Help Please with Bipap settings

[tboss]

I have had my Bipap for a little over two months and have not yet been able to sleep more than a couple hours.
I tried nasal pillows and they gave me major congestion which would last a week before I could even try wearing it again.
I've now switched to a full-face mask and have tried 3.   The pressure is so high that I just cannot keep it on more
than a couple hours.  

My settings are 21 bipap and 17 epap.   Would lowering one or both of those possibly help?

I've had nothing but a nightmare from both my doctor and the durable equipment provider. It took them
six months to even get me the machine.   Therefore, I'm not overly confident that they have this right!

[ardenum]

First things first download OSCAR from the menu above and get familiar with it. What machine do you have exactly? Is it S, ST, VAuto or ASV , its written on the lower right side.

[tboss]

It is the AirCurve 10 VAuto

[DeepBreathing]

G'day tboss. Welcome to Apnea Board.

On the face of it you have been started on a pretty brutal pressure for a newbie. It might be necessary to back off the pressure to something you can easily tolerate then increase it incrementally. However doctors and sleeps tech have been known to get the prescription wrong at times so it would help if you could provide us with some technical data to help advise you.

First, please upload the sleep study report. Your diagnostic study and the titration study (assuming you had one). Not just the tech summaries but the charts and tables which give the real detail we need to see.

Then, as suggested above, download the free OSCAR program and generate some daily pages for us to look at. Please be sure to format the page exactly as per the instructions linked below. Note that You will get much the same information from ResScan, but that program is harder to use. Oscar presents the same data in a much more accessible way.

Download Oscar: https://www.sleepfiles.com/OSCAR/

Format your pages exactly like this: http://www.apneaboard.com/wiki/index.php...ganization

Oscar help system: http://www.apneaboard.com/wiki/index.php...OSCAR_Help

[Sleeprider]

Since you have a Vauto, let's put it in Auto mode and start at a lower pressure. We can us the same pressure support of 4.0 cm as your current settings. I assume there is a reason for your high pressure settings, but let's go much lower and use the OSCAR software to track the effectiveness.

Settings:
Mode: Vauto
Max IPAP: 21.0
EPAP min: 9.0
PS: 4.0

This will start you off at 13/9 (IPAP/EPAP), and the machine will automatically increase pressure up to your current settings of 21/17. You should still get effective therapy, but take advantage of the much more comfortable auto VPAP pressure. It could also be that with your machine in S-mode the Easybreathe feature did not get turned on. This is a comfort feature that changes the pressure transitions from EPAP to IPAP into a smooth wave-form, rather than a harsh square-wave (IPAP on/off). The experiment with Vauto is up to you, but the machine you use is a lot better than the one you can't tolerate. Finally, you should have a copy of your sleep study. It may be worth posting that here so we can help you to understand it. Your machine will not treat central apnea if that is a feature of your sleep disordered breathing.

[Matt00926]

I agree with switching to the VAuto mode. When you sleep in a lab it's just one night and they only have so many hours to try and titrate the optimal settings. Sometimes you may need a high IPAP and/or EPAP during REM sleep or just during part of the night, and you can get away with lower pressures sometimes during other parts of the sleep cycle.

Using reduced pressures to see what we can optimize if needed isn't going to harm you since you have been sleeping without a machine for a long time anyway. It may also improve your sleep/awakenings as well. It also lets us see what the machine wants to do.