+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: IPAP EPAP seperation Necessary? (/Thread-IPAP-EPAP-seperation-Necessary)
IPAP EPAP seperation Necessary? - 3rdMarDiv - 05-19-2019
Dreamstation ST
Currently set at 22 IPAP/21.5 EPAP
Started at 26/22
I believe that what I am doing is pretty straight forward and likely a goal of many CPAP users, i.e., lowering my pressure setting while obtaining effective therapy. I'm trying to maximize mask comfort without sacrificing CPAP effectiveness.
I believe that EPAP is most effective at keeping the airway open and IPAP is for taking a consistent good breath.
My manual shows that both may be equal with IPAP not being lower than EPAP.
Being new at this I was just curious if there are any general rules about the two being equal or slight separation.
I've seen statements that a general rule is a separation of 4.
I'm sleeping better with fewer mask leaks the more I lower the IPAP.
The higher pressure was fine, but the mask would not cooperate. I studied everything on the Net and from the manufacturer about mask use and nothing worked at 26 cmH2O IPAP.
If I lower the EPAP I incur more apnea events. 21.5 EPAP seems to be the best setting. 22 IPAP is also more comfortable and requires less tightening of the mask straps.
RE: IPAP EPAP seperation Necessary? - Sleeprider - 05-20-2019
It appears you are using a spontaneous/timed (ST) bilevel machine as a higher pressure CPAP. I will assume you have disabled the timed backup feature and are using this machine in S mode. It is indeed possible to use equal IPAP/EPAP pressures, and it is EPAP that maintains the airway patent against obstructive events. Most people with high pressures will use some pressure support for comfort. Accepted titration protocols for S-mode bilevel therapy is to start with a pressure support of 4 (IPAP 4-cm greater than EPAP), and to increase EPAP until obstructive events are resolved. In your case that seems to be 21.5 cm. Normally I would expect to see IPAP at 25.5 to increase the comfort of this high pressure, but it's certainly your choice what works and what feels best. Pressure support (IPAP higher than EPAP) is used to treat residual flow limitations and hypopnea once OA is resolved. Your machine is capable of pressure up to 30 cm, so you have enough room for PS if you want or need it.
Here is the bilevel ST and bilevel S titration protocols. A timed backup would only make a difference if you are using PS and need the machine to automatically trigger IPAP.
RE: IPAP EPAP seperation Necessary? - 3rdMarDiv - 05-20-2019
Thanks for the reply and information.
I think I will need to have some separation as it just doesn't feel right at equal amounts. With some separation there is a more distinct feeling of breathing in and out. When they are equal it feels like the exhale overtakes the inhale and vice versa from time to time. 23.5/21.5 felt better, but I still fight with the mask. The pressure is not a problem its the darn mask that keeps waking me up. I love the therapy and often say that my worst night on the machine is 10X better than my best ever night without it.
I just know that it would be even better if I could get the mask under control. Maybe the mask discomfort will just have to be part of it all. It is worth it, that's for sure.
RE: IPAP EPAP seperation Necessary? - Sleeprider - 05-20-2019
Mask fit is one of the harder aspects of the therapy to get right, and it's harder with higher pressure and using a full face mask. Take a look at the Mask Primer http://www.apneaboard.com/wiki/index.php?title=Mask_Primer , and keep trying different models and sizes until you find what works. For side sleeping, you may want to try the CPAP specialty pillows like the buckwheat hull pillow that lets you hollow out a section for the mask, and adjust the fill. If you can move to nasal pillows, that has been a solution that worked for several members with relatively high pressure.
RE: IPAP EPAP seperation Necessary? - sheepless - 05-20-2019
I second the buckwheat pillow and nasal pillows suggestion because they work well for me. p10 mask seals and almost never leaks. nasal pillows are light and not uncomfortable and usually open up congested nasal passages (what a delight!). works with a full beard too. lip leak is an ongoing issue for me though, requiring a soft cervical collar to - mostly - offset. unlike a foam contour pillow, for example, the buckwheat pillow never knocks my mask askew or squeezes the headgear or anything else. it might not be the pillow I'd choose if I didn't have to wear the mask, but it does the job.
RE: IPAP EPAP seperation Necessary? - 3rdMarDiv - 05-21-2019
Never knew buckwheat pillows existed. I can see where they would assist in CPAP therapy. I am a side sleeper and do use the "My Pillow" to aid in securing the mask.
I read all the literature reference.
I'm pretty confident I will be able to get pretty close to where I want to be. I mainly was curious about equal pressure in case I found it doable. I wanted someone to say that while it's not a really common choice, I wasn't doing something that could produce negative effects.
I'm seeing now that I may likely wind up somewhere between 23.5 - 22 / 21 - 20
For now anyway that is a big improvement over 26/22
I'm also noticing that a lot of this is getting things adjusted as best possible combined with long term, persistent use.
Hopefully someday the OSCAR Guru's will include my machine in the covered category
RE: IPAP EPAP seperation Necessary? - Sleeprider - 05-21-2019
(05-21-2019, 03:42 PM)3rdMarDiv Wrote: I'm also noticing that a lot of this is getting things adjusted as best possible combined with long term, persistent use.
Hopefully someday the OSCAR Guru's will include my machine in the covered category
You discovered the real secret to success!
RE: IPAP EPAP seperation Necessary? - ajack - 05-21-2019
PS4 is really a starting point, as it reduces breathing effort by about 50% It moves from there as needed. When you titrate, as per the chart sleeprider posted. You raise the epap till the OA reside. You are actually working in reverse. I would lower the epap till you get 2 OA an hour. So you know, that it needs to be raised a touch. Follow the IPAP down as needed . I wouldn't have more than a difference of 6 for now. It can be fine tuned later, unless something like low tidal comes up. If you have a ST you could have the backup rate at 10 and out of the way, but it seems you don't need it, as you would have had the PS sufficient to inflate your lung if needed
I saw a good video on basic titration, from a tech who does home studies. I can't post the link, as it has ads. You can start at the 3:00 mark
If you youtube: Bilevel and ASV Titrations: Pressure Changes for Technologists and Patients.
RE: IPAP EPAP seperation Necessary? - 3rdMarDiv - 05-22-2019
(05-21-2019, 05:10 PM)ajack Wrote: 1.PS4 is really a starting point, as it reduces breathing effort by about 50% It moves from there as needed.
2.When you titrate, as per the chart sleeprider posted. You raise the epap till the OA reside.
You are actually working in reverse.
3.I would lower the epap till you get 2 OA an hour. So you know, that it needs to be raised a touch. Follow the IPAP down as needed.
4.I wouldn't have more than a difference of 6 for now. It can be fine tuned later, unless something like low tidal comes up.
5.If you have a ST you could have the backup rate at 10 and out of the way, but it seems you don't need it, as you would have had the PS sufficient to inflate your lung if needed
I saw a good video on basic titration, from a tech who does home studies. I can't post the link, as it has ads. You can start at the 3:00 mark
If you youtube: Bilevel and ASV Titrations: Pressure Changes for Technologists and Patients.
Been watching lankylefty for awhile. Lots of good info at freecpap.
Watched the BiPAP video https://www.youtube.com/watch?v=Jgzudnze0ck
BiPAP S
I have Flex ON at 2
Full face ResMed F20 Airtouch
1. & 2. Tried to keep PS at 4. Went from 26/22 to 25/21 to 24/20 to 23/19. At 23 I can wear the mask without tightening the straps like a noose. Still tight but very much better than at 26. Leaks much better.
3.&4. OA's went up a lot. 19 not good. raised the epap only 19.5, 20, 20.5, 21.5, 22. 23/22 uncomfortable, but not due to comfort. Due to feeling weird as to when to breath in and out.
23/20.5 right now feels good breathing, greatly reduces leaks and allows for looser straps.
5. Tried and did not care for the ST mode. It did seem work OK while I was asleep, but falling asleep not good. S mode seems fine for now.
So, a PS of 2 or more is good but not to where it takes IPAP over 23. EPAP no lower than 20 with 20.5 definitely keeping airway open.
At PS 2.5 it feels good going to sleep and I can sleep all night with minimal leak wakening's.
Love to upload my charts, but OSCAR isn't working properly yet with my machine. I believe the Flow Rate Graph is fully functional, but not the reporting for OA, CA, HA.
All I have that should be reliable is the DreamMapper program.
Last Night. Seemed to sleep great with one disconnect to re-adjust mask. Fell right back to sleep.
[attachment=12119]
[attachment=12120]
All this information is really helping and this site is great.
RE: IPAP EPAP seperation Necessary? - ajack - 05-22-2019
Fair enough, I can't think of anything else. You have something you are happy to use and can handle.