CPAP or BIPAP?

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cargo1954 +0 points · 10 months ago

Hi

I was diagnosed with moderate sleep apnea in July 2017 and have been using a CPAP machine (AirSense 10 autoset) with pressure settings minimum =5, maximum=12. I've been monitoring my readings with Resmed MyAir and Sleepyhead. My AHI readings have been between 4- 7 most of the time. However, I notice that most of the AHI's consist of central apneas and hypopneas, hardly any obstructive apneas. I'm wondering if my CPAP machine is the best therapy treatment for these kind of apneas or will a BIPAP machine help more since it focuses more on breathing?

Thanks

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wiredgeorge +0 points · 10 months ago Sleep Enthusiast

Well, I think you are on the right track as I don't believe a CPAP will prevent central apnea events. A BIPAP costs a bucket of money (I was prescribed an Aircurve 10) so best consult with whomever prescribed the CPAP and have them change your prescription, if that is appropriate. My understanding is that BIPAP machines are prescribed in cases of central apneas being an issue.

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cargo1954 +1 point · 10 months ago

Thank you for your response. I've made an appointment with my doctor to discuss further.

Thanks again

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wiredgeorge +0 points · 10 months ago Sleep Enthusiast

If you remember, try and follow up! Good luck and do as much self-education as possible so you can ask the right questions and see if the doc's comments pass the smell test. I don't mean you should argue but you are going for the doc's expertise and if you find things during the appointment that don't make sense, you will be well served to check these things out yourself.

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cargo1954 +0 points · 10 months ago

The ironic part about this is that I was on a trial CPAP machine for the first month after my hospital sleep study After the month trial my doctor discussed the results with me and did not mention anything about my central apneas and said nothing about possibly prescribing a BIPAP machine. Makes me think that he was "pushing" the CPAP machines as opposed to taking the time to analyze my results more carefully I'll see what he says now and as you suggested, will speak up if something does not make sense seeing that I'm a bit more educated now on the different types of apneas.

Thanks again for your comments and input

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wiredgeorge +0 points · 10 months ago Sleep Enthusiast

I had an in-clinic study and the doctor never talked to me nor did I ever see one. I had to insist on the written results which were greek to me, of course when I did receive them but then began the process of looking up and reading about all the terms. It is always best to be armed with as much understanding as possible.

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cargo1954 +0 points · 10 months ago

I basically did the same as you. Had no clue what the terms meant. But in my case, I started researching and analyzing the data once I started monitoring the results with Resscan and Sleepyhead. Amazing what information these two programs give you and how much more you can learn from different sources on the Internet, all of which the doctors don't take the time to educate their patients.

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sleeptech +0 points · 10 months ago Sleep Commentator

How many central apnoeas are you having?

CPAP and BiPAP, while related, work quite differently and are not freely interchangeable. If you do need BiPAP it really should involve another sleep study for it to be set properly.

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cargo1954 +0 points · 10 months ago

Since Sept.1, on average my central apneas have been 17 per night at my appointment with the respiratory specialist, he said that since my combined central apnea + hypopneas were <10, i have nothing to worry about Although my hypopneas are higher than my central apneas, I am concerned that there is something wrong with the message that my brain is sending telling me to breathe with my understanding would increase the central apneas numbers

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wiredgeorge +0 points · 10 months ago Sleep Enthusiast

Less than 10 per hour? Hmmmm. Given your insurance will cooperate, I would find another opinion. To stop breathing for a significant amount of time for ten and perhaps less times per hour is very negative, healthwise. What was your SPO2 levels during these "not to worry" non-breathing times?

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cargo1954 +0 points · 10 months ago

My combined central apneas + hupopneas = my AHI, which are < 10 per Night, not per hour. He said since I was diagnosed with mild sleep apnea (AHI are normally between 5 and 15), my AHI's are within range. My concern was wondering if there might be a disconnect with the signal from my brain which tells me to breathe since almost half of my AHI were central apneas, but was told not to worry. Recently, my hypopneas have increased (breathing/respiratory rate slows down during the night), so now my concern is that my blood oxygen levels are becoming dangerous low. Not sure what my SPO2 levels are. All I know is that many hypopneas are directly related to low oxygen levels. Gonna give it a bit more time to see if hypopneas get better. If not, then time to insist I see the sleep doctor.

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sleeptech +0 points · 10 months ago Sleep Commentator

This is getting a bit confusing because the terminology is getting mixed up. You said that you are having 17 central apnoeas per night but that your total central apnoeas + hypopnoeas per night is < 10? How can the number of central apnoeas and hypopnoeas together be less than the number of central apnoeas alone?

17 central apnoeas per night is not a big deal. For 8 hours sleep that's about 2/hour. Some people naturally have central events at sleep onset or immediately after a disturbance (which won't respond to CPAP). I wouldn't get too worked up about it.

A hypopnoea is a partial decrease in air flow which is accompanied either by a decrease in your blood oxygen level, an arousal (change in your brain activity) or both. Again, if the overall number of events is not too high, then it is likely not a great concern. You sleep study should really have filled in some of the detail here.

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cargo1954 +0 points · 10 months ago

My apology for the confusion. My AHI “index” (central apnea index + hypopneas index) is < 10 per hour, not per night, which the respiratory therapist says is within an acceptable range (5 or less being normal). However, during the last week, my AHI index has increased to over 10 per hour ( between 11-14 per hour) with the majority being hypopneas, not central apneas. So I am concerned that the increasing hypopnea index is significantly decreasing my blood oxygen levels since my understanding is that hypopneas result because of a slow down in breathing which results in lower blood oxygen levels. I’ve only been on CPAP for 3 months and they are telling me to be patient as it often takes 6 months for CPAP therapy to show positive results.

Any comments or recommendations?

Thanks

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wiredgeorge +0 points · 10 months ago Sleep Enthusiast

Buy a PULSE OXYMETER and monitor you own blood oxygen levels. An AHI of over 10 is not very healthy especially if your SPO2 levels are tanking below the acceptable level which is pretty much about 90 I am guessing. Mine were in the low 70s for long periods. Even if this happened 3 or 4 times per hour, you are headed for medical issues long term.

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sleeptech +0 points · 10 months ago Sleep Commentator

An AHI of 11 - 14 is not great. You posted initially that Autoset has a max pressure setting of 12. This is pretty low and may be preventing the machine from delivering sufficient pressure in the worst parts of you sleep. Perhaps this could be adjusted upward and see if your AHI goes down. The autoset should, in theory, only increase its pressure if you need it.

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madjack +0 points · 10 months ago

The AutoSet machine will go as high as 20 (or more).it is probably locked as a cpap (instead of as an apap) at a 12 by your DME for ??? maybe your Drs prescription...you should contact your DME or supplier about this...if you enter the clinical menu, you can change this BUT, you should not do this unless done with knowledge and care...............madjack

p.s. my AutoSet has been set at 8.5 to 14(by me)..the sleep report says my apneas break at 11.5, my DME originally set the machine at a 12 and locked as a cpap....until, I bitched a blue moon about that setting and the locking of the machine as a cpap instead of an apap...they gave me what I had wanted and I had done a ton of research, here and other cpap related sites before making any adjustments...my ahi has gone from a 50+ to 1 or less.................mj

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cargo1954 +0 points · 10 months ago

The Pulse Oxymeter sounds like a good idea. My blood oxygen level was low during my original sleep study but I’m interested to know what it is now as a comparison.

My prescription said CPAP auto with minimum =5, maximum=12. The settings were done by the respiratory specialist, aka DME. When I was having issues with leakages from the mask, he changed the maximum to 14 for about 2 weeks. It brought my AHI down to <10 for about 4 days then it started fluctuating again. I know how to get into the clinical settings but have been hesitant to fiddle wth the settings for reasons mentioned by mad jack. I think I will take sleeptech’s advise and raise it to 14 again and see what happens.

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sleeptech +0 points · 10 months ago Sleep Commentator

Increasing the max pressure setting of an auto is fairly low risk. The auto should only turn itself up if it thinks you need it, and all increasing the max pressure does is let it go higher if it thinks it is necessary. Having said that, I always advocate consulting your doctor. Any reasonable doctor should be open to this.

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OptimisticLimeFlamingo6906 +0 points · 10 months ago

I also have Central Sleep Apnea (severe) and now also have Obstructed Sleep Apnea. My CPAP machine does take care of both. You will still have Sleep Apnea but the machine is really necessary. I’ve been have somewhere around 3 a night. I just recently switched to the Resmed AirSense 10. It’s great because now I can see how many apnea’s I have each night. I met with my sleep neurologist just a couple of days ago and asked him about the apnea’s. He said it’s normal. If you are having too many, it maybe that machine needs to be adjusted higher. Also, my understanding that anymore the 5 apnea’s a n hour you need a machine. My Central Sleep Apnea was so bad that I was waking up with an extreme headache, which went away within 5 minutes of waking. I didn’t know at that time that I even had sleep apnea.

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Xbbkjz8 +0 points · about 1 month ago

I was tested at UPMC and I was told I had mild sleep apnea. I was given a BiPAP S/T . My IPAP is set at 15 , EPAP at 11.0 and BPM at 10. My oxygen is still dropping to low 80 and sometime 70s. When I’ve been telling my doctor this for 4 weeks and still no changes. I can’t use the machine because of this. When I don’t use the machine I seem to be ok for the most part. I tracked my oxygen levels and they will drop to 87 but go right back up. I also bought a brook stone 4-1 wedge pillow which seemed to really help at night. What am I don’t wrong that my oxygen keeps dropping. I’ve use a full mask, one use the new one that just came out where it rest above your nose.

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sleeptech +0 points · about 1 month ago Sleep Commentator

It is possible that your oxygen was dropping lower when using your BiPAP because it was allowing you to get in to REM sleep which previously you were not due to you sleep apnoea. Having said that, if it is set correctly your oxygen level should not be dropping that low. Did you have a sleep study with your BiPAP on? The settings you describe seem rather odd. There is very little difference between your IPAP and EPAP, and it is the difference between these pressure which determines how much extra air the BiPAP helps you breathe. Your doctor should probably be looking in to that. Due to its relative complexity, BiPAP can only be set in a sleep study.

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