New BiPAP User - Assistance with Settings

[weepingwillow]

What should I be looking for with flow limits? Since switching to BiPAP, 95% flow limit has been 0.00 for PS ranging from 4-9, but 99.5% has typically been in the range of 0.10-0.20. Would you say 99.5% of 0.10-0.20 is well-controlled?

Last night I dialed back to PS 5.0 over 10.0-18.0. I woke up feeling like garbage, but I got less sleep than usual so that's probably a factor. My AHI was improved at 2.98, but it's still not where I'd like it to be. Chart is attached.

[Sleeprider]

I am only concerned about the 95% (95th percentile) flow limitation. Percentile describes a normal statistical distribution and that is the flow limit equaled or exceeded 5% of the time, or the value, while the 99.5 percentile is equaled or exceeded one-half percent of the time. If your 95% flow limit is zero at 4.0 PS, you have arrived, and don't need higher PS. I think most of your OA is positional. Can you describe your pillow(s) and sleeping position preference?

[weepingwillow]

I sleep on my side only, approximately 2/3 of the time on my left side and 1/3 on my right side. I use one thick pillow for my head and wrap my top arm around a stuffed animal that's in front of my body. (I realize that sleeping with a stuffed animal might sound ridiculous as an adult, but that's what I've found is most comfortable for my top shoulder.)

I've tried a soft cervical collar, Caldera Releaf, and it was an absolute disaster. (See Session 1 in the attachment.) I've not gone near the darned thing since then.

I'm curious about your 4.0 PS recommendation. I'm not questioning your advice, I'm just truly not understanding the BiPAP settings. My understanding is that PS 4.0 is equivalent to EPR 3 on CPAP. The difference between 3 and 4 is so slight-- how is that enough to resolve flow limitations? And I thought a big advantage of BiPAP is that PS allows you to have the equivalent of much higher EPR, leading to increased comfort and tolerability. Is PS 4 really that much more comfortable than EPR 3? I would have expected most people would use a higher PS than 4. 

Clearly I don't understand, which drives home the point that this system is not working for many patients-- they just send you home with a device and then shrug their shoulders when the initial settings don't help, and the patient quits PAP therapy. It's a shame, but it makes me ever more grateful for the helpful community here.

[SarcasticDave94]

Actually PS 4 is in fact 1 cmH20 over EPR 3. They do act the same if the numbers match PS versus EPR, and will also give identical therapy benefits if numbers match. This additional PS range is why many members needed a bilevel in the first place.

[Sleeprider]

I know you're adverse to a soft cervical collar, and I was not going to suggest that anyway. Since you sleep on your side, I'd like to suggest a more forgiving pillow like duck or goose down. They are very adjustable and flexible. For what it's worth, I use a down pillow from Costco with 650 fill power, but you can get 800 fill power for a taller firmer pillow and still have plenty of give. With a down pillow or something flexible, you can pull a corner between your shoulder and jaw to support your neck position. This serves the same function as a collar and can resolve leaks and chin-tucking obstruction. Based on your description of your sleep preferences, this should be comfortable and fit into your lifestyle. Anything under your jaw and over your shoulder when sleeping on your side will prevent chin-tucking, so give it a try.

Pressure support is the difference between IPAP and EPAP. In your December 4 chart with 10 - 18 pressure PS 5.0, your starting pressure is 15/10 (inhale/exhale) and the maximum pressure is 18/13. If PS was set to 4.0, those same settings would range from 14/10 to 18/14. In the Autoset CPAP chart your just posted, the CPAP pressure of 10-16 EPR 3 results in a pressure range from 10/7 to 16/13, which is much lower than your current settings. The Caldera collar clearly made obstruction worse, and that can happen when the fit is wrong, or the adjustment or sleep position results in poor alignment. I think the pillow trick might be better.