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WarpedTrekker
Unread post  Post subject: Do I really need a BIPAP?  |  Posted: Tue Mar 13, 2018 8:36 am

Joined: Sat Mar 03, 2018 9:29 am
Posts: 29
Location: Texas
PAP Mask: ResMed AirTouch
PAP Machine: ResMed AirCurve 10 vAuto
Pressure Setting: EPAP 5, IPAP max 16, PS3

Offline
My short story...
I'm 46yo. For years, suffered from anxiety/panic attacks, mostly during the day. Also suffered with tachycardia/palpitations and feeling groggy/tired all day. Was treated with meds for all of it. Had first sleep study back in 2007, but was negative. Doctors just thought i had Panic and Anxiety Disorder. Kept having minor attacks for years. In 2015, had a DVT/PE out-of-the-blue. Blood clot in my leg traveled to my lung. Doctor found gene mutation that made me slightly more susceptible to blood clots.

In 2017, panic attacks started getting worse, and I started waking up in my sleep with tachycardia 120bpm+. It seemed positional too. Sometimes if I woke up, my HR was okay, until I started to move my legs/arms and stretch. Then it shot up to 120bpm+ which I found odd. This would happen almost every time I sept or took a nap on the couch. I'd wake up, HR normal, but the minute I'd move my legs or reposition myslef, HR shot up to 120bpm+. Doctors again thought it was just anxiety, but I told them I DID NOT feel anxious. All I did was reposition myself, and HR shoots up.

My cardiologist had me wear multiple holter monitors over the years, and all came back normal. My cardiologist ordered Nuclear Stress Test, all good, and they couldn't find solution to tachycardia at night.

In early August 2017, had 2nd sleep study, diagnosed with "mild" apnea. I think my score was AHI 7. Started APAP 6-13, and felt great the first two weeks! Then started waking up again with tachycardia/palpitations. Woke up one night and my heart was beating wildly! Went to ER, and was in AFIB. Stayed in AFIB for 9hrs, self converted. My Cardiologist put me on Multaq. I also stopped all my other anti-anxiety med's, since those interfere with Multaq. I went to an electrophysiologist to talk about an ablation, but haven't gone that route yet. I find it odd they started me on Multaq(anti-arrythmic) med, just after having only one AFIB episode.

I kept feeling tired during the day, and still having issues in my sleep. My sleep doctor kept reviewing my AHI and said "all is fine" and that I was "doing good". She said I had AHI < 5 most nights. I started looking at my results with SleepyHead myself, and noticed I was still having some long apneas. 30-45sec, some CA as well. Was on APAP 7-14 EPR3, so reduced to EPR1, and that sort of cleared the CA's.

November 2017 -
I went to a new sleep doctor, since I kept having tachycardia again in my sleep. Diagnosed with "mild" again. Study showed CPAP didn't eliminate all events, and BIPAP did. I kept using my APAP machine to see if it would finally start working better.

February 2018 -
Went back to my new sleep doctor, told him still having tachycardia issues. Did another sleep study, they said again CPAP didn't eliminate events, and BIPAP did.

My last Sleep study results:
Total sleep time: 399min with 73% efficiency
REM latency shortened (0 minutes).
Arousal Index: 19.5 arousals/hr
Wake After Sleep Onset: 111.5min
Stage N1: 3.8%
Stage N2: 48.8%
Stage N3: 0% REM.

CPAP started at 6, and titrated to 12. CPAP failed to eliminate events.
BIPAP started at 14/10, and titrated to 16/12.
BIPAP most appropriate setting 14/10. At this pressure, AHI 0, RDI 0, Arousal 0, sleep efficienty 98%, SpO2 93%.
BIPAP eliminated events.




My main questions.....
1. Doctor set my BIPAP to a range of 4-16 PS 4. I don't understand why he set it starting so low compared to the "most appropriate setting of 14/10" during my sleep study.

2. Do I really need a BIPAP , or is my new DME just trying to sell me one now through them? My old machine is still being paid for through insurance to another DME.

_________________
Current settings:
ResMed AirCurve 10 vAuto
EPAP 5, IPAP 16, PS 3.

Old machine settings:
ResMed AirSense 10 AutoSet
7-14, EPR1


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LSAT
Unread post  Post subject: Re: Do I really need a BIPAP?  |  Posted: Tue Mar 13, 2018 2:56 pm

Joined: Tue Sep 05, 2017 9:40 am
Posts: 247
Location: WI
PAP Mask: Quattro
PAP Machine: S9 Autoset
Humidifier: H5i
Pressure Setting: 12-20

Online
It's your therapy...if you are feeling better at the higher pressure, change it!


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diamaunt
Unread post  Post subject: Re: Do I really need a BIPAP?  |  Posted: Tue Mar 13, 2018 4:56 pm
User avatar

Joined: Wed Mar 02, 2016 2:26 am
Posts: 1895
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

Offline
WarpedTrekker wrote:
1. Doctor set my BIPAP to a range of 4-16 PS 4. I don't understand why he set it starting so low compared to the "most appropriate setting of 14/10" during my sleep study.

2. Do I really need a BIPAP , or is my new DME just trying to sell me one now through them? My old machine is still being paid for through insurance to another DME.


1) many sleep professionals (doctors included) are stupid about auto adjusting machines.

2) maybe, but you might be able to get by with a regular machine set at 14-15 with exhale relief enabled, it'd be pretty close to the same thing.

_________________
https://sleep.tnet.com/resources/sleepyhead
how to post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


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WarpedTrekker
Unread post  Post subject: Re: Do I really need a BIPAP?  |  Posted: Tue Mar 13, 2018 7:18 pm

Joined: Sat Mar 03, 2018 9:29 am
Posts: 29
Location: Texas
PAP Mask: ResMed AirTouch
PAP Machine: ResMed AirCurve 10 vAuto
Pressure Setting: EPAP 5, IPAP max 16, PS3

Offline
LSAT wrote:
It's your therapy...if you are feeling better at the higher pressure, change it!


So to clarify a little bit, which i forgot....
He gave me the BIPAP at EPAP 4, IPAP Max 16, PS 4. This was not helping until I changed it myself up one notch, to EPAP 5, IPAP Max 16, PS 3. This fixed most all my issues, and I have been using that for the past two weeks with AHI <1 all nights.

It never gets as high as 16, and actually stays around IPAP 8 or 9 for most of the night. So that is why I'm questioning if I need BIPAP. But the thing is with my APAP at 7-14, it would go all the way to 13.x and still I'd have a lot more events.

Maybe the algorithms in the BIPAP machine are better, or it is the TI control that is helping. I don't know. All I know is that I notice a difference in breathing using BIPAP, and the machine doesn't seem to flucuate up/down as much as the APAP machine.

The AirSense 10 Autoset always seemed to fluctuate and go down quickly to low pressure, then after an event, back up, then down again. I'd keep having events all night long because of that. But with the BIPAP, the pressure graph is much more stable looking. It still goes up after an event, but doesn't go down at such a rapid rate.

If insurance will pay for the BIPAP, I might as well have him order me one, and I'll turn in the APAP to my other DME.

_________________
Current settings:
ResMed AirCurve 10 vAuto
EPAP 5, IPAP 16, PS 3.

Old machine settings:
ResMed AirSense 10 AutoSet
7-14, EPR1


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WarpedTrekker
Unread post  Post subject: Re: Do I really need a BIPAP?  |  Posted: Tue Mar 13, 2018 7:36 pm

Joined: Sat Mar 03, 2018 9:29 am
Posts: 29
Location: Texas
PAP Mask: ResMed AirTouch
PAP Machine: ResMed AirCurve 10 vAuto
Pressure Setting: EPAP 5, IPAP max 16, PS3

Offline
Here is from last night. Besides the major leaks, which I have yet to figure out, I seem to be doing okay now. And I feel better during the day. I did have an UA lasting 32sec. I wish I got get rid of those long apneas. Some last 35-45sec and I don't know why. My Contec O2 sensor alarm goes off, during these events.

I wish I could figure out what causes the "jagged" breathing in the third pic.

Image
Image
Image

_________________
Current settings:
ResMed AirCurve 10 vAuto
EPAP 5, IPAP 16, PS 3.

Old machine settings:
ResMed AirSense 10 AutoSet
7-14, EPR1


Top
diamaunt
Unread post  Post subject: Re: Do I really need a BIPAP?  |  Posted: Tue Mar 13, 2018 11:08 pm
User avatar

Joined: Wed Mar 02, 2016 2:26 am
Posts: 1895
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

Offline
Next thing, get those leaks under control.

_________________
https://sleep.tnet.com/resources/sleepyhead
how to post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


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WarpedTrekker
Unread post  Post subject: Re: Do I really need a BIPAP?  |  Posted: Wed Mar 14, 2018 5:47 am

Joined: Sat Mar 03, 2018 9:29 am
Posts: 29
Location: Texas
PAP Mask: ResMed AirTouch
PAP Machine: ResMed AirCurve 10 vAuto
Pressure Setting: EPAP 5, IPAP max 16, PS3

Offline
diamaunt wrote:
WarpedTrekker wrote:
1. Doctor set my BIPAP to a range of 4-16 PS 4. I don't understand why he set it starting so low compared to the "most appropriate setting of 14/10" during my sleep study.

2. Do I really need a BIPAP , or is my new DME just trying to sell me one now through them? My old machine is still being paid for through insurance to another DME.


1) many sleep professionals (doctors included) are stupid about auto adjusting machines.

2) maybe, but you might be able to get by with a regular machine set at 14-15 with exhale relief enabled, it'd be pretty close to the same thing.


How is a range on APAP of 14-15, the same as my current BIPAP? I don't even reach pressures of 14,15 at night.
The BIPAP usually stays at the minimum settings of IPAP 8-9, EPAP5-6. It rarely goes up to IPAP 12.

_________________
Current settings:
ResMed AirCurve 10 vAuto
EPAP 5, IPAP 16, PS 3.

Old machine settings:
ResMed AirSense 10 AutoSet
7-14, EPR1


Top
diamaunt
Unread post  Post subject: Re: Do I really need a BIPAP?  |  Posted: Wed Mar 14, 2018 8:49 pm
User avatar

Joined: Wed Mar 02, 2016 2:26 am
Posts: 1895
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

Offline
WarpedTrekker wrote:
diamaunt wrote:
WarpedTrekker wrote:
1. Doctor set my BIPAP to a range of 4-16 PS 4. I don't understand why he set it starting so low compared to the "most appropriate setting of 14/10" during my sleep study.

2. Do I really need a BIPAP , or is my new DME just trying to sell me one now through them? My old machine is still being paid for through insurance to another DME.


1) many sleep professionals (doctors included) are stupid about auto adjusting machines.

2) maybe, but you might be able to get by with a regular machine set at 14-15 with exhale relief enabled, it'd be pretty close to the same thing.


How is a range on APAP of 14-15, the same as my current BIPAP? I don't even reach pressures of 14,15 at night.
The BIPAP usually stays at the minimum settings of IPAP 8-9, EPAP5-6. It rarely goes up to IPAP 12.


Set at a max of around 14 or 15.

_________________
https://sleep.tnet.com/resources/sleepyhead
how to post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


Top
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