Dreamstation BiPAP S/T Adjustments

[kbear]

The last 4 nights AHI at EPAP of 7.5cm:
1.7
1.2
1.3
1.9

No OA's or CA's.
Should I try 7.0 EPAP?

[Sleeprider]

Lower EPAP pressure can be tried in the absence of OA. Maintain pressure support.

[kbear]

I'll lower EPAP and keep an eye on OA's
Thanks.

[Sleeprider]

I'll lower EPAP and keep an eye on OA's
Thanks.

In addition to the numbers, I like to keep track of subjective comfort.  Is this getting better as we lower pressures?

[kbear]

Aerophagia has been an issue since being on pap therapy. It's much better now then my first prescribed pressure of 21/16. Years of acid reflux has done it's damage. I'm getting air leakage into my stomach due to a weakened LES. Sometimes I get so much air that it  expands my rib cage to the extent that the muscles in my back cramp up. All this goes away after about 1/2 hour after getting up in the morning. Sometimes I wake up in the morning with the feeling of head pressure particularly  behind my ears. I probably need to see ENT and GI doctors about these issue. (I hate to go to doctors) 

With the current pressure changes, I am still experiencing the above issues, however, I am sleeping thru the night, even though it takes me longer to fall asleep. And my blood pressure is improving (my original reason for taking a sleep study).
I no longer wake up dripping with sweat due to my heart trying to make up for lack of O2 in my blood caused by the apnea.

I have made personal adjustments/changes that I found on this board and other sources to help with aerophagia and reflux, which has had some success.

[Sleeprider]

I think you're on the right track to treat all the issues. Keep lowering EPAP until you see obstruction, then we can review and go from there. You are the master of your therapy at this point and I'm just an observer. Pretty amazing to think of the high pressure we started from. The most important thing is you understand the effect of EPAP, pressure support and the other variables and are making changes with an objective in mind and to solve problems you understand. If every patient got to that point, there would be no failures.

[kbear]

Another relief with the lower pressure is that I'm able to use the P10 nasal pillows instead of the FFM. That has been a whole lot more comfortable for therapy.
Thank you Sleeprider, for you help.

[kbear]

An Update on my nightly EPAP changes and corresponding AHI results:
Pressure      AHI
7                0.5
7                0.8
6.5             0.5
6.5             0.4
6                2.2
6                1.1
6                0.4
6                0.3
No OA's or CA's
Current settings IPAP=14 EPAP=6


Total events being 2 hypopneas last night looks pretty good to me. I wish the attempts to control my aerophagia and reflux would go so well. 

Something I did observe and don't fully understand when making the last set of changes is that my Timed Breaths more than doubled. Patient initiated breaths went from around 85% down to 64%. That would mean that my BiPap was initiating breaths 36% of the night because I was below the 12 BPM threshold setting, is that correct? I tried to search for info related to timed breath of BiPap's but aside from a definition, I couldn't find much.

[Matt00926]

With the pressure support of 8, you're probably breathing deeper which means your respiratory rate is probably decreasing. So you're probably breathing close to the backup rate at rest while awake, and when you fall asleep, your respiratory rate probably falls to or just below the set backup rate more often. It's not a bad thing, the machine doing more of the work of breathing. Your AHI is stellar now, too.

[kbear]

Ah... I'm sure that's what's happening. Thanks Matt00926 for your clear explanation.