New BiPAP User - Assistance with Settings

[Deborah K.]

For mouth tape to work, you need to use good-quality tape cut to the right size. Lots of people here use Cover Roll and Hypafix tapes, both of which work well. I like kinesiology tape better because it is nice and stretchy and conforms better to one's facial contours.

I need 2-inch wide tape cut to 5-1/2 inches long. Any narrower or shorter, and I still leak.

[weepingwillow]

Appreciate your input, Deborah. I'm already using 2" wide Cover Roll stretch tape. I cut it to 4.75" long, but I'll try going a little bit longer to see if that helps at all.

[Sleeprider]

WW, your last chart shows a significant improvement in leaks. EPAP ranged from 9.0 to just under 11, so this resulted in lower pressure for you without a remarkable increase in events. Your 95% flow limit was zero and tidal volume improved to 400 mL/sec which suggests better volume than any of the three charts you have posted to date. I think this is good progress and increased comfort. The remaining obstructive events are random and probably positional in nature. I'm game to try a lower pressure to see if we can improve your comfort from aerophagia, if you are. If you want to try a lower pressure:
Vauto Mode
EPAP min 8.0
IPAP max 15.0
PS: 4.0
no other changes.

[weepingwillow]

I'm game to try whatever you recommend, Sleeprider! I'll let you know how it goes. Thank you. 

[churras]

For mouth tape to work, you need to use good-quality tape cut to the right size. Lots of people here use Cover Roll and Hypafix tapes, both of which work well. I like kinesiology tape better because it is nice and stretchy and conforms better to one's facial contours.

I need 2-inch wide tape cut to 5-1/2 inches long. Any narrower or shorter, and I still leak.

Deborah, have you ever tried “double tapping” with the kinesiology tape?

Putting two layers of tape. 

For me, I have had less leak this way.

Not zero leak, but less leak ?

[weepingwillow]

Update after Night 2:

• Used 2 layers of mouth tape, slightly longer than usual
  
• Used a thinner pillow in the first session; developed neck ache and switched to regular thick pillow in the second session
  
• Less aerophagia compared to Night 1
  
• Moderately bad headache during the night and in the morning
  
• Feeling lousy so far the next day
  

[churras]

Update after Night 2:

• Used 2 layers of mouth tape, slightly longer than usual
  
• Used a thinner pillow in the first session; developed neck ache and switched to regular thick pillow in the second session
  
• Less aerophagia compared to Night 1
  
• Moderately bad headache during the night and in the morning
  
• Feeling lousy so far the next day
  

Wow!! Almost zero leak!!!

[Sleeprider]

Lots of positional obstruction in first session, so a more comfortable pillow position is working better. Let's hold on settings and see how things sort out. I find the comfort on aerophagia encouraging.

[weepingwillow]

Last night's sleep left much to be desired. I woke with a belly full of air, but I suspect it was because of imperfect placement of the Bleep Eclipse halos. Although the machine didn't register it as leaking, there was definitely some air blowing out from beneath the halo when I woke at the end of Session 1. I added tape before starting Session 2 and that took care of the leak, but I slept poorly from that point on.

Looking at Session 1, I'm wondering if my pressure ought to be higher? Or perhaps it just appears that way because of the leaking. Do you think I should give it more time at the current settings, or make some more modifications?

As always, thanks for helping me through this process.

[Sleeprider]

Higher EPAP min can help reduce OA events, but the price is worse aerophagia, and your OA events are mainly positional as seen from the double events, so I actually don't see a lot of up-side to higher pressure for you. Your AHI is still much lower than the baseline you presented with. It's your therapy, and if you were more comfortable with EPAP min 9.0 then I have no objection to your decision. I think sorting out the mask and eliminating other disruptions will better serve your sleep integrity, and I would not dismiss the use of tape as a possible source of discomfort. It's nice to see zero leaks, but you can't get any relief from the aerophagia when your mouth is sealed. There are a lot of variables, and at this point, lower pressure seems an unlikely culprit of your discomfort.