new machine and worse apnea

I have been using AutoPap therapy for about 4 years at a pressure of 13-15. With the nasal mask, my apneas were less than 1/hour. But because of other problems, I had to change to a full size mask, and the number jumped to 11/hour. The doctor increased the pressure on my Auto C-Pap to 16-18 which helped quite a bit. However, because I have a neuromuscular disease that affects the breathing muscles, the higher pressure made it more work to exhale.

The doctor did another sleep study 2-3 weeks ago to change me to a ResMed AirCurve v-auto BiPap so that the exhale pressure could be less. They set the new machine at a max of +16 and a min of +8 with a PS of +4. Last night I had 18.5 events per hour, the highest I have ever been. I have the ramp time set for 5 minutes.

Does anyone know what could be going on? Does the pressure just need to be increased? There are no leaks.

I am back to feeling lousy, and my neuromuscular disease has been ornery with the lack of rest. I'll bring the machine to the respiratory therapist tomorrow so she can take a look at the values, but that's what the ResMed MyAir program is saying, and it sure matches how I feel.

Thanks.

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You were right to seek professional guidance on the machine settings. The neuromuscular issues you have complicates any advice and that should come from your support team. From what you are describing, it appears the BIBAP is actually making the sleep apnea situation worse and since this is complicated, best to rely on their professional judgement and for folks on this board who are not professionals to just offer support and ask you get back after you have had a chance to work with your medical team so that you can let us know how things are working out. Two things changed, the machine (and pressures) and the mask. Seems like your team should be working on trying to mitigate youir problem by adjusting or changing one of these factors at a time to see how it affects your sleep. If there were no leaks, it would appear to me, at least, that the mask wasn't the culprit but either machine settings or the comlicating neuromuscular issues. This type analysis rerquires professional judgement. Again, let us know how this goes!

Great recommendation, wiredgeorge. Treatment of sleep apnea in patients with neuromuscular disease sometimes requires machines with more sophisticated treatment modes (like VPAP, ASV, AutoSV). The changes to the machine are very specific and must be closely monitored. I'm sorry to hear you are feeling lousy, but you have a good plan with the visit to your respiratory therapist. Please keep us posted on your progress!

Thank you Wired George and Dan,

My doctor suspected that the pap therapy after three years has caused central apneas. My apnea was only mild in the first place, but the machine helped me feel so much better until recently when I was experiencing an average of 22 events/hour. About 1/2 the events were central.

Last night, they did another sleep study. They had me sleep on a bed wedge and found that the number of apneas dropped to under 5 (not as good as the original therapy which decreased them to almost 0, but still in the normal range), and the central apneas had disappeared.

I'm waiting for the doctor to review the study. I am anticipating that he will take me off of the bipap and just have me sleep with the bed wedge, but the respiratory therapist seemed to indicate that he may want me to do both but with an even lower pressure setting. Why would that be?

If I do need to get a bed wedge, do either of you have a recommendation? The one I used at the sleep lab last night was 10 x 10 x 24 and was pretty uncomfortable, but I'm sure I'll get used to it. It just takes time.

I started therapy and started sleeping on my back exclusively to not knock my mask around at night. At the same time, my lower back would kill me in the AM. Sometimes the pain woke me. I learned to sleep on a wedge which cured my back issues. I bought a TV pillow; wedge shaped affair that you are supposed to put behind you on the couch and laid it down and used it as a wedge. It works beter for me than propping multiple pillows. Good luck!

Thanks so much for your help.