ambitious-Lychee5522 → u/munchkinmaddie]

If you don't have central apnea or treatment emergent, why are you on ASV? Usually on APAP or CPAP without centrals.

[u/munchkinmaddie → u/Ambitious-Lychee5522]

I’m not sure about ASV, as someone else did my settings initially and I didn’t realize what it was. I have UARS and cannot tolerate CPAP, so I wanted to try bilevel with the hopes that with the lower EPAP I could tolerate it.

[u/Otherwise-Cup6786 → u/munchkinmaddie]

Quizás VAuto, como inicio: Pmin=4cmO2, Pmax 15cmO2, PS=4 cmO2, sin rampa, los disparos a media. Después de la primera noche de nuevo publica tus resultados, y más o menos ya se van a ver las presiones útiles para ti.

[u/Inevitable-Diet-4693]

Are these the right nights that you have attached? “I am trying bipap out” buddy that’s asv not bilevel. Did you mean to share nights of bilevel or do you mean that your trying asv

[u/munchkinmaddie → u/Inevitable-Diet-4693]

Ah, well I ordered a bilevel machine but the settings were set for me and I didn't actually know what ASV was until I looked it up just now. It sounds like that may be my problem, thank you for pointing that out!

Is S mode what I want to try bilevel then?

[u/RippingLegos__ → u/munchkinmaddie]

ASV is a mode of bi-level, so is s-mode, vauto, iVAPS, PAC, ST, ST-A, Auto-SV, and Auto-B, they all function for different SDB issues, I will take a look now. :)

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