Bipap advice

[readyforsleep]

I have used my new Resmed Aircurve 10 for 8 days now.  i do love it.  According to myAir I am doing great - I get 100 almost every day.  I just would like to understand it better, and see if I can reduce my OA's. My ahi has been consistently over 4.0.  I get alot of OA's within the 1st 10-15 minutes.    

https://imgur.com/a/8bwuN

I know you are going to say to raise my IPAP.  My highest AHI's have been with my IPAP at 20.  Any ideas?

[Sleeprider]

Let me throw a curve-ball. Move EPAP min to 10.0 and iPAP max to 16.0 with PS 4.0.

In nearly every case, in the above example, the pressure rise preceded the obstructive apnea. I'm curious if you have tried a soft cervical collar. If you have tried PS 4 and had more CA events, let me know and we would back off that increase.

[readyforsleep]

I have not tried the cervical collar with my bpap.  I know it would help, but I am not ready to add one more thing to my nightly costume.  I was able to get my ahi below 4  without the cervical collar when using my APAP.  Hoping I can do the same with the Bipap.

Regarding the CA's.  I did try 4PS and found I had CA's.  I'm game to try your formula, but would like to creep up on the PS.

[Sleeprider]

Well, try the lower pressure with PS 3 and we can add more PS later if this works out.

[readyforsleep]

I'm game but have no idea how this combination could work.  Sorry.

[ajack]

When I use my ASV machine, I normally try to get my min epap around the median number to start with. I then make sure my max epap is set above the max shown on the chart. If it was my chart, I would have min epap 14 and max epap to the max setting 21 or 25? with PS4. I would also switch to a full face mask, because of what seems posible mouth breathing? It doesn't look like leaks. Pressure induced ca can increase with PS or just increasing the pressure. I guess I would want to know if they are the type that are waiting for the co2 to build back up, before I took my next breath and are of no concern. Possibly expected because a bpap can alter my co2 level. Or if they are a true central with O2 desaturation. I guess the length of time in CA could be an indicator. If I didn't have a recording o2 meter.

[Sleeprider]

RFS, you indicated higher pressures resulted in higher event rates. This happens sometimes, and the purpose of trying lower pressures is to identify whether you might have some flow limitation issues that are raising pressure and resulting in events at higher pressures that might not occur with a lower pressure setting. That is entirely the rationale and purpose of trying this reduced pressure trial. There has been some evidence from the beginning that some of your OA is related to positional apnea, but the soft cervical collar is a non-starter for you. So no harm in trying a lower pressure and observing if events increase or decrease. Normally, we expect OA events to increase with lower pressure, however there are numerous exceptions that I have worked with on the forum, most of them female, with UARS symptoms.

[readyforsleep]

I will give your pressure range a try.   I like lower pressures...

[ajack]

That's just what I'd do, your pressures will become apparent as you self titrate with the forum.

[Shin Ryoku]

I have not tried the cervical collar.  I know it would help, but I am not ready to add one more thing to my nightly costume.  

I wouldn't be so sure about it helping.  It gave me nothing but neck pain and didn't help at all.  And I know what you mean about the nightly costume!