More EPAP, IPAP or Pressure Support?

[Sleepster]

I made a second change to EPAP 10 IPAP 18 and pressure support to 4-8.

Do you mean a min EPAP of 10 and a Max IPAP of 18?

[Cookie]

Yes. Sorry that wasn't very clear.

[Cookie]

Last night I increased my min EPAP to 10.5 and my max IPAP to 19, my pressure support remained at 4-8.

I do not feel that I slept sound last night. Looking at sleepyhead I had a significant number of RERA's but some of that I can attribute to an unrelated pain issue.

Even though I raised my max IPAP to 19 I still reached that max.

I did see a significant increase in CA's. Does that mean that I raised my pressures too much?

Should I have narrowed my pressure support to 6-8 from 4-8 and left my pressures lower? I have seen a trend since my last 2 changes that my AHI is high almost every night for the first 2-3 hours and then tapers down. Is this because my pressure support has not risen enough to take care of the obstructive events?

Not sure I made the right change, any advice is appreciated.

As I have said in the past I am not always quick to adjust to changes even though they may be small. So understanding that one night doesn't provide a trend or all of the answers here is a look at last night's chart. [attachment=1915]

I am willing to leave these changes in place for the week to see how the week goes unless it seems that I am moving in the wrong direction.

Thanks to all who take the time to read and offer advice

[Sleeprider]

Your latest results indicate that you have reduced OA events, but may have replaced them with CA. I use the same machine, and find it takes some time to let new settings settle in, so it may be best to stand pat, however I have a recommendation.

Return your EPAP min to the previous setting of 10.0, leave IPAP max at 19, reduce PS MAX by 1.0 to not exceed 7.0. You are experiencing CA when the PS increases to the maximum allowed, while still allowing some H and OA to get through. I'd rather see the EPAP increase automatically, but for some reason it is flat-lining at your minimum setting of 10.5.

CA in your case seems driven by excess pressure support. Limiting PS should avoid over-ventilation and cause the machine to increase both EPAP and IPAP as necessary to deal with flow limitations. It's too early to pass judgement on RERA, but I think reducing the range of PS may be the ultimate solution. If RERA seems to continue when PS is near the bottom of its span (4.0), then narrowing the span to 4.5 or 5.0 to 7.0 might be the answer. Take it slow.

[Sleepster]

Cookie, I cannot raise my PS much above 4.4 as it elevates my CA index. Although this is not a common condition, I have seen documentation of it. It happens to some people.