Top Topics
I'm a little confused because you keep switching terms between CPAP and BiPAP. Which are you using and what pressure(s) are you on? Both CPAP and BiPAP will only help with your headache if it caused by something respiratory- or sleep-related (just like a headache tablet won't help with your baldness).
When you can't feel the air, it's not because of something the machine is doing but rather it's you. Many people report that, once they are used to their PAP therapy, they can't feel the air any more until they lift the mask up to check. You should be able to feel the air coming out of the exhaust vent of the mask, unless you have a mask with a diffuser over the exhaust like the Fisher & Paykel Eson.
I agree that it is odd. I really don't know what price difference there is in the US as I am in Australia and I know that things cost a lot more here than they do there. Here an ASV is several thousand more expensive than an CPAP.
You report waking with a headache, which is a classic symptom of elevated CO2 levels. I'm not sure why they are using the non-vented mask treatment. I have heard of it before, but ASV has been the industry standard in treating respiratory events due to hypocapnia for quite a few years now. It is correct that you would need to have your heart check to see if your left ejection fraction of above 45%, and would hope that your doctor would do this as a matter of course as it is part of the standard procedure. You are also correct in your suggestion that giving you a low AHI but elevated CO2 (above the healthy limit) can also be injurious to your health and so is not a great solution. If you are struggling with your current treatment then I would hope your doctor would at least discuss the idea of ASV and its possible suitability or otherwise.
I find it interesting that you do not treat respiratory failure in your sleep lab. I spend A LOT of time treating respiratory failure of various kinds in the sleep lab because we are the ones with the expertise in using BiPAP which is by far the best tool for treating chronic respiratory failure in many instances. Having said that, I know that we treat far more respiratory failure patients than any other lab in the country that I am aware of.
I know that BiPAP is sometimes used in treating OSA simply for improved comfort, or at least has been in the past, but this practice has generally been superseded by use of CPAP with pressure relief which achieves exactly the same thing. BiPAP was not designed for treating OSA, and using it to do so is almost always rather unwieldy and unnecessary. A BiPAP costs several times as much as a CPAP. Using one to do the job of a CPAP is a bit like using a helicopter to go to the local shops in stead of a car - whilst it could actually be a sensible option in a few rare cases, it's almost always going to be an unnecessarily complicated waste of time and money. I have also come to discover over the years that few doctors properly understand how BiPAP works, which further complicates things.
I do agree that the starting point is a trustworthy sleep specialist. They should be able to guide you through the correct process, and be willing to educate you in what they are doing and why.
In cases where you CO2 levels are too low (which is called hypocapnia) usually ASV is used. That is, in fact, why it was invented. And you can use a normal, vented mask with it. Perhaps your doctor would be open to trying it?
The DreamWear cushion that sits under your nose, rather the one with the 2 prongs, may be helpful to you. You could also try wiping your face/nose with a wet flannel before putting your mask on at night, as this can also help with your problem.
Well, you shouldn't be on BiPAP for obstructive sleep apnoea for a start. Whether it's more comfortable or not is a matter of individual taste, but it's definitely a more expensive and complicated machine (surely they must also cost more in America?) and you don't need it if that's the only reason you've been given. BiPAP is for treating central apnoeas and respiratory failure, not just OSA. BiPAP can only be properly set in a sleep study by an experienced technician. It is a far more complex device than CPAP, there are way more variables to take into account, and it is important to see how your body is responding as adjustments are made. Also, it may be part of the cause of your onset events. BiPAP makes you breathe more air in and out, which can lower your CO2 levels. It is a tiny rise in your CO2 that tell you when to breathe, and if your CO2 is too low your breathing reflex is nor triggered, causing central events. You should be able to get your BiPAP set in CPAP mode instead of buying a new machine. Also, I'm not sure I'd stick with a doctor who recommends inappropriate treatment like that. See if you can find someone who can recommend a good sleep specialist and get some proper advice and management. Is the AHI of 15.9 when you are using your BiPAP, or in your diagnostic study? Did you ever have a titration study with a CPAP?
I Just noticed that in another post you said that your pressures are 8/4. This is equivalent to a CPAP pressure of 4 (not 8), which is as low as they go, so it's probably not helping your obstruction either.
Where I work the studies are all free, so we don't have to worry about the price of the study, but it is important to have one. A CPAP machine is supposed to be be set specifically for you, which requires a sleep study. Also, you may not have just OSA but there may be other complications involved. I would strongly recommend a study if you can manage to have one.
It makes good sense that when you slept on your back you snored and your AHI was higher. Most people obstruct worse on their back, and it sounds like you do too. It suggests that you need your pressure increased slightly to account for this. As suggested above, talk to your doctor. It should be pretty easy to address.
A sleep study is about what your body is doing physically when you are asleep, not whether you feel like you slept well or not. Or, to put it another way, it's not about how hard it is for you to fall asleep or stay asleep, but it is about what your body does once you are asleep. Despite the unusual environment, you generally still breathe the same. It is likely the best shot of getting to the bottom of your difficulties.
