[Pressure] Reaching maximum IPAP - Time to change settings?

[Frajola81]

That is good to know Stacey! Thanks for the reply. I will adjust the pressure and see if things improve.

@GuyScharf, I sometimes sleep on my back but for the most part (I want to believe....), I sleep on my side. However, following doctors orders, I piled up 2 pillows to elevate my head during my sleep. According to her, this would help with the bad sensation of swallowing air during therapy.

So as of now, I need to increase my EPAP and max IPAP, get rid of that second pillow, and what about PS (Pressure support), should it still stay at 4? Does it play a role like EPR in a APAP machine?

[Sleeprider]

Here is, the problem with pillows, and I will say I totally disagree with this doctor's order. The pillows cause chin-tucking and it is evident in the clusters of flow limitation which are increasing your pressure. I think without this, your pressure would be very steady and therapy much improved. Please read our wikis:
Positional apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft cervical collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

[SarcasticDave94]

Maybe try a thinner or a single pillow than what you've been using. I'd disagree with doc here as well. And the collar suggested will help out. There's a good collar called Corflex Ultra Cervical Collar that several members have tried that does well.

[Frajola81]

Great advice here, thank you both!

I will do some research on them and will definitely get rid of the pile of pillows that I have been using.

About the collars, should I buy it myself online? Do I need an Rx for it? Could I ask my DME to provide me with the one my choose and charge the insurance?

[GuyScharf]

I agree with Sleeprider and SarcasticDate94. I would focus on the positional apnea/chin tucking problem first.

Is there a reason the doctor suggested the pillows for swallowing air? Did you have that problem before?

[Frajola81]

Yeah, that makes sense. The pressures may not go too high fixing these problems first.

I am new with this biLevel machine (about 1 month). Before that, I was using an Airsense 10 and my compliance was terrible due to swallowing a lot of air during therapy and wasn't handling well the therapy in general (and of course, tired all the time). 

When the NP asked me about the bad compliance and I gave her this response, that's the advice she gave me. 

Afterwards she Rx'd the biLevel machine. According to her, I would tolerate the therapy better with this machine which was true. My compliance now is 100%!

[Sleeprider]

Pillows under the head are a very bad idea and leads to chin tucking. Individuals with aerophagia usually get relief from a wedge pillow which elevates the whole body from the hips, but does not tuck the chin. We have seen some people prop up the whole bed by stacking blocks under the head of the bed frame, and of course articulating beds make all of this very easy. There are some other tricks as well. Needless to say, if your pillows cause flow limitation, that leads to an increase in pressure, and the result is aerophagia, so you're clearly at cross-purposes. If we resolve the positional apnea, we may even be able to reduce pressure.

[Frajola81]

I will definitely address that first especially because with the biLevel PAP, I haven't suffered from aerophagia. 

It doesn't look like it will come back. Need to study/decide on the collar though. Or maybe, one step at a time: first the pillows then the collars if it doesn't improve the clusters of flow limitation.

Thanks for your advice!

[martyedb]

About follow-up appointments...    S. Dave gave me some good advice on talking with my sleep dr.     
My    thread?   was titled   "advice appreciated".     That specific advice was #32 in that thread.

[martyedb]

Welcome to the forum!     I wrote that short note last night.    
I just want to tell you that I admire you and all the other people who get started learning these things!      I am new to forum, too,   it is very helpful.