BiPAP Breathing Technique

I've had mild to severe sleep apnea for the last 15 years. I have a mix of obstructive and central apneas. I have been treated by a sleep specialist, two neurologists, used an oral device, had numerous sleep studies, and one trial period with a cpap device. I did not meet compliance. My last two sleep studies indicated severe sleep apnea.

I am now in the 3rd week using a ResMed AirCurve 10. (BiPAP BIPAP-ST: EPAP=10 cm H2O via mask during sleep 99 mo) I think the higher number is 16. I’m doing pretty good so far. Compliance is an issue though because I have difficulty staying asleep, and keeping the device on at least four hours a night. What happens after a couple of hours is that the pressure pushes the mask off my face. This has been consistent with every sleep study, Cpap and now Bipap I have used.. It does not appear to be a problem with the pressure, mask or equipment. No matter how tight the straps are, I end up gasping for air and fighting the pressure. My theory is that after a few hours of sleep, I wake up abruptly and either start holding my breath, or try breathing at my own rate (time between, and length of breaths) competing with the machine making it almost impossible to keep the mask on. I end up becoming so uncomfortable, I become completely awake, the mask comes off, and I'm awake for the night. Only once was I able to relax enough to fall back to sleep. Since using the bipap, I have been in compliance 13 of the 16 nights. By the way, I normally only sleep 5 to 6 hours a night without a machine.

Since getting to sleep is also difficult even with a long ramp time, I am finding a benefit from trying NOT to inhale on my own, and letting the machine fill my lungs, and then concentrate on exhaling. When I do this, it doesn’t feel like I’m competing with the machine for a breathing rate, and I usually fall asleep fairly easy. I don’t know if this technique is appropriate for this machine, but it seems to work for me for at least getting to sleep. I have a follow up appointment with my doctor in six weeks. In the meantime I’d be interested in the opinions of the professionals and users in this forum. Thank You

The Bipap ST machine initiates your breathing as it records the number of breaths per minute you have taken. The number is a set parameter I think. I am on an Aircurve 10 in Bipap mode and don't believe this ST thing is actuated on my machine. To my thinking, the ST feature may be like stuffing air down your throat and would discuss if this is a benefit or a detriment since you are having problems with compliance. You may want to discuss turning off the ST function with your sleep doc to see if things improve. As far as length of sleep, I sleep between 4.5 and 6 hours generally and this has been the norm all my life. On therapy, I sleep much more deeply and don't feel tired within those times. Follow up on your visit with the sleep doc and hopefully some positive will come of it.

easiest way is to go back to your DME, the ST isn't set up properly for you. The waking up short of breath is telling. You may finish up back at the doctor for a script change. If you have a physical problem, obesity, copd etc, then the ST is the right choice. If it's a brain signalling issue and there are a lot of central apnea. Then if your heart is ok, an ASV is more suited. Get a copy of your sleep report. You may need another sleep study to sort it out. If you are self funded, probably apneaboard forum could help you with self diagnosing.

Hi, regarding your issue during night i would recommend you to not follow the machine in the breathing and use your tempo on the breath cycling, you have to check the back rate at ST machine which may have been adjusted very high to avoid your sleep apnea, this could be an issue, because BiPAP ST machines generally isn't the correct device for the Central apneas, however sometimes doctors prefer BPAP's instead of ASV due of other cardio reasons. also if your EPAP pressure is on 10 which is high enough could make the compliance more difficult. and lastly one idea is to activate the Ramp time so this will help you fall asleep before the pressures reach the high level and eventually you will sleep little bit more.

Hi,

I'm not sure where the people above are getting there information from but I have been treating people with CPAP, BiPAP, ASV etc for over a decade. BiPAP in ST mode certainly is good for treating central events. In fact it is the default treatment for central events. ASV, As I added above, is only for specific cases.

One of the resasons that ASV is less widely used than it used to be (which is a good thing as too may doctors would throw ASV at a patient without checking to see if it actually worked) is that there was a study which showed an increased risk of mortality if your left ejection fraction is less than 40%. To put it more simply, if your heart is dodgy (in a particular way) then ASV could kill you. This is yet another reason not to get carried away playing doctor with your own treatment.

BiPAPs are complex devices and setting them is equally complicated. Yours was set the way it is for a reason. Your doctor should know what that reason is, so make sure that they explain it to you. Ask question until you get answers and be very involved in your own therapy, but beware of changing stuff based on responses from a forum such as this or, indeed, anything but advice from a qualified medical practitioner.

Many of my patients who use BiPAP say, as you have, that they find it easier to fall asleep with BiPAP when they follow its rhythm. This is fine. It should be adjust to something quite similar to you normal breathing pattern in sleep so going with the flow should not be a big change.

Overall, BiPAP therapy of any kind is complicated and should not be mediated through an online forum, nor should you make random adjustments yourself. I have treated hundreds of people with BiPAP (possibly thousands, I lost count long ago) and it has to be done hands on with all of the data at your disposal. If all else fails, perhaps a different doctor would be better.