Posted by christinequilts on January 07, 2005 at 14:12:06:

In Reply to: adjusting to BiPAP posted by needzzzz on January 06, 2005 at 12:19:51:

Another CSA poster here- not many of us around that have central apnea only with no obstructive component. I was DXed a little over a year ago and have been on BiPAP ST ever since- I couldn't imagine sleeping without it now. I have a Respironics Synchrony BiPAP ST from my DME and I also have a Respironics BiPAP STD of my own for backup. They have never found a cause for my CSA which always makes you wonder...I mean remembering to breath is a pretty important thing. My case is even more unusual in that its only partially responsive to BiPAP ST- I still have 30+ central apnea events per hour though it is a big improvement over the 65+ I had without it.

Do you know how many events you had per hour? Were they able to stop most of them with BiPAP? Which model/brand of BiPAP do you have? Is it a regular BiPAP or a BiPAP ST?- A regular BiPAP will SPONTANOUSLY change from inhale (IPAP) to exhale (EPAP) with you. A BiPAP ST will SPONTANOUSLY change IPAP/EPAP but it also has a TIMED backup function to give you IPAP/EPAP to attempt to get you to breath after a predetermined amount of time. BiPAP ST can do some other stuff like running in just TIMED mode and such for other non-sleep related breathing problems. Not all people with CSA need a BiPAP ST but it helps to know which you are on along with the brand and model. If you have a regular BiPAP your prescription would have had 2 number- IPAP & EPAP [12/7]; with BiPAP ST you would have 3 numbers- IPAP/EPAP & backup rate (given in breaths per minute)[12/7-backup 10].

It is common to have 'REM rebound' when you start xPAP. I went from very rarely remembering I even dreamt let alone remembering a dream to vivid dream overload the first few weeks on BiPAP ST. It does calm down after a while to 'normal' (if anything about sleep can be called normal)- now I'm aware I dream nightly though I only remember a few dreams per week.

You may want to have your DME check out your BiPAP if you really feel it is not putting out the correct pressure- even brand new machines can fail (I had one die with 12 hours of total use). Do you feel starved for air when it happens? 4 is a pretty low pressure- I would not feel like I was getting enough air but I'm use to higher pressures.

A couple of other things come to mind- (I'm not a medical professional- just another person with CSA...yada,yada,yada). When people first start xPAP they are very aware of the air pressure in the mask but after awhile it becomes normal and the 'pressure' seems to disapear. A lot of people report that they think their xPAP is not on or is broke until they go to take the mask off and then the air pressure is very apparent. When I started on BiPAP ST I was extremely aware of the IPAP/EPAP pressure changing to the point of almost being obsessed with it but now I really have to concentrate to feel it. SOme masks make the pressure changes more noticable too- when I wear a nasal mask (Ultra Mirage, Activa, etc) I notice it more then I do with a nasal pillow (Breeze, Swift, Comfortlite, etc).

Could you be breathing so shallowly that your BiPAP is not picking up the breaths and therefore staying at the EPAP pressure? I've never been on a strait BiPAP so I'm not sure what it does when you don't take a breath. A few times I have woke up in the middle of the night and try to figure out why when I realize I've been semi-awake for a couple of minutes and haven't taken a breath. My BiPAP ST had gone into Timed mode and was trying to get me to breath but all I was doing was taking the air into my nose and exhaling it out as the pressure changed- nothing was making it to my lungs. Needless to say taking a nice deap breath or two helps and I typically fall back asleep. BiPAPs are pretty sensative to any air movement by the user but you could be doing something similar to what I do. I've tried to breath as shallowly when I'm awake and my body reacts the same as if I held my breath (still amazes me that I can go without breathing so much at night but am probably the worst person I know when it comes to holding my breath).

You sleep quality will change a lot during the first few weeks so what you're describing is normal. SOme of it is that we're so exhausted by the time we start on xPAPs that any improvement makes us feel like a million bucks. You will see big changes overall in your sleep and daytime tiredness in the first few weeks or so and then you may not notice any changes though subtle changes can occur for a year or more. It took years for us to built up the sleep dept and it will not go away overnight. You are correct in that the mask and such can also interfer with your sleep but with time they will become a habit- just like wearing glasses or contacts.

I can't comment on #4...maybe some of the guys can help out with that one. Most people do notice an increase in libido after starting xPAP.

You still need to clean your mask and hose regularly- each person has to find their own scheduled though I will admitt I don't clean my equipment nearly as often as I did at first. The part of your mask that comes in dirrect contact with your face (cushion or pillows) needs to be cleaned everyday to help prevent leaks and prolong its life. You should also wash your face right before putting your mask on for the same reason.

Good luck- christine

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