Help with PS and Sleeping Position

[aperez440]

Hello everyone. I asked for help on here a while ago and I was instructed to lower my pressure from 15 - 17 on my bipap to PS 4 over 11 - 17 to reduce my flow limits. This helped when I slept on my sides but when I sleep on my back, my preferred position and the one I always end up in, I see my flow limits sky rocket. 

I'm, wondering if I should increase my pressure support and if I should increase it then what is the formula. If I want my overall pressure to be 15 - 17 then should my EPAP and PS always equal 15? Does it matter what the ratio is? I have read the flow limit pages on here and I can't quite get my head around what it means. So any help on understanding what PS actually is, whether I should increase it to deal with my flow limits, and if there's something else I should be doing to deal with this. 

I'm also curious if anyone thinks that my problem comes from sleeping on my back. I try to sleep on my sides but I always end up on my back when I wake up. Based on my readings how much of this is positional apnea? If there are any links that could help me learn how to identify this on my data I would love to see them and anyone can spare the time. 

Here are my last three nights below. I appreciate any help that can be given. Still trying to figure this out even after five months of treatment. Thank you!

Edit: Friday and Saturday, I was using my F20 and Sunday, my P10.

[PeaceLoveAndPizza]

Based on what you say and what the charts show, sleeping supine is a major cause of your problems. You need to find a way to stay on your side if at all possible. You can possibly increase pressure enough to keep the airway open, but it will likely be most uncomfortable to do so.

Folks here have far more experience with staying off your back than I, but what I have read before recommends using something on your back (tennis ball or other device) to keep you from rolling onto it. Hopefully someone with experience will chime in with ideas.

If we remove the flow limitations whilst on your back, I think things will be much more comfy and you will sleep better overall. If you absolutely must sleep on your back, you can just increase your EPAP min and IPAP max leaving PS alone. I think though that you will need to increase PS if back-sleeping is going to be the norm as you have many FL’s when sleeping supine.

[aperez440]

Hey Pizza, thanks for the reply. So if I understand you correctly then your recommendation, if I want to sleep on my back, is to raise my EPAP and IPAP and also to increase my PS? If so, is that a thing that is possible? When I have my pressure at 15 - 17 then I can't raise my PS past 2. Is there something limiting this that I can change? Or perhaps I didn't quite understand what you meant. 

I think I saw the tennis call on your back as well now that mention it. I'll look into it and see if I can find anything interesting. In the meantime any clarification would be great. Thank you again.

[PeaceLoveAndPizza]

You need to set something like:

Mode VPAPauto
EPAP min 15
IPAP max 20
PS 4
No ramp

You may need even more pressure and possibly pressure support than that. You will have to experiment.

[aperez440]

Interesting. Ok I'll try those numbers tonight and see how it goes. I'll report back soon. Thank you.

[PeaceLoveAndPizza]

One more thing to consider is if you must sleep on your back sometimes a wedge pillow can help. I use a special wedge for shoulder injuries with body pillow and sleep on my side. The wedge is at a 10° angle at 6” height. I expect for your use you would need to try something with a steeper angle and a bit taller.

[aperez440]

Oh good think I have one of those frames that move up and down on my bed lol. I'll move it up a bit and see how that goes.