Bipap advice

[Shin Ryoku]

Sorry, I'm back to the soft cervical collar... Your choice is to either increase pressure, or resolve the positional apnea.  Your latest chart clearly shows the problem, and there is no doubt. You will either need 20+ cm to break the apnea during positional episodes, or you must resolve the problem with chin tucking.

I disagree with this. I had similar charts, and a soft cervical collar had no effect at all in resolving it. I tried several of them of different sizes and firmness, and the only effect they had was to induce discomfort. Raising my minimum pressure did help, and I did not have to go to 20+ pressures.

I don't disagree that a collar could help you, and I know that sometimes it helps people; but I disagree that the chart you showed is pathognomonic for chin tucking and that a soft cervical collar will definitely help. The only way to know is to try.

[Sleeprider]

I missed the stomach sleeping, and don't know how a CC will work with that. The charts posted so far, show improved obstructive results with pressure. I don't use a cervical collar and never have, but observed it helps people that tend to have OA clusters. I'm not vested in how the treatment results wanted by ReadytoSleep are achieved, but I think there are two alternatives. Pressure or position. Beyond that, the problem is not so complicated and is pure obstructive apnea.

[Walla Walla]

Even sleeping on your stomach you still can tuck your chin in and cut off the airway. Higher pressure may work but it didn't for me. I got up to 25cm and the only thing that happened was I ended up with mouth leaks. The collar is the only thing that worked for me in preventing cutting off the airway.

[ajack]

I would follow basic auto titration procedures first. Or you may finish up chasing your tail. The suggestions on median, 95% and max are manufacturer suggested, as well as in studies and I'm just passing them on. The principal can be used to set up an auto bpap. Then if that didn't work, I would look at alternatives. A collar can work miracles with some people.

The biggest result was a person ending up on an ASV after years of trying to fix it. It was solved overnight with a collar.
http://www.apneaboard.com/forums/Thread-AHIs?page=4

[Sleeprider]

Just adding an attachment with the information ajack is referring to.  This is BiPAP-S (fixed bilevel) titration protocol, but the principles are the same for auto bilevel.

[readyforsleep]

Thanks Guys. I am studying. Like Sleeprider says it is trial and error.

[readyforsleep]

My ahi and number of events are moving in the right direction.  For the last 3 days I have been using a firmer pillow and raised EPAP. 

https://imgur.com/a/GxrHc

I would like to keep tweaking.  Not sure which way to go right now.  Lower EPAP? I goofed and broke my rule of only changing one thing at a time.  I raised EPAP and tried the firmer pillow. The firmer pillow is helping alot. Try a lower IPAP and EPAP?  Any advice?

[Walla Walla]

Based on your last chart I'd bump the EPAP up 1cm.

[Sleeprider]

I agree with Walla. Your results show only OA events which call for higher EPAP, so I would just lt the range go a little higher by bumping both EPAP and IPAP.

[ajack]

I would do it a bit different and raise the PS by 1. I think it gives the same result in the end, it raises the ipap by 1, but it may help your tidal volume and respiration rate. With doctor supervision, I would split the median and 95% tidal volume and target 420, It increases by 40ml. as an example 30ml is a shot of spirit.
I assume you are a a bit less than average height female. Your max breath was 840 and lung capacity is some litres in volume.

This was the median and 95% numbers for auto cpap titration I was referring to. It is different to the normal manual titration in most labs.
https://aasm.org/resources/practiceparam...rating.pdf
https://tinyurl.com/y7aegqty