Dreamstation BiPAP S/T Adjustments

[kbear]

If possible, I would like to get help tweaking my BiPAP in an effort to lower my AHI.

Tonight will be exactly 3 months since I have begun PAP therapy. After two terrible months of dealing with pressure related issues as a result from my initial prescription (I=21, E=16), my doctor reduced the pressures to ipap=12, epap=8, which has been much better. However, the AHI numbers are higher, from about 1-2 AHI average for the first two months to my current monthly average of 4.4 AHI.

I have attached Encore charts. The waveform chart shown is typical of my events.

Thanks,
Kevin


  ReportKB052118Pg8.pdf (Size: 377.14 KB / Downloads: 76) [attachment=6108]

[Matt00926]

You need to increase your IPAP - your AHI is made up of hypopneas, and a trace amount of vibratory snores/flow limitations. Try 2cmh2o higher and see what happens. They must have really messed up your titration. You cut your EPAP in half and still no obstructive apneas!

[kbear]

Titration study was done with a CPAP. When the OA's disappeared, the CA's came on with a vengeance. They finally maxed out the CPAP pressure and the doctor wrote my prescription based on the data. During the followup visit he told me that it's hard to determine the best prescription for me based on data that had only a few minutes at each pressure level.
I'm going to raise my IPAP to 14 and see how I do. 
I would assume the EPAP should stay at 8?

[Sleeprider]

Keep EPAP the same, but increase IPAP (pressure support) in increments of 0.5 cm until hypopnea is controlled. The increase in pressure support may increase CA events and at that point you have to compromise and look for the best solution I basically agree with Matt, but I'm suggesting you go much slower, increasing the pressure support by increments, rather than a big 2-cm push. This is basic self-titration, and the best results will come with patience and smaller changes, and observations before making further changes

It's good to see your therapy is going better, and perhaps we will have Sleepyhead support for the ST thanks to you.

[kbear]

I will give at lease 2 nights for each 0.5 cm increment (more if CA's show up). 
Thanks for introducing me to the Sleepyhead devs. JediMark and company are a hardworking group. I appreciate what you all are doing.

[kbear]

Here's a daily summary of my changes:

cm        AHI
12.5      4.9
12.5      5.1
13         4
13         3.5
13.5      1.5
13.5      4.1
14         1.6
14         2
14         2.5

Data was based on 8 hour (approx.) BiPAP usage per night with 100% mask fit. Only one CA recorded for one of the nights all the rest was hypopneas. The difference in my aerophagia symptoms was minimal with the increase in pressure. 

Should I continue to make adjustments or should I hang with 14cm for a while?

Thanks,
Kevin

[Sleeprider]

Just to clarify, we are now at EPAP 8.0 and you have increased IPAP to 14 for a pressure support of 6.0 cm. I think the trend is definitely in the right direction with hypopnea diminishing and your report being comfortable. I think you can proceed with incremental increases of 0.5 but don't pass 15 cm (PS 7.0). This approach is now starting to do part of the work of respiration for you and overcoming the resistance or restriction that was causing hypopnea. The single CA event is not a concern, and you have not had OA events either. Alternatively, we can try reducing EPAP by 0.5 instead of increasing IPAP. In other words 7.5/14. As long as we don't see OA events, that is acceptable.

[kbear]

Current settings are EPAP=8, IPAP=14 & PS=6 (I'll update my profile when I finish adjustments)

So do you recommend first dropping EPAP by .5 intervals, keeping an eye on OA's, before making increases in IPAP?

Also, my other BiPAP settings are Ti=2.0 and BPM=12. I don't know if these matter in your observations.

[Sleeprider]

I think since you're not having any OA events, lets try the move to reduce EPAP to 7.5 first. I want to keep you in the most comfortable pressure range that works.

[kbear]

Thanks Sleeprider.
I'll make the adjustment, try out for a few nights and report the results.