Help me understand these OSCAR charts and self-titrate my BiPAP

[uarsapnea90]

I have self diagnosed myself with UARS/Sleep Apnea and bought a BiPAP from Marketplace (please see post history for more context).

Can you please help me titrate and optimize my BiPAP. I have included OSCAR reports from the last few days.

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I use a nasal pillow. I have noticed my leak rate might be high. Is that possibly because of my mouth opening in the night and the air leaking through the mouth? I am a mouth breather and have symptoms of dry mouth/drool etc.

[SarcasticDave94]

What I would do first thing is reduce PS from 8 to 3 or 4 at most. Also increase Min pressure to 6 from 4. You're probably inducing the CA because of the high PS when you likely doing need it this high.

Try this edit for a night and post OSCAR along with telling us how the therapy felt.

If the CA doesn't diminish you may need to change Trigger to High. But hold off on this one for one more night.

[uarsapnea90]

Thank you so much for the quick response. I will use PS of 4 tonight and min pressure at 6. 

IPAP 12 seems okay?

I have noticed on the charts there are some leaks. I use a nasal pillow as that is the best that I can tolerate. Can the leaks be caused during my sleep because of an open mouth? I usually open my mouth while sleeping and have symptoms of dry mouth and drool when i wake up in the morning.

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I have already set the trigger settings to be very high. Is that okay?

[SarcasticDave94]

What I'm seeing 12 Max maybe is ok.

For next chart, be sure to include left panel data minus calendar and pie chart. This contains your summary, which is used with the big right side charts. Do that style chart tomorrow if you would.

[uarsapnea90]

@SarcasticDave94 I am back with 2 nights of data based on your recommendation. Please see attached.

In terms of symptoms, I dont feel any different or better.

I have noticed I am waking up often with drool and dry mouth. Do you think my treatment is effective because of my open mouth? Should I consider mouth taping? If yes, any recommendation on which mouth tape is the best?

Also, I was under the assumption that IPAP = EPAP + PS. My BiPAP alllows me to change all 3 parameters. If my EPAP is 6 and PS is 3, how is IPAP equal to 12 then in the machine?

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Another attachment from last night.

[SarcasticDave94]

Leaks can be a thing to address, the chart pattern might be a combo of mask shift leaks and a bit of mouth leaks. Dry mouth would be a telltale I would think.

I've not used tape before, so I'll defer to those that have. I believe there's several choices, which unfortunately makes it possibly a trial and error situation. No surprise, that's much like masks themselves.

VAuto pressure, per info copied from the clinical manual about it...

"VAuto mode
In VAuto mode, the AutoSet algorithm automatically adjusts pressure in response to flow limitation,
snore and obstructive apneas.

Min EPAP, Max IPAP and pressure support in VAuto mode
Pressure support allows you to set the difference between inspiratory and expiratory pressure and
is fixed throughout the night. Min EPAP and Max IPAP settings allow you to restrict the delivered
pressure ranges in which the AutoSet algorithm can operate.
The EPAP and IPAP will vary across the session according to the patient’s needs. It responds to
snoring, apneas and flow limitation of the patient’s flow curve.
Min EPAP and Max IPAP can be adjusted to limit the upper and lower delivered pressure limits."

I've not used VAuto, but my interpretation based on this info, PS is a static number that adds to EPAP, setting the difference, and with EPAP and IPAP the set numbers being the bookend low and high extremes where the auto range is permitted to roam.

[Sleeprider]

Your therapy is effective at these pressures. There are some leaks that need to be resolved. There are a number of ways to avoid opening your mouth, including using some kind of collar that puts pressure on the jaw like an airplane pillow, or perhaps a chin strap that pulls upward, not from the chin to the back of the head which pulls the jaw back. I even will sleep with a corner of my pillow over my shoulder and under my jaw. Whatever works for you and allows you to sleep with your mouth shut is the name of the game. I was glad to see your PS setitng reduced after you started at PS 6, and your current PS 3.0 seems good. Remember you can make adjustments in increments of 0.20

[AndyB]

You're already getting expert advice here, but I'll add that you may want to try taping your mouth. A quick search of the forum will produce numerous threads that discuss taping. I've taped my mouth every night for years, and it's eliminated mouth breathing for me.

[HalfAsleep]

That might not be drool you're getting in your mouth: it might be rainout. Experiment with your humidity settings, and be sure your hose goes uphill for at least some of its journey between the machine and you. This can happen in an FFM even if your mouth is dry.

Fill out your avatar info with full name of mask, etc. This allows posters to get your info at a glance without having to dig into an attachment.