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Tonight will be my first night on BiPAP. I just picked up my new AirCurve 10 bilevel machine and would appreciate guidance on initial settings. I met previously with Dr. Barry Krakow, and he thought I sounded like a good candidate for bilevel therapy due to my aerophagia and lack of improvement on CPAP. Unfortunately, my current sleep doctor has not been very helpful, and I'm practically on my own to figure out the optimal settings.
I’ve attached data from the past few nights for reference. Based on this, what settings would you recommend? My doctor ordered pressures of 17/13.
Thank you for your help!
p.s. - In case it factors in, lately I've been using Bleep Eclipse rather than regular nasal pillows.
Your pressures are pretty high on CPAP and are equal to Vauto mode with EPAP min 12.8, IPAP max 20.0 and PS 3.0. I see several issues. Leak rate is relatively high and appears to be mouth leaks. Flow limits are variable and is likely related to some positional apnea issues which leads to the occasional obstructive apnea. I'd like you to read the positional apnea article so we're on the same page on the many ways you might be able to address that issue. In addition to avoiding obstructive positions, a soft cervical collar or even just tucking a corner of your pillow between your shoulder and jaw, can also help avoid these mouth leaks that are disrupting your sleep.
Since I don't have a good history of your pressure titration, I'm going to back off on pressure quite a bit with recommended settings. We will leave room for the device to add pressure as needed, but I'm hoping to find better comfort, lower leaks and good efficacy with a lower pressure range. The recommendations are:
Vauto mode
EPAP min: 9.0
IPAP max: 18.0
PS: 4.0
Ti Min: 0.3
Ti Max: 2.8
Trigger sensitivity: High
Cycle sensitivity: Medium
All other settings default
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Wonderful, thank you so much! I will try these settings and I'm sure I'll be back to fine-tune things.
A few things to mention in response to what you wrote:
I am indeed prone to mouth leaks-- that's even with tape across my entire mouth.
I previously tried a soft cervical collar and it was AWFUL for me so I promptly gave up on that solution. But I will revisit the positional apnea info to see about the other approaches you mentioned.
I only sleep on my side so I've been skeptical about how big of a role positional apnea is playing in my poor sleep.
I cleared my sleep study/titration with AHI < 5 at a pressure of 10, but as I've fiddled around with pressures, I generally do feel better with higher pressures and am very weary of the 10 that was initially prescribed.
A possible alternative to the collar might be a flatter pillow or using the pillow corner wedged under your chin to block the tuck movement.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Sleeping on your side is a perfect setup for the technique I mentioned of pulling a corner of a pillow between your shoulder and jaw. I use that when I feel I'm losing control of the seal in my mouth to prevent leaks. I use a down pillow. Anyway, give the settings a try. Part of this is to see if we can get your pressures lower, which should make everything a bit easier. Deborah K. is your expert on mouth tape issue.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I tucked a rolled up t-shirt between my chin and chest in hopes of helping with positional apnea. I found that approach to be quite tolerable, but I'm unsure if it made a difference.
I woke up several times throughout the night.
No noticeable improvement in my sleep (yet), aside from improved comfort with the machine.
Sleeprider or others, do you have any recommendations for adjustments after this first night? Thanks so much for helping me through this.
Any chance you could post an Oscar chart from your first night. We might find some opportunity to lower pressure even more, but without the charts we are looking at only qualitative input.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
