Bipap Pressure Levels

[Abletree]

I have migrated from the AS10 to AirCurve Vauto bipap.  My AHI is fine, less than 1.0  - only a few OA events. I am still struggling with aerophagia and would like to optimize my levels. 

I am trying to have the lowest possible IPAP that works for me - and the EPAP that makes it easiest to exhale. Exhalation back-pressure difficulty has been my other problem.

My current settings are:

Vpap Auto
Epap   6.00
Ipap    8.80
PS      2.80

If I increase Ipap, will my aerophasia worsen?


To make exhalation easier, do I increase Epap, or decrease Epap?

How low can I set PS? - I'm at 2.8. Is this too low?

I'd like to achieve the lowest functional Ipap for me, The easiest Epap level  (I think)

Obviously, I need help thank you   

[Gideon]

Aerophagia: the strategy is to lower average pressure on a temporary basis untill you can tolerate and return to your therapeutic pressures. How?
Increase PS,. Higher PS can decrease average pressure.
Lowering IPAP
Lowering EPAP

Keep in mind that it is EPAP That treats obstructive apnea. This is the first thing to be set.
Pressure support treats hypopnoea, flow limitations, RERAs.

PS=0 is the lowest possible setting.

[Abletree]

Thank you for your response

I'm not sure I understand exactly what settings to try

I was at 

Vpap Auto
Epap   6.00
Ipap    8.80
PS      2.80

Last night I changed to:

Vpap Auto

Epap   5.8

Ipap    8.80
PS      3.0

My AHI was still good at 0.66 with just 4 OA events. Pressures seemed comfortable - less aerophagia

I would appreciate exact settings, since I don't quite grasp the concept - I must be a slow learner Thank you

[Sleeprider]

Abletree, could you post an Oscar detail chart? We usually suggest setting changes to target a specific objective, and other than aerophagia, we really don't have much to work with in your case. Your recent change to PS 3 seems to have improved your sleep. With OA events, we will normally increase EPAP to stabilized the airway, which would take you to EPAP 6..0, IPAP 9.0 contingent on comfort with aerophagia.

[Abletree]

Yes - Thank you.    This is my 2nd week on the Aircurve Vauto.  My chief complaints have been aerophagia and difficulty breating against expiratory pressure, which caused me to unconsciously remove my headgear during the evening

Both the aerophagia and exhalation has improved with the Aircurve (AS 10 prior machine). Also, my AHI has improved

Still, I would like to eliminate the aerophagia completely and enjoy the comfort of a nice and easy EPAP setting, while keeping breathing happening

My sleep doc put me at 11 IPAP and 7 EPAP - at that setting I experienced extreme aerophagia and had some CA events, which I don't normally have

* I have been losing weight, getting fit - so I think that is playing a helpful role as well.

Here's the OSCAR - Thank you!

[Gideon]

Thank you. You have no idea how much the charts help us.
Your numbers are excellent,
Based on that try EPAP min of 4.

We may suggest increasing it after you post the results.
Definitely let us know how your aerophagia fares.

[Sleeprider]

It's easy to agree with Gideon since he is pretty darn good at this. I think using EPAP min 4.0, IPAP max 7.2 will give you the ease of expiration and comfort you are seeking. That will be PS 3.2 which you should tolerate well, and protect against aerophagia. Thanks for posting the chart. The way your OA events occur doesn't seem to require the increase in EPAP pressure, and it's really easier to dial you back and move forward in pressure methodically, as I'm sure Gideon is intending.

[Abletree]

Thank you so much! I will make the change tonight and report back!

[Abletree]

Perfect! Thank you so much! I will make the exact changes tonight and report back!  I'm excited

[Abletree]

Update - I had a very nice night with the new settings as suggested. Also, I maintained a low AHI of 0.47 with no CA events

The EPAP pressure was extremely comfortable. 

I felt like I could use a little boost of more IPAP. It felt like I needed to suck in the air. It wasn't intolerable, but a slight boost might make it nicer - if it won't muck up everything

The aerophgia was gone - completely corrected!

What would you think about boosting the IPAP from 7.2 to 7.4 and the PS from 3.2 to 3.4?   *OSCAR screenshot is below

Thank you so much - I think this is going to be a great success story. You all helped me navigate starting off with the AS10 - and then making a strong argument for the Aircurve Vauto to my providers. Making the pitch for the Aircurve got me a 2nd sleep study, which really dialed in my sleep assessment

The Aircurve truly is a much better machine for me. It has been a journey!

Thanks again ~ on to the next level

*I'm working on getting a Muse S EEG sleep monitor and O2 recorder to find out more about deep sleep status