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Failed Cpap and Bipap, would love help with my OSCAR report

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Ryanns +0 points · about 1 month ago Original Poster

Hello, I'm a first time poster! Apologies if I'm not posting this correctly/not providing the right info.

I was diagnosed with moderate obstructive sleep apnea a year ago and now have to return my Bipap as I'm noncompliant. I never adapted to wearing it all night and hated it. When I wear it I fall asleep fine but I find myself waking up at least once to go to the bathroom, when I don't wear it I sleep through the night. I've felt not positive difference in how I feel during the day. The reason I was told to get a sleep study was because I have TMJD which is causing me significant chronic pain and a high sleepiness score. That hasn't been helped by the Bipap. I have a misaligned jaw and am pursuing surgery to correct that. I have tried to get guidance from my pulmonologist and the DME company with no luck. My Dr. tells me to just stop using the machine if it's causing me so much grief. I'm hoping to get some guidance on this forum on what's going on while I sleep and what can be done differently the next time I try a machine.

Background: I'm a 33 year old woman, normal BMI. I got a sleep study done in August 2021. During my study I had 5 central apneas, 2 obstructive, 0 mixed and 80 hypopnea resulting in an AHI of 15. There were 0 RERA's. The mean oxygen was 98%. The REM AHI was 44, supine was 32. No periodic limb movements. The mean pulse was 77 BPM. No significant EKG abnormalities. I was prescribed a CPAP (don't remember which one, was a Resmed) and started with nasal pillows and a chin strap. I keep having aerophagia that would wake me up in the early morning due to the pain. I had to stop using the chin strap because it was exacerbating my TMJD. I switched to a nasal mask and mouth tape.

I struggled to adapt to the CPAP and the aerophagia so my Dr. switched me to a BiPap- Resmed Aircurve 10. This resolved the aerophagia but I still struggled with sleeping through the night. I recently got a Cpap (not Bipap for some reason) titration study done but have to return my machine before my next appointment with my doctor as insurance will no longer pay for it. If anyone can help with my OSCAR data I'd really appreciate it! Below is my Bipap info. Also, the most recent change to settings was me bumping up the pressure on my own just to see if it'd make any difference. All other changes were done by the Dr.

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Sierra +0 points · 24 days ago Sleep Patron

It is too bad that your post got delayed. Did not see it until today. It was probably hung up in the spam filter due to the graphics included. In any case I think this is the key big of information:

"During my study I had 5 central apneas, 2 obstructive, 0 mixed and 80 hypopnea resulting in an AHI of 15"

Hypopnea is the biggest issue and after that it is central apnea. An APAP or BiPAP can effectively treat hypopnea with EPR or Pressure Support. EPR can give you 3 cm of pressure difference between inhale and exhale. Your AirCurve is giving you slightly more at 4 cm. It is not obvious that you really need a BiPAP. The problem is that while hypopnea is much improved, you now have a significant central apnea (CA) problem. Pressure can cause central apnea in some cases. The bottom line is that your AHI is now over the recommended maximum of 5 in North America. In the UK they do not treat apnea unless AHI is over 15. So, certainly one option is to not take any treatment.

I have experienced increased CA as the result of using an APAP. What I have found most helpful is keeping the pressure as low as possible. So one option you may have is to reduce your IPAP to say 7 cm, while leaving EPAP the same. Pressure support could stay at 4 cm. Similar settings on an APAP may work too with EPR set at 3 cm.

Hope that helps some, any questions just ask. Without graphics included, your posts should not get delayed.

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